Subcision for Acne Scars: What It Is and Which Scars It Suits

Subcision is a procedure in which the doctor inserts a needle or a cannula beneath a depressed acne scar to cut the fibrous bands that pull the skin downward. Once those bands are released, the skin that was tethered lifts up, and the blood and lymph that fill the space left behind help stimulate new collagen. It mainly suits rolling scars. Results vary by individual.

What Is Subcision, and How Does It Work

Subcision (subcutaneous incisionless surgery) is a minor dermatologic procedure that uses a needle or a cannula inserted into the layer beneath the skin to “cut” the fibrotic strands that tether the base of an acne scar to the tissue below. The technique has been described since 1995 and remains a standard option for the tethered type of acne scar.

Two parts of the mechanism work at the same time. The first is the release of tension: once the bands are cut, skin that was held down rises back toward the level of the surrounding skin. The second is the body’s own repair process. Information from DermNet explains that releasing the bands, together with new collagen laid down during wound healing, is what improves the appearance of the scar, with the blood and lymph that fill the space acting as a temporary scaffold for connective tissue to grow in its place. This is where it differs from laser, which works on the surface and the upper dermis. As long as the tethering beneath the skin remains, stimulating collagen in the upper layers alone usually gives limited results.

Which Acne Scars Respond to Subcision

Rolling scars respond more clearly than the other types, because they are caused directly by fibrous bands pulling the skin down. Boxcar scars respond in part, and ice pick scars often respond poorly. If you are not sure which type your own scars are, the descriptions below set out how the three differ.

• Rolling — shallow scars with sloping edges that give the skin a wavy look. They are caused by fibrous bands beneath the skin pulling the surface downward, which matches the mechanism of Subcision directly. A review article in The Journal of Clinical and Aesthetic Dermatology reports improvement rated at roughly 50–60 percent by investigators and roughly 51 percent by the people treated.
• Boxcar — scars with steep walls and a flat base. The type that still “stretches out,” meaning it looks shallower when the skin on either side is pulled taut, is generally considered workable. The deep, sharp-edged type usually needs laser alongside it.
• Ice pick — deep, narrow scars resembling pinholes. DermNet states that these are not an indication for Subcision, because the problem is not fibrous tethering, so doctors tend to consider TCA Cross for this group instead.

One person usually has several types of scars mixed together, so the question is not “Subcision or not” but which technique suits which scars. If pulling the skin on either side makes a scar look clearly shallower, there is a tethering component. If it stays just as deep, releasing the bands alone is usually not enough.

What Happens During a Subcision Session

Subcision is performed in the clinic and needs no stitches, because the skin is not cut open; the needle puncture serves as the point of entry. A session generally takes about 30–60 minutes, depending on the number of scars and the size of the area.

1. Assessment and marking — the doctor examines the type and depth of the scars, then marks only those with a tethering component.
2. Cleansing the skin and applying anaesthetic — a local anaesthetic is injected, and in some cases a topical anaesthetic is applied first to reduce the sensation of the anaesthetic needle.
3. Inserting the needle or cannula beneath the skin — DermNet describes the original technique as using a roughly 18–20 gauge needle inserted at a sharp angle parallel to the skin, then moved in a fanning motion within the dermis to cut the fibrous strands. Many places now use a blunt-tipped cannula instead, which a review of the literature in NIH/PubMed Central reports gives higher satisfaction and fewer complications than a sharp needle.
4. Pressure to stop bleeding, a cold compress, and a follow-up appointment — to limit collected blood beneath the skin. The doctor then schedules a review to assess the result and to decide when to combine other procedures.

During the procedure, the common sensation is pressure or pulling beneath the skin rather than the pain of being cut.

How Long Is the Recovery After Subcision

Subcision has more visible downtime than the short-recovery lasers, because it works beneath the skin where the small blood vessels sit. Bruising is therefore something to expect rather than an abnormal complication. In general, bruising and tenderness ease within about a week, and many people go back to work within 1–2 days using make-up to cover the bruising. Here is what to prepare for.

• Bruising and swelling — common in roughly the first 3–7 days, and possibly longer when a large area is treated. A review of complications in the Journal of Cosmetic Dermatology (2025) found that sharp needles were reported to cause significantly more bruising than blunt-tipped instruments, and reported mild to moderate swelling in roughly 27.8 percent of the group treated with a blunt-tipped blade.
• Temporary bumps beneath the skin — some people can feel small lumps, which are collected blood or tissue in the middle of repairing itself. Reports indicate that these usually settle gradually over roughly 1–2 months. If a lump grows larger or becomes more painful, come back for the doctor to assess it.
• Dark marks or patchy pigment afterwards — both darkening and localized lightening have been reported, particularly in darker skin, which includes many Thai skin types. Consistent sun protection after the procedure therefore matters.

Actual recovery differs a great deal from person to person, so it is worth choosing a time when you have no important commitments in the week that follows.

How Many Subcision Sessions Are Needed, and How Far Apart

Subcision is generally not a procedure that finishes in a single round, because both releasing the bands and building new collagen take time, and in many cases the fibrous bands sit in several layers, more than can be addressed at once without adding to the risk of bruising. In practice, cases with fewer scars usually fall in the range of roughly 1–3 sessions, while wide or deep scars can take more than that. DermNet states that most people with moderate acne scarring use around 3–6 treatments, spaced at least about a month apart, which matches the commonly used interval of roughly 4–6 weeks per session. That interval exists so that bruising can resolve and enough new collagen can form for the result to be assessed before the next round. Reviews of the literature also found that satisfaction scores in some studies declined somewhat over the 3–6 months after treatment, which is why doctors usually plan a course and follow up continuously.

