Acne scar subcision releases the tight fibrous bands beneath indented scars, allowing them to level up.
“Personally, I have a love-hate relationship with acne scar subcision.”
That usually gets a laugh from my patients.
They look at me and ask,
“Doctor...how can you both love and hate the same treatment?”
And honestly, it’s a fair question.
Because despite performing subcision regularly, every time I prepare for the procedure, I know exactly what's coming.
It’s physically demanding.
It requires patience.
It takes up quite a bit of time.
And by the end of the session, my hands are usually much more tired than after many other treatments.
But despite all that...
I still genuinely enjoy performing subcision.
Because when it's done for the right patient, the improvements can be extremely satisfying, not just for me as the doctor, but even more importantly, for the patient.
Warning: The following demonstration may contain medical scenes that some viewers may find uncomfortable.
Before understanding subcision, it helps to understand why acne scars become depressed in the first place.
Many patients assume the scar is simply “a dent.”
But underneath the skin, there’s actually much more happening.
After severe inflammation from acne heals, tough fibrous bands can develop beneath the scar.
These bands tether the skin downwards, like tiny ropes pulling the surface inward.
Even though the skin has healed, those attachments continue to hold the scar down.
This is why certain acne scars remain depressed for years.
And, no amount of skincare can remove these fibrous attachments because they're located much deeper beneath the surface.
Subcision is a medical procedure designed to release these fibrous bands. During the procedure, a specialised needle is carefully inserted beneath the skin.
The needle is then gently moved underneath the scar to dissect through the fibrous attachments that are tethering the skin down.
Once these bands are released, the skin is no longer being pulled inward.
Over time, healing occurs in this newly released space, and collagen production may further improve the appearance of the scar [1].
Although the idea of placing a needle beneath the skin sounds intimidating, the area is first numbed with local anaesthesia to allow maximum comfort during the procedure.
If you have ever asked me what makes subcision so rewarding, the answer is actually very simple.
The results can be incredibly satisfying.
I remember one young gentleman who had struggled with acne scars for many years.
Whenever we discussed his concerns, he would always point to the same few deep scars on his cheeks. Those scars bothered him far more than the rest of his face. After examining him, I explained that these particular scars appeared tethered beneath the skin.
Following subcision, those scars gradually became much shallower and less obvious. When he returned for review, the first thing he said was,
“Doctor, my face finally feels smoother when I wash it. It doesn’t look like the surface of the moon anymore!”
And, gratifying comments like that make all the effort worthwhile.
Not every scar disappears 100% of course, but even 50% improvement is quite obvious already.
Seeing patients become more uplifted and confident because their scars no longer dominate their attention is one of the most rewarding parts of my work.
Now comes the other side of the story.
Subcision is hard work.
Unlike treatments where a machine performs most of the work, subcision depends almost entirely on the doctor's hands.
Depending on the number of scars being treated, the procedure can also be quite time-consuming.
By the end of a session, my hands have usually done countless of repeated, controlled movements.
It’s physically tiring.
But it’s also one of those procedures where taking shortcuts simply isn't an option. Each scar deserves careful attention. That’s exactly why good subcision procedures require patience.
Not necessarily.
Not every acne scar should be treated with subcision.
In reality, acne scars come in different forms.
Subcision tends to work best for rolling scars and other depressed scars that are tethered beneath the skin [2]. However, scars such as narrow ice-pick scars or sharply defined boxcar scars may require different treatment approaches.
This is why it is important to assess the type of scar before recommending any procedure.
The treatment should fit the scar, not the other way around.
This is another question patients commonly ask. And, it really depends.
Many patients often have different scar types on the same face. For this reason, subcision is frequently combined with other acne scar treatments as part of a personalised treatment plan.
The goal isn’t necessarily perfection.
It's about meaningful improvement that looks natural and continues to improve over time.
So yes...
I still have a love-hate relationship with acne scar subcision.
I may moan about how physically demanding it can be.
But I love the improvements it can achieve for the right patient.
One thing I always remind my patients is that successful acne scar treatment isn’t about choosing the newest or most expensive procedure. It’s about choosing the treatment that best addresses the underlying cause of the scar.
When deep scars are tethered beneath the skin, simply treating the surface may not be enough.
Often, those hidden fibrous bands need to be released first before the skin has the opportunity to heal more smoothly.
If you are bothered by indented acne scars and would like to know whether subcision is appropriate for your skin, schedule a consultation with One Face Clinic for a personalised assessment and treatment plan.
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