Subcision for Acne Scars in Singapore
What Is Subcision?
Subcision is a procedure used for selected depressed acne scars that are held down by fibrous tissue beneath the skin. A doctor uses an instrument under the skin to release these attachments. It may be considered for some rolling scars and other scars where tethering contributes to the indentation.
A depressed appearance does not always mean a scar is tethered. Suitability depends on the scar’s structure, the surrounding skin, previous treatment and individual clinical assessment. At The Acne Clinic, Dr Ramita Kaur Shahi assesses these factors before discussing whether subcision has a role.
Read more on Subcision
How does Subcision Work?
What the Treatment Does
Some depressed scars are pulled down by fibrous attachments beneath the skin. During subcision, an instrument is passed below a selected scar to release these attachments. This addresses the tethering rather than treating only the visible skin surface.
Its Role in Acne Scar Management
Subcision may be considered when tethering is an important reason a scar remains indented. It can be discussed on its own or as one part of a plan for mixed scarring. The other parts of the plan should each have a clear purpose.
What It Does Not Replace
Subcision does not manage active acne or remove flat red or dark acne marks. It is also unlikely to be the relevant procedure for every narrow ice pick scar. TCA CROSS or fractional laser resurfacing may be considered for different scar features after assessment.
CONSIDERATION
When may Subcision be Considered?
Broad, depressed scars with a rolling appearance may be assessed for attachments beneath the skin. Subcision may be relevant if releasing those attachments is likely to address part of what is causing the depression.
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Tethered Rolling Scars
Broad, depressed scars with a rolling appearance may be assessed for attachments beneath the skin. Subcision may be relevant if releasing those attachments is likely to address part of what is causing the depression.
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Scar and Skin Factors
Dr Ramita should assess the number and location of scars, their depth, the condition of the surrounding skin and whether several scar types are present. The appearance of a scar in a photograph alone may not establish whether it is tethered.
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Previous Treatment
Tell Dr Ramita about previous scar procedures, how you healed and whether you experienced prolonged bruising, pigmentation or other concerns. Current medicines and ongoing acne treatment should also be discussed before planning a procedure.
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When It May Not Be Appropriate
Subcision may not have a useful role when a scar is not tethered or when the main concern is flat pigmentation, redness or a raised scar. Active inflammation or another issue in the proposed treatment area may also affect timing. The decision requires examination rather than selecting treatment by scar name alone.
PART OF ACNE TREATMENT
Why Might Subcision be Considered as Part of Acne Scar Treatment
Subcision is chosen for a specific structural reason: fibrous attachments are pulling a scar down. A surface treatment cannot directly release those attachments. If a patient also has narrow deep pits or broader texture changes, other treatments may be considered for those separate features.
Clinical Insight from Dr Ramita
What do you look for when deciding whether a depressed scar is tethered and whether subcision should come before another scar treatment?
I would examine the scar's shape, depth and how the skin moves when gently stretched or palpated. Broad, rolling depressions that appear anchored beneath the surface may indicate fibrous tethering, where subcision can be considered to release the underlying attachments before other resurfacing treatments.
What to Expect with Subcision
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Before Treatment
Dr Ramita assesses the scars proposed for treatment and discusses the intended benefit, alternatives, risks and recovery. Let the clinic know about medicines you take, previous procedures and any history of unusual bruising or healing.
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During Treatment
Local anaesthetic is used for comfort. An instrument is then passed beneath selected scars to release fibrous attachments. TAC’s current treatment article describes the use of a fine needle. The exact technique and extent of treatment should be explained for your plan.
Read more on How Subcision Helps Smooth and Lift Acne Scars
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Immediately After Treatment
The treated area may feel tender or swollen. Bruising can develop and may become more visible after the procedure. The skin’s early appearance reflects treatment and healing beneath the surface; it is not the final appearance of the scar.
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Recovery and Downtime
Swelling, bruising, redness and tenderness may affect how comfortable you feel returning to usual activities. Recovery varies with the area and extent treated. Ask Dr Ramita what to expect for your plan, particularly if you have an event or travel coming up. Follow the clinic’s instructions on cleansing, skin care, exercise and when to restart active products.
Read more on What happens after Subcision and how to skin aftercare
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Follow Up
Review allows Dr Ramita to assess healing and any remaining scar concerns. Contact the clinic earlier if pain is worsening, swelling increases rapidly, redness spreads or discharge develops.
What Should you Know before Subcision?
What the Treatment Is Intended to Address
Subcision addresses tethering beneath selected depressed scars. Releasing an attachment may change the scar’s appearance, but it does not guarantee that the skin surface will become even or that no further treatment will be considered.
Possible Side Effects
Bruising, swelling, tenderness and temporary redness can occur. The extent and duration vary between patients and according to how much skin is treated. TAC’s aftercare guide describes these as common early recovery concerns.
Read more on What happens after Subcision and how to skin aftercare
Potential Risks
Reported complications include bleeding or a collection of blood beneath the skin, infection, persistent lumps and changes in pigmentation. These risks should be discussed in relation to the proposed technique and the patient’s clinical history.
Read more on the Potential Risks of Subcision
Limitations
A patient may have tethered scars alongside ice pick scars, boxcar scars or flat acne marks. Subcision would address the scars selected for release, not every visible change. Other approaches may be considered if different scar features remain.
Number or Frequency of Treatments
There is no fixed number of sessions that applies to every patient. The need for further treatment depends on the scars, the extent of tethering, healing and the findings at review.
Common Questions about Subcision
Is subcision suitable for every rolling scar?
No. A rolling appearance can suggest tethering, but the scar and surrounding tissue need to be assessed. Subcision is most relevant when fibrous attachments are contributing to the depression. Dr Ramita can explain whether that feature is present and what treatment may address it.
Is subcision the same as TCA CROSS?
No. Subcision releases attachments beneath selected depressed scars. TCA CROSS applies an acid precisely within certain narrow, deep scars. They address different structural features and may be considered separately when a patient has mixed scar patterns.
Will I have bruising after subcision?
Bruising is possible and may become more visible after treatment. Swelling and tenderness can also occur. The extent depends on the area treated and individual response. Discuss your schedule with Dr Ramita before the procedure rather than assuming there will be no visible recovery period.
Can subcision be combined with fractional laser resurfacing?
It may be considered when tethering and surface texture are both relevant concerns. The reason for each procedure and whether they should be staged need to be explained after assessment. Combining treatments is not automatically necessary for every patient.
When should I contact the clinic during recovery?
Contact the clinic if pain becomes severe or worsens, swelling increases rapidly, redness spreads, or you notice discharge or another concerning change. For skin care, exercise and restarting acne products, follow the instructions given for your procedure and check if you are uncertain.
Read more on Subcision aftercare and what happens next
Considering Subcision for Acne Scars?
Assessment of Scar Tethering
A consultation can establish whether fibrous attachments are contributing to your scars, whether subcision may be appropriate and how it would fit with any treatment needed for other scar patterns or active acne.
Consult
Dr. Ramita Kaur Shahi
Dr Ramita Kaur Shahi leads acne consultations at The Acne Clinic. She assesses the skin and relevant history before discussing management options and follow up.