4 Reasons Why There’s No Scar Improvement After Subcision

People with acne scars often report being embarrassed in social settings and a lack of self-esteem.

And if you are already investing a good sum of money and time visiting a doctor to get treatment – it can be hard to feel hopeful when you aren’t seeing the results you want.

There are currently a plethora of acne scars treatments that are available to patients today; however, one of the best treatments to tackle depressed, rolling scars is subcision.

An old surgical technique first described by two New York dermatologists in 1995 – subcision is a minor surgical procedure that has since been used to lessen depressed scars, wrinkles, stretch marks, and even cellulite!

During the healing process of acne, the deeper layers of our skin gets damaged – causing scar tissue to form and our skin to lose its underlying support. Subcision helps to combat this by supporting the production of collagen loss and severing the fibrous tissues beneath the scar that are anchoring the skin downwards.

By doing so, it is able to lift the scar whilst forming new collagen to encourage further remodeling over the next 3 – 6 months after treatment.

Subcision is a tried-and-tested procedure that has been reported in multiple scientific papers and research studies as effective in treating atrophic, depressed scars – specifically for rolling scars (depressed scars with gentle sloping edges)

However, there are still certain reasons why subcision may not be working for you, here’s why:

#1: Your doctor did NOT use the right tools and technique.

Subcision is typically performed using a sharp tool that doctors use to manually break apart the scar tissues that are causing depressions in the skin.

Depending on the doctor, he or she may use a hypodermic 18 –23G needle, Nokor needle, or blunt-micro cannula to perform the procedure. In fact, the Nokor needle is a tri-bevelled needle that is specifically designed for subcision treatments.

Although all the instruments will work to break the fibrotic strands in real-time to free the skin from being pulled down –  newer research is showing that the best rate of scar breakdown that comes with fewer less side effects is when doctors use a blunt cannula instead of Nokor.

A 2015 study also showed that conducting subcision with a blunt cannula provides patients with considerable fewer treatment sessions and faster recovery times. Overall, using a cannula is less invasive, has fewer complications, and offers higher patient satisfaction rates!

This is not to say that the remaining instruments are any less valuable; however, that your doctor should be using a needle of sufficient size to improve the chances of effectively breaking the adhesions while balancing it with the recovery times and side effects that will maximize your results.

Once the needle is inserted, the doctor will proceed to advance the needle through the dermis and move it back and forth in a fan-like motion to break down the scar tissues horizontally.

Important to note here is that a doctor who is inexperienced and does not properly execute the technique may fan too deeply in a plane below the dermis – causing greater side effects such as bleeding, swelling, and trauma to the skin.

Ideally, you should ask your doctor about the tools and technique he or she uses before proceeding with your treatment, as this can make all the difference in whether or not subcision works for you!

#2: You are NOT a suitable candidate.

Despite subcision being a versatile treatment that is ideal for all ages and skin types – it is important to first identify the type of acne scar you have.

The type of scars that will see best results with subcision are rolling and tethered scars. This is normally identified as a depression or dent in your face when you talk or smile, or when a doctor manually feels your skin to make a proper diagnosis.

However, there are still some people who are NOT advised to undergo subcision treatment – this includes those with experiencing active acne or a viral infection, or those susceptible to abnormal skin scarring such as hypertrophic or keloid scars.

Ultimately, consulting an experienced doctor who considers all these factors is just as important to your results as the treatment itself!

#3: You are NOT patient with your results.

Subcision requires at least 2 – 6 months in order to see noticeable results. This is because the process of collagen stimulates and wound healing takes time to produce significant effects.

In addition, your treatment results will largely depend on your own ability to form collagen, acne scar location, acne scar type, and the severity of the depression. In general, the majority of individuals will improve their acne severity by 1 – 2 grades after 6 months post-treatment.

Typically, 2 – 4 sessions will be required in order to treat mild-to-moderate scarring at intervals of at least one month in-between treatments.

Often times, patients may be quick to dismiss a treatment when they do not see results immediately. Speaking to your doctor to discuss what you can expect from the treatment can help you to stay committed throughout.

Just like how your acne scars were not formed in a few days – it will take several months in order to see results.

#4: You are NOT using a combination approach.

Acne scars all have a different depth and appearance that require different solutions.

Should subcision treatment alone not be providing you satisfactory results – consider using a combination treatment that includes subcision, fillers, and fractional CO2 laser.

A 2016 study done with 50 patients split into multiple treatment groups reported that employing subcision before CO2 laser showed better scar improvement compared to just using laser alone.

When you combine the release of scar tissues with skin rejuvenation and volumizing effects – you get synergistic results that no single treatment is able to provide.

A great healing compound that we like to use is Rejuran Healer – a safe and effective treatment that acts as a spacer in-between the skin tissues while also boosting healing and hydration. At our clinic, we offer Rejuran S – a more viscous injectable compared to Rejuran that is designed specifically for creating an immediate volumizing effect when injected post-subcision to fill sunken scars and prevent it from re-collapsing.

Since majority of acne patients face more than one type of acne scar – this adds to the complexity of treatment and why a combination approach is the only way that doctors can provide maximal results.

Our doctors will first assess your age, needs, lifestyle, and skin condition before customizing a treatment plan for you. We offer a wide range of acne scar treatments for our patients, including microneedling, chemical peels, TCA Cross, and acne scars laser such as fractional CO2 and INFINI RF microneedling!

Subcision may not be ideal in the case of ice-pick scars or for patients dealing with active acne, which is why we also offer a comprehensive range of treatment modalities that allows us to provide the best acne spot treatment in Singapore!

At the end of the day, subcision is a well-tolerated and valuable procedure that allows patients to see permanent results. Treating acne and acne scars is always going to be “work in progress” and will require patience, commitment, and a good doctor to support your journey from start to finish.

Contact us to book your consultation today!

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