Subcision Treatments; At A Glance
- Best Results1-3 sessions
- Treatment Recovery3-10 days
- Procedure Time20 to 60 min
- Skin SpecialistDavin Lim
- Duration of ResultsA long time
- AnaestheticLocal, gas, sedation
- Back to Work0-7 days
- Cost$$-$$$$
Subcision for Cellulite
Surgical subcision is best reserved for divots & dimpling caused by fibrous bands. Limited release can markedly improve cellulite. Subcision can be performed manually, via lasers, radiofrequency, or vacuum assisted. Collagen stimulation via dermal fillers & energy devices are helpful in strengthening the dermis, further improving cellulite.
FactsFacts on subcision for Cellulite
- This is a surgical procedure that releases fibrous septae that cause dimpling & divots
- Subcision is best for isolated bands seen on the buttock & outer upper thighs
- Manual subcision allows for greater control over vacuum subcision
- Wavy generalised cellulite is best treated with radiofrequency & collagen stimulation
- Cellurase is a form of laser assisted subcision
- Cellfina is a form of guided vacuum subcision
- Lymphatic massage as adjunctive therapy can speed up recovery following subcision
What is subcision for cellulite?
Subcision is a minimally invasive surgical procedure designed to free up depressions, divots & deep dimples.
This surgical procedure is performed under local anaesthetic in an operation theatre. I use various instruments to break down the fibrous tissue that cause cellulite divots. The procedure is painless & typically takes 10 to 20 minutes to perform, depending on the number of bands.
How many sessions will I require?
1-3, depending on the extent of cellulite. For extensive areas of cellulite, I generally split the treatments 6- 10 weeks apart. This is due to safety. Extensive subcision exponentially increases side effects such as bleeding, haematomas, iron staining & fibrosis (lumps).
Subcision must also be controlled, as extensive undermining can also lead to increased laxity– this is why I combine this procedure with skin tightening devices such as radiofrequency.
How soon are the results seen, and how long do they last?
Results can be seen as early as day 2. Note: swelling contributes to this result. The final results take 8-16 weeks. Remember, subcision is only one of the three modalities used to treat cellulite.
Dermal collagen remodelling through the use of dermal fillers & RF devices take several months to maximise, hence the best results are seen around 6 months. Studies have shown that results following subcision have exceeded the 5 year mark.
Is the procedure painful?
No. I use several methods to eliminate the pain of this procedure including-
- Local anaesthetic
- Muscle relaxants & pain medications
- Sedation
- Gas
The ideal combination depends on the extent of cellulite & the planned procedures.
View our Treatment Gallery
How long is the recovery period?
You will be required to wear compression stockings for 7 days. Thereafter you can transition to daily use for another 28 days.
Heavy exercise including running, gym work & classes should be avoided for 7 days post procedure. You can commence low intensity/impact exercises such as swimming, stretching, slow walking from day 2.
Why are combination treatments the ONLY way to treat cellulite?
Cellulite has three components: cellulite dimples that form when fat is pushed through taut bands of connective tissue fibers (septae), fat bulges beneath the skin, & skin laxity. All three components can cause cellulite dimples and puckering on the surface of the skin, to different degrees.
Surgical de-banding via subcision only addresses the taut bands of connective tissue. It does not address fat bulges, or skin laxity. This is why combination therapy with dermal fillers & energy devices such as Venus Legacy RF are needed. These two methods address laxity & increase dermal collagen. An increase in dermal collagen gives your skin more resilience to help mitigate the extrusion forces of the underlying hypodermis.
A slightly acidic skin environment optimizes skin barrier function & reduces the chances of infections as a low (ish) pH is disadvantageous to pathogens
.
👉What about very low pH ingredients? Some formulations such as #ascorbic acid, lactic, glycolic, salicylic, mandelic, citric, and beta hydroxy acids function best in a low pH formulation as this increases bioavailability & skin penetration. Not an issue for most skin types, but maybe an issue for those with compromised skin barrier function- namely acne, rosacea, dermatitis-eczema patients.
.
👉What about higher pH products? Fortunately the days of alkaline washes/cleansers/soaps are limited. Mainstream brands such as La Roche Posay, Paula’s Choice & CeraVe have cleansers ranging between pH 5.1 to 5.4.
.
😎Davin Lim
Dermatologist
Brisbane/Sydney🇦🇺
.
#skincare #skincarescience #skinscience #dermaltherapy #dermatology
#healthyskin #skinhealth #drdavinlim #davinlim #dermatoloigstsydney #brisbanedermatology
Picosecond fractional resurfacing with Picosure Pro, 2 sessions spaced 4 weeks apart
.
