Subcision in Ankara, Turkey

Subcision is a non-surgical dermatological technique used especially in the treatment of acne scars, depressed scars, and deep skin deformities. By entering under the skin with a special fine-tipped needle, the fibrous bands that pull the scar tissue downward are cut. This procedure reduces skin depressions and provides a smoother appearance.

In skin rejuvenation treatments, subcision supports tissue remodeling by creating microtraumas that stimulate collagen production. In this way, the skin surface becomes fuller over time and scar depth decreases. The treatment is generally effective in moderate and deep scars.

The subcision procedure is performed under local anesthesia and patient comfort is high. It can be applied alone or in combination with dermal fillers, PRP, or laser treatments to increase effectiveness. Mild bruising or edema may occur after the procedure, but recovery is usually observed in a short time.

This method is an effective skin rejuvenation option that provides permanent tissue repair without requiring surgical intervention. When applied in regular sessions, a noticeable increase in skin elasticity and a significant reduction in scar appearance can be achieved. Subcision is a safe method for patients seeking natural and lasting improvement.

What Is Subcision?

Subcision is a surgical procedure used especially in the treatment of acne scars and skin depressions, based on cutting the fibrotic bands under the skin with a special needle. In this way, the skin underneath is released, the surface becomes flatter, and collagen production is triggered. More effective results are generally achieved when it is combined with other treatment methods. It is performed with local anesthesia and the recovery period is short.

How is subcision performed?

Think of it this way: that depressed scar on your skin is as if it is being pulled downward toward the deeper tissues under your skin by an invisible band. These bands are hardened, scarred connective tissues (medically called fibrous bands) formed while the old acne lesion or wound was healing. No matter how much you try to smooth the skin surface with creams or lasers, as long as this “anchor” underneath keeps pulling the skin downward, that depression will not improve.

This is exactly what subcision targets. The procedure has two main goals:

The first is immediate mechanical release. Through an entry point just under the skin, the special instruments physically cut or release these firm bands that pull the skin downward. As soon as the skin is freed from this pulling force, the depression rises to some extent immediately.

The second part, which provides the real long-term effect, is the biological repair process. This controlled and targeted intervention under the skin creates a small wound area there. The body immediately sends an “emergency signal” to repair this area and directs repair cells (fibroblasts) to the region.

These cells begin to produce intensive amounts of new collagen and elastin (the basic building blocks of the skin) in that area. This newly formed, fresh, healthy connective tissue fills the space under the released scar, providing a natural “filler” and “support” to the skin. In this way, the skin surface is permanently elevated and the overall skin quality improves.

Which types of scars are suitable for subcision treatment?

Subcision is not a magic wand for every depressed scar. Its success depends on applying it to the correct scar type. Basically, it is effective in conditions where the skin is adhered to the underlying tissues.

The conditions where we get the best results and use it most frequently are:

• Rolling scars (broad-based, undulating scars)
• Boxcar scars (box-shaped scars with an adherent base)
• Some deep chickenpox scars
• Depressed scars formed after trauma or surgery
• Bands that cause the appearance of cellulite
• Some deep facial wrinkles (for example smile lines)

Especially ‘rolling’ scars, which do not have sharp edges and appear more like broad, wavy depressions, are ideal candidates for subcision. This is because the main problem in these scars is already the adhesions underneath them. In ‘boxcar’ scars, which have sharper edges, if their bases are tethered deeply, subcision can be a fundamental treatment step. However, for very deep and narrow scars called ‘ice pick’ scars, it is generally not sufficient on its own and usually needs to be combined with other treatments.

Who is not suitable for subcision treatment?

For this treatment to be safe and effective, in some situations it should not be performed or should be postponed. Each patient’s condition is evaluated in detail.

In general, the situations in which we prefer not to perform or postpone subcision are as follows:

• People with active blood clotting disorders (such as hemophilia)
• People who use high-dose blood thinners (such as aspirin, warfarin) in an uncontrolled way
• People with active infection in the treatment area (such as herpes, impetigo, or inflamed active acne)
• People who have used systemic isotretinoin (Roaccutane and similar drugs) within the last 6–12 months
• People prone to keloid or hypertrophic scar formation
• People with systemic diseases that seriously impair wound healing, such as uncontrolled diabetes
• People with severely suppressed immune systems
• Pregnant women and breastfeeding mothers (these periods are generally expected to end first)
• People with unrealistic expectations from the treatment

Especially isotretinoin use and keloid tendency are very important. Isotretinoin temporarily changes the skin’s wound healing mechanism. Subcision, on the other hand, owes its success entirely to healthy wound healing. For this reason, it is essential to wait for a certain period after stopping the drug (generally 6–12 months). In people with a tendency to keloid formation, subcision, which is a controlled wound-opening procedure, may trigger the formation of a new raised scar instead of correcting the depressed scar. Therefore, this patient group should be approached with extreme caution or different methods should be preferred.

