Subcision in Acne Scarring Safely Improves Appearance

Atrophic acne scars can be treated safely and effectively with subcision, minimally invasive subcutaneous incisionless surgery. Modifications of the subcision procedure reduce side effects and efficacy is improved with combination therapies. These are among the review findings published in the Journal of Cosmetic Dermatology.

Conventional needle-based subcision to address acne scarring can cause bleeding, needlestick injuries, damage to neurovascular structures, and pain resulting in limited use of this method. Investigators sought to review various subcision techniques alone or in combination with other modalities in management of acne scars and assess efficacy and adverse effects.

They conducted a search of PubMed and Google Scholar for clinical trials in English published before June 2022 on subcision treatments for acne scars. They excluded case series, case reports, conferences, editorials, letters to editors, commentaries, and review articles. Studies poorly designed (based on the Jadad scale) were also excluded. They found 12 articles investigating subcision combined with other modalities and 4 articles comparing modified technique blunt cannula-based subcision vs conventional needle-based subcision.

Investigators found subcision to be an efficacious and safe method for treating atrophic acne scars. Blunt cannula-based subcision (blunt blade with blunt head and thin wall to undermine the depressed scars) using a single insertion point would be expected to lower risk of vascular and neurological damage. This modification seems to cause fewer side effects resulting in greater patient satisfaction. Variable, though comparable, efficacy with needle-based and cannula-based subcision has been reported.

Subcision alone is an effective technique, however, recurrence of scar depression is common. Investigator found that outcomes can be improved and re-depressing of scars avoided when combining subcision with artificial materials (hyaluronic acid gels and threads) or application of autologous tissues (platelet gel). Combination of subcision with frequent suctioning can result in the same positive effects. Investigators noted microneedling or fractionated microneedle radiofrequency combined with subcision have also proven efficacious and safe.

Alternatively, investigators observed that pneumatic needle-free injections that break fibrotic strands and stimulate fibroblasts have fewer side effects compared with needle subcision but require more sessions to reach a comparable efficacy. They found controversial results with subcision combined with platelet-rich plasma to progress connective tissue formation and improve outcomes.

Review limitations include the nature of review design, limited studies comparing combination therapies involving subcision, exclusion of articles not written in English, and a noncomprehensive search strategy. 

Investigators concluded, “Subcision is a safe and effective method for treating atrophic acne scars.” They went on to write, “Modifications of this procedure lessen its side effects, and combination therapies improve its efficacy.”