Subcision Acne Scar Treatment
Treat Tethered Rolling and Depressed Acne Scars with Subcision
Subcision is a minimally invasive acne scar treatment used primarily for tethered rolling scars and selected depressed scars.
These scars develop when fibrous bands form beneath the skin and pull the surface downwards, creating visible depressions or an uneven, wavy appearance.
Unlike resurfacing treatments that mainly work from the skin surface, subcision targets the deeper structures responsible for this tethering.
By carefully releasing the fibrous bands beneath the scar, the skin is allowed to lift more freely while the healing response may stimulate new collagen formation in the treated area.
How Do Depressed Acne Scars Form?
Depressed, or atrophic, acne scars can develop after deeper inflammatory acne damages collagen and supporting tissue within the skin.
During healing, the body may not replace enough collagen to restore the skin to its original level.
In some cases, fibrous scar tissue also forms beneath the surface and anchors the skin downwards.
This can produce:
- rolling scars
- shallow depressions
- uneven contours
- tethered scars that appear more obvious under angled lighting
Subcision is designed specifically to address this tethering component.
Learn more about acne scar treatments →
How Does Subcision Work?
During subcision, a doctor inserts a fine needle or cannula beneath the acne scar and carefully moves it through the underlying tissue.
This helps release the fibrous bands that are pulling the scar downwards.
Once these bands are released, the skin is able to sit more freely.
The controlled injury created beneath the skin may also stimulate a healing response and encourage collagen formation within the treated area.
Subcision does not resurface the top layer of the skin.
For this reason, it is often used together with treatments that target surface texture, pores or deeper collagen remodelling.
Which Acne Scars Respond Best to Subcision?
Subcision is most useful for scars where the skin is physically tethered down by fibrous tissue.
ROLLING SCARS Rolling scars often have a broad, shallow depression with a wave-like appearance. They are commonly associated with fibrous bands beneath the skin and are one of the scar types most suited to subcision.
SELECTED BOXCAR SCARS Some boxcar scars may also have a tethered component. Where this is present, subcision may help improve the depressed base of the scar. However, sharper-edged or deeper boxcar scars may also require resurfacing or other targeted scar treatments.
ICE-PICK SCARS Deep, narrow ice-pick scars are generally not treated with subcision alone. Treatments such as TCA CROSS may be more appropriate for this scar type.
How Can I Tell If My Acne Scars Are Tethered?
Tethered scars often appear more pronounced when the skin is stretched or when light falls across the face from the side.
During consultation, a doctor can assess whether the scar is being held down by fibrous bands beneath the skin.
This is important because not every depressed scar requires subcision.
If the scar is not tethered, treatments focused on resurfacing or collagen remodelling may be more suitable.
What Is the Difference Between Acne Scars and Acne Marks?
Acne scars involve structural changes within the skin.
They may appear depressed, raised or uneven in texture.
Acne marks, on the other hand, usually refer to colour changes left behind after inflammation.
These may appear as:
- red or pink marks
- brown pigmentation
- purple or darker areas
These colour changes are not the same as true acne scars and usually require different treatment.
Subcision is intended for structural depressed scars, not pigmentation alone.
Can Subcision Be Combined with Other Acne Scar Treatments?
Yes.
Most patients have more than one type of acne scar, so subcision is often used as part of a combination treatment plan.
Depending on the scars present, it may be combined or sequenced with treatments such as:
RF MICRONEEDLING To stimulate deeper collagen remodelling and improve overall skin texture.
FRACTIONAL CO2 LASER To resurface uneven skin and improve selected depressed scars.
TCA CROSS To target deep ice-pick scars.
DERMAL FILLER In selected cases, filler may be used to provide additional support beneath a depressed scar after tethering has been released.
The most appropriate combination depends on scar type, depth, skin condition and previous treatment history.
Learn more about RF microneedling →
Subcision vs RF Microneedling
Subcision and RF microneedling work in different ways.
Subcision mechanically releases fibrous bands beneath tethered scars.
RF microneedling delivers radiofrequency energy into the skin to stimulate collagen remodelling.
For patients with both tethering and surface textural changes, the two treatments may sometimes complement each other.
Subcision addresses the structural pull beneath the scar, while RF microneedling focuses more on collagen remodelling and skin texture.
Subcision vs CO₂ Laser
Fractional CO₂ laser works by creating controlled microscopic injury from the skin surface downwards to stimulate resurfacing and collagen production.
Subcision works beneath the skin to release scar tissue that is physically pulling the skin down.
Neither treatment replaces the other.
Where tethering is present, resurfacing alone may not fully correct the depressed scar because the fibrous band remains in place.
For this reason, subcision may be performed before or alongside resurfacing in selected patients.
Learn more about Fractional CO2 laser →
Frequently Asked Questions About Subcision
Benefits
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Releases fibrous bands beneath tethered acne scars -
Improves the appearance of rolling and selected depressed scars
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Helps lift scars that remain anchored beneath the skin
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Stimulates collagen production during the healing process
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Can be combined with RF microneedling, CO₂ laser and other scar treatments
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Targets the deeper structural cause of selected acne scars
Best For
People with tethered rolling scars and selected depressed or boxcar scars where fibrous bands beneath the skin are contributing to visible indentation.
