Subcision is a minor surgical procedure used for treating depressed cutaneous scars and wrinkles. Subcision is performed using a special hypodermic needle inserted through a puncture in the skin surface. The sharp edge of the needle is used to break fibrotic strands that are tethering the scar to the underlying tissue.
The release of the fibrotic strands and new collagen deposition caused by wound healing leads to cosmetic improvement of the scar. Subcision can be safely performed in the outpatient setting and is usually well tolerated.
The decision to perform subcision will depend on the type, location, and severity of scarring.
Subcision may be used for the treatment of:
Depressed distensile scars (due to acne, trauma, surgery)
Depressed bound down scars (varicella (chickenpox), …)
Depressed skin grafts
Subcision may not be suitable in the following circumstances:
Patients with a history of hypertrophic or keloid scars
Current or recent (within 12 months) systemic oral retinoid (e.g. isotretinoin)
Bleeding or blood clotting disorders (coagulopathy)
Active bacterial or viral infection
Post care subcision procedure:
Pressure and ice are applied to the operated site to maintain haemostasis and reduce the risk of bleeding.
Some authors recommend antibiotics and anti-inflammatory medication.
The number of subcisions required will depend on the type and location of depression.
Three to six visits suffice for the majority of cases of moderate scarring.
Intervals of at least one month in-between treatments are generally recommended
The complications of subcision include:
Bleeding of treated sites
Pain/tenderness and Bruising
Hypertrophic scars or keloid scars, which are most likely in periorbital skin, glabella, labial commissure and upper lip
Infection; this usually presents as localized acne form papule or pustule
Injury to nerve or blood vessel, which is most likely in mandibular, temporal and pre-auricular sites