Why Subcision Is Usually Combined With Other Methods

Because Subcision addresses only the layer where fibrous bands are the cause, while real acne scars usually have several components at once: tethering bands, uneven surface texture, deep scar openings, and lost volume beneath the skin. Reviews of the literature in NIH/PubMed Central therefore report consistently that combining it with other methods gives better results than using it alone. This is in line with the American Academy of Dermatology, which states that dermatologists usually use more than one method to address acne scars.

A frequently cited example is Subcision combined with hyaluronic acid filler, with reported improvement of roughly 94 percent compared with roughly 67 percent in the group treated with Subcision alone. Combining it with fractional CO2 laser and with Microneedling is also reported to add to the result consistently. These figures come from studies in different populations, so they are useful as an overall picture of the direction of the results, not as numbers to expect for everyone.

In cases where the scars relate to lost volume beneath the skin, the doctor may consider filler or a collagen-stimulating agent (biostimulator) alongside, to support skin that has just been released. You can see an overview of the approach at acne care programs.

How to Care for Your Skin After Subcision

The aim of aftercare is to help bruising ease faster and to prevent dark marks from following. Here is the guidance doctors usually give.

• Use a cold compress in the early period — this helps reduce swelling and limits the spread of blood collecting beneath the skin. In some cases the doctor may switch you to a warm compress later to help the bruising clear faster.
• Avoid alcohol and medicines that affect blood clotting — such as blood thinners, fish oil, or high-dose vitamin E, as instructed by your doctor. Do not stop your regular medication on your own without consulting the doctor who prescribed it.
• Apply sun protection consistently — skin after a procedure is sensitive to light and prone to dark marks, so use a broad-spectrum sunscreen and avoid strong sun in the early period.
• Avoid massaging or rubbing the treated area, intense heat, and heavy exercise — during the first 1–2 days, because these increase blood flow and can make bruising worse.
• Watch for anything abnormal — if redness and swelling increase, pain increases, or you have a fever, pus, or a hard lump that does not settle, contact us so the doctor can assess it.

Who Is Not Yet Suited to Subcision

Subcision does not suit everyone. Some conditions call for postponing it or using another method instead. DermNet and the review of complications identify the groups that need careful consideration.

• People with a history of raised scars or keloids — their own or in the family, because they tend to form fibrous tissue more than usual. If the procedure is done, it is usually advised to limit the area and assess the response in the first round.
• People who still have inflammatory acne — the acne should be settled first, because performing a procedure on skin that is still inflamed adds to the risk of infection, and acne that is not under control will create new scars while the existing ones are being treated.
• People who bruise or bleed easily, or who take anticoagulants — always tell the doctor, because this affects the collection of blood beneath the skin.
• People who have recently taken oral vitamin A derivatives — DermNet gives a watch period of up to around 12 months after stopping the medication.
• People with a skin infection in the area to be treated, or who are pregnant or breastfeeding — the infection should be cleared first, and the appropriate timing should be discussed with the doctor.

Roughly How Much Does Subcision Cost

Market prices span such a wide range that no single middle figure applies to everyone. The factors that make costs differ include the size of the area that needs treatment, the number and depth of the scars, the instruments used, the number of sessions across the course, and any other methods combined with it. A more realistic approach is to have the doctor assess the type and extent of your scars first, then plan which approach to use and estimate the cost according to that plan. If you would like a doctor at Onnyx Clinic to assess your skin and advise on an acne scar approach suited to you, ask us and make an appointment via LINE: @onnyxclinic

What Results to Realistically Expect, and When to Consult a Doctor

Subcision helps acne scars “look shallower” rather than returning the skin to the way it was before the acne. A review article in The Journal of Clinical and Aesthetic Dermatology concludes clearly that no single method, and not even a combination of several methods, improves acne scars completely. What usually improves is the depth of the shadow that falls into the scar; skin that looked wavy under side lighting may look smoother, and some people find that make-up sits more easily because foundation settles into the grooves less. What usually does not change is enlarged pores, deep ice pick scars, and uneven skin tone, which are separate problems. Skin that is swollen in the first week can also make scars look temporarily shallower than they really are, so the result should be assessed at least one to two months later. What to understand is that acne scars cannot be removed completely; the aim is to make them look shallower. Results vary by individual.

This article describes Subcision as a general dermatologic technique. The approach that suits each person, and which procedures can actually be done, depend on the doctor’s assessment on the day of the consultation. Since most people have several types of scars mixed together, treating acne scars always has to start with assessing the type of scar. If you are unsure where to start, you can come in for an experienced doctor at Onnyx Clinic to assess your skin and create a plan suited to it. Message us with questions and to make an appointment via LINE: @onnyxclinic

References

• DermNet — Subcision
• NIH / PubMed Central — Subcision for Atrophic Acne Scarring: A Comprehensive Review
• Journal of Cosmetic Dermatology (2023) — Subcision in acne scarring: A review of clinical trials
• Journal of Cosmetic Dermatology (2025) / NIH PMC — Complications of Subcision for Acne Scarring: Experience From Clinical Practice and Review of the Literature
• The Journal of Clinical and Aesthetic Dermatology — Atrophic Acne Scarring: A Review of Treatment Options
• American Academy of Dermatology — Acne scars: Consultation and treatment

This content is for general information only and is not a diagnosis or individual medical advice. Results vary by individual. Please consult a doctor for an assessment suited to you.