Subcision Acne Scars

Cannula Subcision At A Glance

  • Best Results2-5 sessions
  • Treatment RecoveryNil to 7 days
  • Procedure Time40-60 min
  • Skin SpecialistDavin Lim, Dermatologist
  • Duration of ResultsLife (if acne controlled)
  • AnaestheticSedation, blocks
  • Back to Work2-5 days
  • Cost$$ Partial Medicare rebate in most cases

Subcision Acne Scars

Subcision is a surgical keyhole surgery for the treatment of deep acne scars. This method immediately ‘releases’ scar tissue attached to deeper facial structures. Subcision is the gold standard for the treatment of deep scars. This procedure is often combined with lasers, peels, energy devices & dermal fillers.

FactsFacts on Subcision Acne Scars

  • This is a surgical procedure that addresses scars under the skin’s surface
  • Cannulas are preferred to needles as this technique is more effective
  • Blunt cannula has much less side effects compared to Nokor needle or needle subcision
  • This procedure can be combined with other scar directed therapies such as lasers, microneedling & deep peels
  • Downtime following cannula subcision ranges from 2-10 days
  • This procedure is comfortable as it is usually performed under mild sedation

What is subcision?

Subcision Acne Scars

Surgical subcision was first reported in 1995 by two dermatologists practicing in New York. This first report was with a hypodermic needle inserted into the dermal – fat layer just below the scar. The needle was then manipulated in a horizontal sweeping action, in turn causing breakage of scar tissue. Since the initial reports, there have been numerous surgical techniques that have evolved including-

  • 18, 21, 23 Gauge needles (various sizes)
  • 18 G Nokor needles used facilitate cutting
  • 18 G to 25 G cannulas designed to sever in addition to delivery of dermal filler-fat
  • 12- 16 G instruments (blunt subcision)

I utilise everything from a 12 Gauge to a 30 Gauge, and everything in between. Majority of my cases involve concurrent treatment of superficial scars with other modalities.

YouTube video

Why is cannula subcision more effective than needle subcision?

The majority of dermatologists-plastics now use cannula over needle because;

  1. Cannula is more effective as bonds are broken in a front back cf side to side motion
  2. Cannula is safer as the tip is blunt (pushing)
  3. Cannula can be used to deliver dermal fillers or fat
  4. Cannula tactile feelcan be at different levels (subdermal, mid fat, lower fat)
subcision for scars
The greater the selection of instrumentation, the better the treatment. Apply instruments as required or called upon.

Is the procedure painful?

The procedure is well tolerated by most. For regional (small area) subcision using small cannulas, only local injections containing anaesthetic are required. For large bore instruments, most patients are sedated with muscle relaxants & mild anaesthetic agents. Pain is NOT an issue as anaesthesia is planned prior to the procedure.

What is the recovery following surgical subcision?

This depends on the EXTENT of surgical subcision & typically ranges from 2-10 days. As I am primarily working under, not on the skin’s surface, downtime is kept to a minimum. For small areas of subcision, expect bruising for a day or two. For extensive areas of subcision, expect swelling &/or bruising for just over one week to ten days. I will give you an accurate time frame depending on the projected treatment/s. Restriction of exercise-activity will depend on the area treated.

Davin’s take on cannula subcision

This is my go to procedure for the majority of acne scars I see in my scope of practice. I employ all sizes of cannulas & instruments from 12 gauge to 30 gauge sizes. This procedure is akin to key hole surgery, it should be applied accordingly. Most cases are combination treatments as i concurrently address superficial scars with procedures such as lasers, RFM, focal deep peels etc…

subcision for scars
The greater the selection of instrumentation, the better the treatment. Apply instruments as required or called upon.

All procedures (apart from excision) rely on your ability to generate and remodel collagen. Subcision is primarily aimed at breaking down scar tissue holding or pulling the demis down. There is some element of dermal remodelling due to mechanically induced trauma (dermal or hypodermis scraped). In most cases I perform other treatments such as lasers, RF, RFM & deep peels, when indicated.


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