👉Indication: Pigment in all skin types. Our pilot study suggests that off label picosecond laser in the 755 wavelength, delivered in full beam to select spots & high powered fractional is superior to IPL & non-ablative fractional laser resurfacing💯
.
👉Cons: It’s off label. Downtime of 48+ hours (still less than 1927 Fraxel & IPL). With the marked cytokine release, I now give a short sharp application of topical CS post treatment to reduce post treatment swelling. For patients with pigment > solar dysplasia, I prefer pico to thulium lasers (& TCA-Jesser peels). The Picosure Pro by #Cynosure is really that good👍🏻
.
😎Davin Lim
Dermatologist
Brisbane/Sydney🇦🇺
.
#picosure #skinscience #dermatology #picosurepro #picolasers #skinrejuvenation
#drdavinlim #davinlim #dermatoloigstsydney #brisbanedermatology
Can cellulite be addressed without surgery?
Some forms of cellulite do not respond to subcision. Patterns include wavy generalised cellulite as well as cellulite of the medial or inner thigh.
This pattern of cellulite will respond best to a combination of dermal fillers to strengthen the dermis-fat junction, as well as energy devices including radiofrequency/electromagnetic stimulation. Intermittent positive & negative pressure vacuum devices can also be used to improve lymphatic drainage, & decrease inflammation.
As a guide most patients require 5-8 sessions spaced 2-4 weeks apart.
What are the potential side effects of subcision?
It is important to differentiate the expected recovery from subcision compared to side effects.
Subcision is a surgical procedure & it carries associated risks.
Expected recovery
- Swelling & bruising for 4 weeks
- Lumps & bumps for 2-4 weeks
Side effects
- Swelling & bruising for longer than 4 weeks
- Persistent swelling & bumps for longer than 8 weeks, over correction & fat herniation
- Iron or hemosiderin staining longer than 8 months
- Infection
Side effects can be reduced with compliance to post-operative care including the application of compression & restriction of strenuous exercise.
What precautions should you take prior to subcision procedures?
You must refrain from things that may increase your bleed time. This includes Aspirin, (stop 2 weeks prior), NSAIDs, & anti-inflammatories including vitamin E, St.John’s Wort & fish oil.
Iron supplements should be discontinued for the week leading up to subcision & one week after the procedure.
Why don’t I use Cellfina?
Cellfina uses a stabilized platform with vacuum extraction. This platform can only subcise in two levels. Additionally, once aligned, breakage of the fibrous bands cannot be controlled independent of angle.
Manual subcision offers more control & finesse as this allows me to approach banding at different angles in the vertical & horizontal plane.
Why don’t I use lasers such as Cellulase?
Because I do not require a laser to break up tethers. I do just fine with instrumentation. I also do not use RF cannulas. Yes, I get it, devices can stimulate collagen when applied to the underlying tissue. The argument is that a limited amount of collagen can be remodelled in one sitting. This is why I employ slow heat RF devices over multiple sessions & not fast heating lasers/RF.
(Note: I do use energy devices to aid in subcision for face & neck tightening, so I am not totally against this idea.)
Do creams help with cellulite & the recovery process?
Cellulite creams have a marginal, if any effect on cellulite. Anti-bruising creams including arnica can reduce bruising. Arnica is more effective in a tablet form, & can be taken 48 hours prior to surgical procedures.
Other ingredients that have been reported to help include caffeine, retinol, retinoids, vitamin E, & peptides.
What is the device of choice to complement subcision?
My device of choice is the Venus Legacy. This has one of the highest patients satisfaction rates. It incorporates-
- Multipolar Radiofrequency designed to reduce adipocytes (fat cells) & increase dermal thickness.
- Pulsed Electromagnetic Fields which improves circulation & stimulates collagen.
- Intermittent suctioning which increases energy delivery & improves lymphatic circulation.
How much does it cost?
As a guide, subcision costs (includes 2 sides, includes 5 sessions of RF Venus Legacy)
Small area- $1900 to $2990
Medium area – $ 2900 – $4990
Large areas – $4990 to $7990
Cellulite treatment includes planning, photography, marking and post procedure care.
Davin’s Viewpoint on Subcision for Cellulite
Subcision can be performed via a novel vacuum device, namely Cellfina, via side firing lasers, as well as RF assistance. I do believe that manual methods using surgical instruments are the best as this procedure offers far greater control over the larger bore instrumentation. I subcise at least 3-4 acne scar patients on a daily basis with this method. Energy devices, though useful, give too much unnecessary collateral damage.
Deep depressions & dimpling do best with surgical subcision. I limit my subcision to 12-16 areas, as extensive surgical instrumentation can lead to worsening of laxity as too many fibrous septae are disrupted. In many cases I combine subcision with collagen stimulating dermal fillers, radiofrequency & electromagnetic devices. Combination treatments work best.
