Subcision: Technique for Acne Scars

Overview / Definition Subcision is a surgical procedure designed to treat atrophic scars, particularly those resulting from acne. The technique involves the insertion of a specialized needle into the dermis to break apart fibrotic bands that tether the scar to the underlying tissue, thus allowing for elevation and improved contour of the scar. Epidemiology Atrophic acne scars affect a significant portion of individuals who have experienced acne, with prevalence rates ranging from 20% to 80% among those with a history of acne. The severity and incidence of scarring can vary based on factors such as skin type, acne severity, and individual healing responses. Pathophysiology / Mechanism Atrophic acne scars develop due to a loss of collagen and elastin in the dermis during the healing process of inflammatory acne lesions. The fibrous bands form between the scar and the underlying tissue, resulting in a depressed appearance. Subcision works by disrupting these bands, promoting new collagen formation and improving skin texture. Clinical Presentation Patients with atrophic acne scars may present with various scar types, including: Ice pick scars: Deep, narrow scars that resemble small punctures. Boxcar scars: Broad depressions with sharp edges, often seen in the cheeks. Rolling scars: Widespread depressions that create an undulating appearance to the skin. Clinical evaluation involves assessing the type and extent of scarring, as well as the patient’s skin type and overall health. Diagnosis / Workup Diagnosis of atrophic acne scars is primarily clinical, based on a thorough history and physical examination. Important aspects of the workup include: Evaluating the patient’s history of acne and previous treatments. Documenting the number and type of scars present. Assessing for any contraindications to surgical intervention. In some cases, imaging techniques such as ultrasound may be used to evaluate the depth and extent of scarring. Treatment / Management Subcision is typica