How acne-scar subcision works

Which scars are most relevant?

Subcision is most often discussed for rolling or visibly tethered atrophic scars. Narrow ice-pick scars, sharply edged boxcar scars, raised scars and pigmentation without a depression may need a different approach.

Needle or cannula-based subcision?

Subcision can be performed with different sharp or blunt instruments. The scar depth, tether pattern, treatment area, anatomy, practitioner training and planned combination treatment influence the choice. A blunt cannula is not automatically suitable for every tether, and a sharp instrument demands particularly controlled depth and direction.

Why combine treatments?

Releasing a tether does not automatically correct surface texture, enlarged pores, pigment change or every scar edge. A staged plan may later include microneedling, PRP/PRF, PDRN, a selected peel, filler support, laser referral or no further treatment.

Recovery and risks

• Bruising, swelling, tenderness and temporary firmness are expected possibilities.
• Bleeding, haematoma, infection, pigment change, prolonged swelling, nodules, altered sensation and injury to deeper structures are possible.
• A history of poor wound healing, keloid tendency, anticoagulant use, active infection or active inflamed acne can change or prevent the plan.
• Improvement varies with scar type and often needs more than one modality or session.

Evidence used for this explainer

• Acne scarring: pathogenesis, evaluation and treatment options
• Complications of subcision: clinical experience and literature review
• Review of clinical trials in acne-scar subcision