Nokor Subcision Acne Scars At A Glance
- Best Results1-10+ Treatments
- Treatment Recovery4 - 8 days
- Procedure Time5 to 30 mins
- Skin SpecialistDavin Lim, Dermatologist
- Duration of ResultsVariable - years
- AnaestheticNumbing to sedation
- Back to WorkVariable
- Cost$-$$$$
Nokor Subcision Acne Scars
Subcision can be performed with many different instruments including a cannula, modified instrumentation, needles & special blades including the NOKOR needle. This needle is a modified instrument designed to cut underlying dense acne scars.
FactsFacts on Nokor Subcision Acne Scars
- This is the most aggressive form of surgical subcision
- It uses a cutting blade at the end of a large bore needle
- Nokor blades are employed to cut deep, dense scar tissue
- Bruising is common after Nokor, lasting 7-12 days
- Nokor is often combined with other surgical techniques
- Nokor can also be combined with lasers, RFM & peels
What is Nokor Subcision Acne Scars?
Nokor subcision uses a blade to cut underlying scar tissue. This is a special form of subcision employed when normal instrumentation can not shift fibrous scar tissue. Essentially it is keyhole blade surgery for acne scars.
For context, I employ Nokor approximately in one patient per twenty I treat. My acne scar demographics are skewed as the majority of my patients have had failed procedures elsewhere, hence I am seeing ‘severe & often recalcitrant ‘scars. Regardless, Nokor is used when I have trouble breaking scar tissue with my normal 12 gauge to 22 Gauge modified cannulas.
In my practice, I reserve Nokor for thick, dense, scar tissue that often lies subdermally. Nokor slices through this fibrous tissue with ease. The blade itself is super small- measuring only 1.3 mm, hence the entry hole heals up nicely.
I also use other blades including sapphire blades to cut very fine scars, or even 15 blades to go through thicker tissue.
Occasionally I perform flap surgery to open up the entire area of scarring & manually cut scars with larger blades. I then ensure I have hemostasis and then suture the cut as I would for facelift surgery. The entry is just in front of the ear.
What types of scars are treated with Nokor over normal subcision?
In the majority of cases, normal subcision using 12-22 G modified cannulation can treat atrophic & fibrous scar tissue. If fibrosis (scar tissue) is dense, even a 12 gauge instrument will not break up the scar. This is when I use blades like the Nokor needle.
Hence the scar type I treat with Nokor is dense, fibrotic, broad based subdermal scarring. This pattern is relatively rare, & seen in extreme cases.
What other types of scar subcision do I perform?
I also perform cannula subcision using 12 G to 27 G instruments. In the context of needles, my most frequently used gauges are 25, 29 & 30 G via dermal hydrodissection.
My usual mode of practice is to employ specific instruments based upon scar tissue. The morphology can be identified during the procedure itself.
What are the risks of Nokor Blade subcision?
I am always mindful of the risks of sharp subcision, in particular Nokor blades. To date
I have not had a major complication. As a guide the side effects I am mindful of include-
- Transection of motor & sensory nerves. If this occurs, it can be long lasting. One has to know the level & location of these nerves to provide safe subcision. Transient sensory loss is common in some areas like the temples & forehead. It is due to transection of smaller branches of sensory nerves. Most regain sensation back after 6 -24 months.
- Transection of arteries & veins. This can occur if subcision is too deep (former) or as a side effect of Nokor – the latter.
- Haematomas, & seromas can occur secondary to cutting blood vessels. I am very careful with haemostasis.
- Late onset nodules are usually secondary to organised haematomas. Seromas are extremely uncommon.
- Hyperpigmentation can be a side effect of extensive subcision, this is usually due to bleeding (haemosiderin) and or non-specific melanocyte hyperactivity.
- Idiosyncratic scars are very rare, I have not encountered this side effect but it has been reported in the literature, probably a variant of subdermal hypertrophic scars – subdermal fibrosis.
See the section on injectables for a more detailed explanation.
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What other revision methods do I combine with Nokor?
Rarely do I only use one form of subcision, it is my norm to combine Nokor with blunt & modified cannulas. Any associated scars are treated according to their morphology. The upper dermal layers can also be treated with RFM, lasers, deep peels, etc.
How many treatments will I require?
1-4 depending on the severity of scarring. Some patients ‘re-attach’ scars, especially if one has background inflammation. For this group several sessions are required. In extreme cases of scarring, I may require multiple subcision sessions over 6-10 months to improve skin scars.
What is the cost of Nokor subcision?
This procedure is partially covered under Medicare.
Costing ranges from $790 AUD to $4890 AUD out of pocket, depending on your Medicare status. I do not charge per ‘scar’ unlike some physicians, the price is for revision of all scars that are amendable to treatments in the one sitting.
Is Nokor the best instrument for subcision?
This has been covered in my publication in 2023 in Derm. Surgery (Lobo, Lim). We discuss how to employ specific instruments based upon the job & discuss the risks-benefits of each device.
Nokor is great for efficient & effective dispatch of scar tissue in the lateral areas of the face, it is less useful for medial areas as the needle length is short.
Other instruments such as repurposed cutting cannulas (my favourite 1.0 to 1.6 mm) are better for extensive areas, whilst the Taylor Liberator is more efficient at transaction of thick fibrous scars in patients with a thick dermis & or subcutaneous layer. Be guided by your physician.
Can Nokor subcision cause facial laxity?
In theory, yes, however I personally have never come across this side effect, nor is it reported in the literature (as of 2024).
Any subcision procedure can transect the fibres in the retinicular cutis, however it is the extent of undermining & the depth that determines the risks. Given the short needle length of Nokor, it is unlikely to cause collateral damage, if used appropriately.
Davin’s Viewpoint on Nokor subcision for acne scars
Despite the aggression of this procedure, it is still a very useful method to revise the most dense fibrous tissue. I do feel that the absolute majority of scars can be transected with blunt or modified cannulas, hence I only employ this technique of Nokor needle in exception cases.
Sensory loss is not uncommon, especially areas such as the temples as small branches of sensory nerves are inadvertently transected, even with tumescent anesthesia. Sensory function usually returns within a year.