How should one prepare for subcision treatment?

When the day of the procedure arrives, there is a preparation stage that is at least as important as the procedure itself. We call this “scar mapping.” This is not an ordinary examination.

The room lighting is specially adjusted and “tangential light” (light hitting from the side) is directed onto the skin. This special illumination exaggerates the shadows of even the slightest depressions that might otherwise go unnoticed. At that very moment, all depressed areas and the borders of the adhesions are marked one by one on the skin with a special pen.

This marking must be done before the next step, which is anesthesia. Because the anesthetic fluid we are about to mention temporarily “camouflages” these depressions by swelling the tissue. This “map” in our hands shows us which points need to be treated even after anesthesia and serves as a guide that directly affects the success of the treatment.

Is pain felt during the subcision procedure?

This is the question patients are most curious about. The answer is: No.

• Modern subcision applications are performed with a highly effective local anesthesia technique called “tumescent anesthesia.” This technique not only numbs the area but also revolutionarily increases the safety and comfort of the procedure.
• Tumescent anesthesia is the administration of a special serum fluid containing diluted local anesthetic (such as lidocaine) and adrenaline (epinephrine) under the skin throughout the entire treatment area.

This fluid has three main functions:

• Completely blocking pain (Anesthesia)
• Stopping bleeding by constricting blood vessels (Hemostasis)
• Separating skin layers by inflating them with fluid (Hydrodissection)

Especially the last two items are very critical. The adrenaline in the fluid immediately constricts the capillaries in the area. In this way, there is almost no bleeding during the procedure. This also means that there will be much less bruising afterward.

“Hydrodissection” is a safety shield. The high-volume fluid swells the underside of the skin like a “water cushion,” safely distancing the area we work on from important deeper nerve and vascular structures. After this fluid is administered, a period of waiting is required for the effect to settle, and then the procedure begins. The patient does not feel any pain or discomfort during this time.

Which instruments are used in subcision treatment?

The success and safety of subcision are directly related to the technology of the instrument used.

In the past, this procedure was performed with very sharp needles (for example the ‘Nokor’ needle). Although these needles were effective in cutting firm bands, because we do not advance “visually” under the skin, they carried a risk: they could also cut healthy vascular or nerve tissue in their path without distinguishing them. This increased the risk of more bruising, nerve injury, or post-procedure hard lump formation (nodules).

Today, in modern dermatology, we prefer special instruments called “blunt-tip cannulas” (non-sharp, rounded tips). The logic of these cannulas is much safer.

As the cannula advances under the skin, it does not “catch” flexible and healthy vessels and nerves; it gently pushes them aside. However, it “catches” the firm and inelastic fibrous bands that are our target and breaks or separates these bands with the controlled force we apply.

In short, blunt cannulas intervene only on the target tissue while protecting healthy tissues. This is a “gold standard” approach that statistically significantly reduces the risk of complications after the procedure (especially hematoma and nodule formation).

How effective is subcision treatment and what should I expect?

The effectiveness of subcision has been proven especially in the correct scar type, namely ‘rolling’ scars.

Managing expectations correctly is very important: this is not an “erasing” procedure, it is an “improving” and “correcting” procedure. The goal is to reduce the depth of the depressions, minimize the shadowing created under light, and provide the skin with a smoother contour.

Clinical studies show that subcision is very successful in reducing the grade of scars (for example from ‘severe’ to ‘moderate’). This structural correction directly affects the patient’s confidence in social life.

Often even a single session provides noticeable improvement, but in very deep and old scars, more than one session planned at intervals of 3–6 months is generally required to achieve the best result. Patient satisfaction rates are usually high, especially when used with combination treatments.

Why should subcision treatment be combined with other methods?

The best aesthetic results are generally achieved not with a single method but with intelligently planned combinations. In depressed scars, the problem is usually multilayered. Subcision solves the “foundation” of this problem, meaning it eliminates the “adhesion” that pulls the skin downward.

