A-Z OF SKIN

Subcision

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Subcision is a surgical procedure for the treatment of acne, traumatic and surgical scars. This method ‘releases’ scar tissue attached to deeper structures. This procedure is often combined with other scar revision procedures including lasers, peels, energy devices, dermal fillers & fat transfer.

Surgical subcision was first reported in 1995 by two dermatologists 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 variations reported in the literature including

  • Hypodermic needles of various gauges
  • NOKOR cutting needles
  • Blunt cannula
  • Specialized instrumentation
  • Radiofrequency assisted cannulation

The original reports in 1995 by two dermatologists was with a hypodermic needle that was inserted below the scar. A ‘wiper’ horizontal action released attached scar tissue from underlying structures. Subsequently there have been numerous publications using different instruments. Additionally, there are numerous papers documenting entry points, levels of subcision, as well as the use of dermal fillers, dermal grafts, fat, and platelet rich plasma.

Atrophic scars including rolling and tethered scars can be treated with subcision. In most cases several treatments are required to improve the appearance of scars.

Side effects are possible following this surgical procedure. These include-

  • Haematomas or blood clots
  • Prolonged bruising & swelling
  • Bleeding
  • Infection
  • Skin colour changes (most often hyperpigmentation); especially in darker skin types
  • Hard lumps (fibrosis or organised haematomas)
  • Hypertrophic scarring / incision scars
  • Nerve / vessel / ligament damage

As this is a surgical procedure, physicians including dermatologists & plastic surgeons may elect to employ subcision for the management of suitable scar types.

This information has been written by Dr Davin S. Lim MBBS, FACD. 

Published February 2020

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