What is Subcision?
Subcision is a minor surgical procedure used for treating depressed cutaneous scars and wrinkles. It is also called subcutaneous incisional surgery.
Subcision is performed using a special hypodermic needle inserted through a puncture in the skin surface. The sharp edge of the needle is used to break fibrotic strands that are tethering the scar to the underlying tissue.
What does Subcision Work?
The release of the fibrotic strands and new collagen deposition caused by wound healing leads to cosmetic improvement of the scar. Subcision can be safely performed in the outpatient setting and is usually well tolerated.
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What Are The Indications of Subcision?
Subcision may be used for the treatment of:
- Depressed distensile scars (due to acne, trauma, surgery )
- Depressed bound down scars (due to acne*, varicella(chickenpox), trauma, surgery)
- Depressed skin grafts
- Cellulite dimples
*excluding deep ice-pick scars
What Are The Contraindications to Subcision?
Subcision may not be suitable in the following circumstances:
- Patients with a history of hypertrophic or keloid scars
- Current or recent (within 12 months) systemic oral retinoid (eg acitretin, isotretinoin)
- Bleeding or blood clotting disorders (coagulopathy)
- Active bacterial or viral infection
How is Subcision Performed?
The procedure of subcision is described below:
- The area to be treated is cleansed to remove dirt and make-up
- The scar margins may be defined with a surgical marker, adjusting overhead lighting to delineate depressions
- Local anaesthetic is infiltrated
- A tri-bevelled needle (number 18 or 20 gauge) or a Nokor needle (fig.3) is inserted at an acute angle adjacent to the scar with the bevel upwards and parallel to the skin surface. Smaller gauge needles (25–27) may be used for small superficial scars and wrinkles
- The needle is advanced through the dermis and moved back and forth in a fan-like motion. A snapping sound is heard as fibrous bands are transacted in the deep dermis and deep dermal subcutaneous plane*
- The needle is rotated 90 degrees and moved again in a fan-like motion through the dermal scar (fanning subcision)
- The needle is removed and squeezed circumferentially around the exit point to prevent large haematoma formation due to bleeding
- Manual pressure is applied to the wound for several minutes.
*A common pitfall is to fan too deeply in a plane below the dermis
What Happens After the Procedure?
Immediately after subcision:
- Pressure and ice are applied to the operated site to maintain haemostasis and reduce the risk of bleeding.
- Make-up may be applied to camouflage bruised areas.
- Some authors recommend antibiotics and anti-inflammatory
The number and intensity of subcisions should be limited during the first treatment to review the patient’s response, particularly when treating areas with a predilection for a hypertrophic reaction after subcision.
How Many Treatments Are Required?
Individuals vary in their ability to form collagen (scar tissue). The number of subcisions required to correct a depression will depend on the type, location, severity of depression, and intensity of treatment.
Three to six visits suffice for the majority of cases of moderate scarring. Intervals of at least one month in-between treatments are generally recommended.
What Are The Complications of Subcision?
The risks and complications of subcision include:
- Haematomadue to bleeding (a small haematoma is normal)
- Pain/tenderness of treated sites
- Hypertrophic scars (5–10%) or keloid scars, which are most likely in periorbital skin, glabella, labial commissure and upper lip
- Infection; this usually presents as localised acneform papule or pustule
- Temporary post-inflammatory hyperpigmentation (advise sun protection/avoidance)
- Sub-optimal response or lack of improvement in scarring
- Injury to nerve or blood vessel, which is most likely in mandibular, temporal and pre-auricular sites
Treatments Combined With Subcision
Subcision as an acne scar treatment can be effectively combined with:
- Topical retinoids
- Microneedling- Dermaroller, Dermapen, which may be safely performed > 1 day after subcision
- Acid peels, eg 15% trichloracetic acid applied every 4 weeks
- TCA CROSS
- Dermal fillers
- Skin Boosters
Why choose Medikas?
- Our professional team work closely together to ensure our customers receive the highest quality care and customer service
- We provide a comprehensive range of services and solutions to promote good skin health and treat the signs of ageing
- We believe that through natural enhancement we can make our customers look and feel their best
- We treat our customers with respect and discretion so that they feel safe in our care
- We are highly trained experts and innovators within the aesthetic field dedicated to the safety and care of our patients
- We believe in a duty of care to ensure our patients make informed choices via our trusted advice
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*Disclaimer: Results and patient experience may vary. These are dependent on a number of factors such as age, medical history and lifestyle.