Needle Subcision for Acne Scars At A Glance
- Best Results6-10 sessions (outdated)
- Treatment Recovery5-10 days
- Procedure Time10-40 min
- Skin SpecialistNot performed as treatment outdated
- Duration of ResultsLife
- AnaestheticBlocks
- Back to Work2-8 days
- Cost$$$ Partial Medicare rebate in most cases
Needle Subcision For Acne Scars
Subcision can give good results. Needle subcision was first reported over 25 years ago using standard hypodermic needles. Over the past decade, needle subcision has been replaced with cannula dissection as cannulas offer greater efficiency & safety. This page discusses the history of hypodermic subcision as this procedure is outdated.
FactsFacts on Needle Subcision For Scars
- This procedure was invented in 1995 by dermatologists in New York
- Needle subcision was the very first form of subcision
- This has been largely replaced with Nokor & blunt cannula methods
- Historically 21, 23, 18 gauge needles have been used
- This page is for historical context, as majority of revision specialist now use updated techniques
Why is needle subcision largely outdated?
Newer techniques offer much greater efficiency, efficacy & safety. Cannulas can cover 20 times the surface area at the same time. Additionally longer cannula means less entry holes, as well as increased safety & less side effects.
What is the history of needle subcision?
Two outstanding dermatologists from New York first published this method of acne scar revision in the mid 1990s. Since then, subcision has been used to treat many forms of scarring, including suture scars, traumatic scars, & even scarring secondary to abdominal surgery- liposuction.
View our Treatment Gallery
When do I perform this procedure?
I perform a variant of traditional hypodermic needle subcision known as Nokor subcision. This is a special technique that uses a blade to cut dense scars.
Occasionally I use hypodermic needles to perform hydrodissection with saline- especially useful on the temples & forehead area.
NFI what happened here. True story. No fillers or fat used in this revision
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🔬Skin Science: This is large volume atrophic scars, sure there’s subdermal fibrosis, but chances are there’s more than just collagen loss. Clinically acne took out a sh*t load of adipocytes with the inflammation. My plan years ago was to subcise / RF microneedle then either fat transfer or fill with dilute Ca Oh. After 3 sessions, I lost contact with the patient, he showed up towards the end of 2021. He denied any treatments after seeing me, including dermal fillers
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😲Sometimes the biology of skin is amazing. Given his age & clinical findings, I was certain that this degree of volumetric correction was not possible without a helping hand
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👊🏻No way of explaining this, so don’t expect miracles with this degree of atrophy, call it a fluke of nature💯
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#acne #acnescars #scarrevision #scartreatment #acnescarcure #acnescartips #drdavinlim #dermatoloigstbrisbane #skinscience
Fillers are invaluable in the management of atrophic acne scars. If there is too much collagen & or fat loss due to inflammation, some patients require a helping hand to correct volumetric deficits. In many cases soft tissue fillers accelerate the revision process. Filling in this patient was done over two sessions
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🔬Scar types: Atrophic rolling scars are amenable to fillers, especially if there is significant volume loss. In older patients fillers provide structural support to the overlying scars in addition to traction & countertraction in specified vectors
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⚖️Filler vs Fat: in the context of acne scars, I prefer to correct volume loss with fillers. Smaller volume defects with hyaluronic acid fillers, larger defects with hyper diluted calcium hydroxyapatite & larger defects with poly L lactic acid. I also employ autologous fat if volume loss exceeds 15 to 20 ml. The predictability of fat is the unpredictable nature of adipose resorption
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#drdavinlim #davinlim #PLLAfiller #acnescarcure #skinclinic #scareraser can’t fill #dermatologist #brisbanedermatology #hyaluronicacid #HAfillers #injectors #acnescars #scarrevision #dermalfiller #hyaluronicacidfiller #dermatologistbrisbane #facialanatomy
Multimodality treatment to address atrophic scars in this patient, skin type 3+
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🔬Skin science: Treat scars based upon morphology & merits. The primary scar types are rolling & atrophic. These were treated with subcision. Given the marked tethering I swapped instruments from my usual dovetails to Taylor Liberator (Mark’s device). Adjunctive TCA & CO2 laser resurfacing
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👍🏻Fillers: are an essential part of scar revision, especially in the more mature patient. Fillers can-
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1️⃣Support the overlying scars
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2️⃣Replace collagen & fat loss
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3️⃣Stimulate collagen production
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4️⃣Replace age related volume loss
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5️⃣Provide countertraction by volumetric displacement
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👉My choice in this patient was Ca Oh apatite in a hyper-diluted solution. The after picture was taken 6 months post final revision
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#acnescars #scarrevision #scareraser needs to learn to fill #drdavinlim #davinlim #dermatologistbrisbane #acnescartreatment #acnescartips #icepickscars #boxcarscars #rollingscars #subcision #taylorliberator
🙏🏼Thanks to my colleague dermatologist, @drclarepatterson for referring this patient to me for scar revision, with her help, we got this result. GIve her a follow for skincare tips
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👉This patient: Asian skin type 4. Ethnics scar easier, more prone to PIH. Every cloud has a silver lining. Flipside is that the fibroblast response is more brisk. This mean more efficient scar remodelling & neocollagenesis
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👉Acne: Management by @drclarepatterson 💯
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👉Scar revision: Sharp subcision, 2 levels. CO2 fractional, TCA paint & punches
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👍🏻Today: moped up a few remaining ice picks, next step is polishing with the pico, will keep you posted with the final results
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#dermatology #brisbanedermatologist #drdavinlim #davinlim #acnescars #scarrevision #co2laser #fractionallaser #acnetreatment #acneskincaretips #acnescartips
What has replaced needle subcision?
Cannula or modified blunt cannula subcision has largely replaced needles. Cannula subcision has the following advantages over traditional 18, 21 23 G needles-
- More efficient
- Subcision in different levels are easier felts
- Covers much wider area (both surface area & volumetric measurements)
- Added safety (blunt vs sharp)
- Ability to inject with cannula (large bore, hence increased fat viability cf. needles)
When are dermal fillers used?
Dermal fillers are employed if your atrophy (volume deficit) is large or if your immune system can not generate fat or collagen to replace the divot or depression.
HA fillers give immediate correction, whilst collagen stimulating fillers take 3-4 months for optional correction.
Newer hybrid HA fillers (Profhilo) is promising as they have a large amount of data behind them.
Davin’s Viewpoint on Needle Subcision
Though outdated, hypodermic needles were the very first forms of surgical subcision invested by two dermatologists (brothers) from New York in 1995. Over the years, other forms of subcision were invented including Nokor, 18 G Goodman report, blunt cannula, hydrodissection technique, air dissectors, & many more.
The progress of medical research has led scar revision experts to continually evolve techniques over the years.
