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Acne Scar Revision: Subcision + Fractional Radiofrequency Microneedling

In revising old acne scars, a proper evaluation must be made to ascertain the type of scars the patient has. Aside from this, one should also take into consideration the patient’s skin type and lifestyle.

Remember that each patient and unique… and so is their treatment. There are many combinations of procedures that can be done but everything should always be customized to the patient’s needs and lifestyle.

Let’s go over what we did for our patient 🙂

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The road to acne scar revision

Cystic acne is the main culprit of acne scars, because it creates a bag of pus within the skin. When the pus resolves, the hollow space it leaves behind forms a crater on the skin. When one has cystic acne flares, acne scarring ensues.

There are numerous modalities that can improve acne scars and large pore size. As dermatologists, we follow guidelines as to what modality to use to treat a certain type of scar. But we must also remember that the results of same treatment may vary from person to person. 🧐

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Cutting Ties

No, I’m not talking about relationships; rather, I’m talking about one of my favorite treatments for acne scars — SUBCISION.

Before we go into the treatment, let’s talk about why we get acne scars. Acne scarring can be in the form of pigmentation, textural changes or both. Pigmentation is quite easy to remedy. The darkened skin color will eventually lighten to normal skin color by itself or with the help of lightening products. On the other hand, textural changes such as ice pick scars, box scars, rolling scars and atrophic scars stay with you throughout your life. We get depressed scars because when have a pimple the pus in the hair follicle disrupts the skin. So when the skin heals, there is a hallowing in the area where the pus used to be and fibrous adhesions to the upper layer of the skin. This is what we see as depressed scars.

Subcision is a minor surgical procedure that cuts the fibrous adhesions that pull the scars down. After the area is anesthetized, a needle is inserted under the skin to release the fibers. You will hear and feel the a “cruck cruck cruck” sensation as the needle cuts through the fibers. It can be quite bloody and bruising is to be expected after the treatment. In our office, we place the patient under LED light to hasten healing after subcision.

In our Acne Scar Revision Program, I almost always do subcision as a first treatment on patients with box scars and rolling scars. Because the anchoring fibers have been cut to release the skin, the depressions improve faster especially after microneedling or other procedures. 🙂