Subcision for Acne Scars: How It Works, Who It’s For, and What to Expect
Updated: Sep 28
Acne scars can remain long after active acne has cleared. While skincare products and treatments such as chemical peels, microneedling, and laser resurfacing can improve the appearance of many scars, some types of acne scars are caused by deeper changes beneath the skin.
Subcision is a minimally invasive procedure designed specifically to address certain depressed acne scars by releasing the fibrous bands that tether the scarred skin to the underlying tissue.
What Is Subcision?
Subcision is a procedure used to treat depressed or indented acne scars, particularly scars that appear pulled downward or tethered to deeper tissue.
A specialized needle or cannula is carefully introduced beneath the scar. The clinician then uses controlled movements to release the fibrous connective tissue bands underneath the scar.
Once those attachments are released, the skin can lift and move more naturally, reducing the appearance of the indentation.
Unlike treatments that primarily work at the skin's surface, subcision targets the structural cause of certain acne scars beneath the skin.
Which Acne Scars Can Subcision Treat?
Subcision is generally most useful for atrophic, tethered acne scars.
These can include:
Rolling scars – broad, shallow depressions that can give the skin an uneven or wavy appearance
Tethered scars – scars that are pulled downward by fibrous bands beneath the skin
Some shallow boxcar scars, depending on their depth and characteristics
Subcision is generally not the primary treatment for ice-pick scars, which are narrow and extend deeply into the skin. Other treatments may be more appropriate for those scars.
Because acne scars often have different shapes and depths, treatment is frequently customized rather than using one technique for every scar.
How Does Subcision Work?
The basic goal of subcision is to separate the scar from the tissue underneath it.
During the procedure:
The treatment area is cleansed and prepared.
A local anesthetic is used to minimize discomfort.
A sterile needle or cannula is inserted beneath the depressed scar.
The instrument is moved in a controlled manner to release the fibrous bands tethering the scar.
The released skin is allowed to reposition and heal.
The controlled release creates space beneath the scar. As the area heals, the body's natural repair processes can help remodel the treated tissue and support improvement in the appearance of the depression.
Does Subcision Permanently Remove Acne Scars?
Subcision can provide significant improvement in appropriately selected scars, but it is important to have realistic expectations.
The goal is generally improvement rather than complete removal of acne scars.
Some scars may require multiple treatment sessions, and many patients benefit from combining subcision with another scar treatment. The appropriate combination depends on the type, depth, and characteristics of the scars.
What Can Subcision Be Combined With?
Subcision is sometimes incorporated into a broader acne-scar treatment plan.
Depending on the patient's skin and scar pattern, a provider may consider treatments such as:
Microneedling
Fractional laser treatments
Chemical peels
Platelet-rich plasma (PRP)
Dermal fillers for selected depressed scars
Other collagen-remodeling treatments
Combination treatment can be particularly useful because different techniques address different components of acne scarring.
For example, subcision can address tethering beneath the skin, while resurfacing treatments may target surface texture and collagen remodeling.
Your provider can determine which approach is appropriate after evaluating your individual scars.
What Is Recovery Like After Subcision?
Recovery varies depending on the extent of treatment and the individual patient.
It is common to experience some degree of:
Swelling
Bruising
Tenderness
Redness
Temporary sensitivity
Bruising can sometimes be noticeable for several days, particularly when larger areas are treated.
Your provider will give you specific aftercare instructions. These may include avoiding excessive pressure or manipulation of the treated area and temporarily modifying certain skincare or cosmetic products.
Following your aftercare instructions can help support healing and reduce the risk of complications.
When Will You See Results?
Some improvement may be noticeable after the initial swelling and bruising resolve. However, acne-scar improvement is a gradual process.
Your skin continues remodeling the treated tissue over time, so results may continue developing for weeks to months following treatment.
The number of treatments needed depends on factors such as:
Scar depth
Number of scars
Degree of tethering
Skin characteristics
Previous acne-scar treatments
Individual healing response
Are There Risks?
As with any procedure that breaks the skin, subcision has potential risks.
Possible side effects and complications can include:
Bruising
Swelling
Pain or tenderness
Temporary numbness or altered sensation
Infection
Bleeding or hematoma
Changes in skin pigmentation
Irregularities or contour changes
Injury to underlying structures
Scar formation
Choosing an appropriately trained and experienced medical professional is an important part of minimizing these risks.
Subcision at Vitality PDX
At Vitality PDX, we take an individualized approach to aesthetic treatment. Acne scars are not all the same, which is why treatment should be based on the specific type and characteristics of your scars.
If you're considering subcision, a consultation can help determine whether the treatment is appropriate for you and whether combining it with another treatment may provide a more comprehensive approach to improving the appearance of acne scarring.
Interested in learning whether subcision could be right for your acne scars? Contact Vitality PDX to schedule a consultation.
Frequently Asked Questions
Is subcision painful?
Local anesthetic is typically used to make the procedure more comfortable. You may experience pressure or movement during treatment, followed by some tenderness afterward.
How long does subcision take?
Treatment time depends on the number and size of scars being treated. Your provider can give you a more specific estimate during your consultation.
Can subcision treat all acne scars?
No. Subcision is particularly suited to tethered, depressed scars, especially rolling scars. Ice-pick scars generally require a different treatment approach.
How many subcision treatments will I need?
There is no single number that applies to everyone. The number of sessions depends on the severity and characteristics of the scars and how your skin responds to treatment.
Can I wear makeup after subcision?
Your provider will give you specific instructions based on the extent of your treatment. It is generally important to follow post-procedure recommendations regarding cosmetics and skincare while the treatment area heals.
Does subcision prevent new acne scars?
No. Subcision treats existing scars. Controlling active acne is important for preventing new acne lesions and subsequent scarring.
The Bottom Line
Subcision is a minimally invasive treatment that addresses one of the underlying causes of certain depressed acne scars: fibrous bands that tether the skin downward.
By releasing these attachments, subcision can improve the appearance of rolling and other tethered acne scars. For some patients, combining subcision with additional collagen-remodeling or scar treatments can provide a more comprehensive approach.
If you're frustrated by acne scars that remain despite topical skincare or other treatments, a professional evaluation can help determine which treatment options are appropriate for your skin.