However, in most scars, there are other problems in addition to tethering. These include:

• Volume loss (loss of tissue under the scar)
• Surface texture irregularity (roughness of the upper skin layer)
• General weakness in skin quality (lack of collagen)
• Color irregularities (redness or pigmentation)

Once subcision corrects this “foundation,” other treatments become much more effective. After elevating the skin, performing laser treatment for surface irregularities or applying filler to restore lost volume perfects the treatment outcome.

What benefit does combining subcision and PRP treatment provide?

PRP (Platelet-Rich Plasma) is a fluid obtained from the person’s own blood that is extremely rich in repair cells and growth factors.

Let us remember that the second stage of subcision is “biological repair” (that is, new collagen production). When we inject PRP into that space in the same session immediately after releasing the area under the skin with subcision, we virtually “boost” the body’s natural repair process.

These concentrated growth factors delivered to the region trigger much stronger and faster collagen production than normal, increase blood supply to the area, and accelerate healing. Clinical studies clearly show that using subcision together with PRP provides much better improvement than subcision alone.

Why are subcision and filler applications preferred together?

Dermal fillers (generally hyaluronic acid-based) have two invaluable roles when used together with subcision:

First, if the scar has a significant “volume loss” in addition to tethering, filler application after subcision instantly restores this volume and immediately fills the depression.

Second, and perhaps even more importantly, the filler material acts as a “scaffold.” The filler that enters between the skin base we separated with subcision and the underlying tissue physically prevents these two surfaces from “re-adhering” to each other during healing. It keeps the area open and supported until new collagen tissue forms, which increases the permanence of the treatment.

How do subcision and laser treatments create synergy?

This is one of our favorite and most effective combinations. In summary: subcision addresses the problem from the “deep” side (the foundation), while laser (for example Fractional CO2) addresses the problem from the “surface” side.

If you apply laser directly to a depressed scar, you need to use very high energy for the laser beam to affect the very bottom of the depression. This increases the risk of damaging healthy skin.

However, if we first “lift” that depression with subcision and bring the skin to a flatter contour, laser treatment can then be applied to a much more homogeneous surface. In this way, with safer laser doses, we can renew both the skin’s surface texture (roughness, pores) and collagen quality much more effectively. The combination of these two treatments multiplies the results.

What are the risks or side effects of subcision treatment?

When performed with the correct technique (tumescent anesthesia and blunt cannula) by experienced hands, subcision is an extremely safe procedure. However, like any medical intervention, it has some expected effects and, although rarely, some risks:

The following are part of the natural healing process that we expect to see after the procedure:

• Temporary edema (swelling)
• Redness
• Mild tenderness in the area
• Bruising (ecchymosis)

These effects generally decrease on their own within a few days. Bruising (ecchymosis) is the most common side effect, but thanks to tumescent anesthesia and blunt cannula use, it is not as severe as before and disappears completely within 1–2 weeks.

Rare but manageable complications include:

• Hematoma (accumulation of blood clot)
• Subcutaneous nodules (hard lumps under the skin)
• Infection (very rare)
• Pigment changes (post-inflammatory pigmentation)
• Temporary nerve injury (very rare, usually associated with sharp instruments)

Hematoma and nodule formation are more common especially when sharp needles are used; a blunt cannula minimizes this risk. Small nodules that form generally resolve spontaneously over time. The risk of infection is almost negligible when the procedure is performed under sterile conditions. The risk of pigmentation (PIH) can be almost completely prevented with sun protection, which will be mentioned in the next section.

What should be considered after subcision treatment?

After the procedure is completed, there are some “golden rules” that the patient must follow in order to make the treatment success permanent and prevent risks. The most important points to consider during the healing period are:

• Strict sun protection (the most important rule)
• Keeping the area clean
• Avoiding intense exercise for the first 24–48 hours
• Using compression bandages recommended by the doctor (if necessary)
• Protecting the area from trauma (scratching, rubbing)
• Avoiding alcohol and smoking for at least a few days
• Avoiding hot baths or saunas for the first 24 hours

The most critical item on this list is protection from the sun. Exposing treated and especially bruised skin to the sun (or tanning beds) can lead to what we call “post-inflammatory hyperpigmentation” (PIH), meaning permanent brown discoloration in that area. This is a serious complication that overshadows the success of the treatment. For this reason, it is essential to use a high-factor, broad-spectrum, high-quality sunscreen until the area is completely healed (and in fact always).