Subcision

What is Subcision?

Subcision is a minor surgical procedure used for treating depressed cutaneous scars and wrinkles. It is also called subcutaneous incisional surgery.

Subcision is performed using a special hypodermic needle inserted through a puncture in the skin surface. The sharp edge of the needle is used to break fibrotic strands that are tethering the scar to the underlying tissue.

What does Subcision Work?

The release of the fibrotic strands and new collagen deposition caused by wound healing leads to cosmetic improvement of the scar. Subcision can be safely performed in the outpatient setting and is usually well tolerated.

See great results

Before

After

Disclaimer: Results and patient experience may vary. These are dependenton a number of factors such as age, medical history and lifestyle.

Arrange to speak to one of our experts

What Are The Indications of Subcision?

Subcision may be used for the treatment of:

• Depressed distensile scars (due to acne, trauma, surgery )
• Depressed bound down scars (due to acne*, varicella(chickenpox), trauma, surgery)
• Depressed skin grafts
• Wrinkles
• Cellulite dimples

*excluding deep ice-pick scars

What Are The Contraindications to Subcision?

Subcision may not be suitable in the following circumstances:

• Patients with a history of hypertrophic or keloid scars
• Current or recent (within 12 months) systemic oral retinoid (eg acitretin, isotretinoin)
• Bleeding or blood clotting disorders (coagulopathy)
• Active bacterial or viral infection

How is Subcision Performed?

The procedure of subcision is described below:

1. The area to be treated is cleansed to remove dirt and make-up
2. The scar margins may be defined with a surgical marker, adjusting overhead lighting to delineate depressions
3. Local anaesthetic is infiltrated
4. A tri-bevelled needle (number 18 or 20 gauge) or a Nokor needle (fig.3) is inserted at an acute angle adjacent to the scar with the bevel upwards and parallel to the skin surface. Smaller gauge needles (25–27) may be used for small superficial scars and wrinkles
5. The needle is advanced through the dermis and moved back and forth in a fan-like motion. A snapping sound is heard as fibrous bands are transacted in the deep dermis and deep dermal subcutaneous plane*
6. The needle is rotated 90 degrees and moved again in a fan-like motion through the dermal scar (fanning subcision)
7. The needle is removed and squeezed circumferentially around the exit point to prevent large haematoma formation due to bleeding
8. Manual pressure is applied to the wound for several minutes.

*A common pitfall is to fan too deeply in a plane below the dermis

What Happens After the Procedure?

Immediately after subcision:

• Pressure and ice are applied to the operated site to maintain haemostasis and reduce the risk of bleeding.
• Make-up may be applied to camouflage bruised areas.
• Some authors recommend antibiotics and anti-inflammatory

The number and intensity of subcisions should be limited during the first treatment to review the patient’s response, particularly when treating areas with a predilection for a hypertrophic reaction after subcision.

How Many Treatments Are Required?

Individuals vary in their ability to form collagen (scar tissue). The number of subcisions required to correct a depression will depend on the type, location, severity of depression, and intensity of treatment.

Three to six visits suffice for the majority of cases of moderate scarring. Intervals of at least one month in-between treatments are generally recommended.

What Are The Complications of Subcision?

The risks and complications of subcision include:

• Haematomadue to bleeding (a small haematoma is normal)
• Pain/tenderness of treated sites
• Hypertrophic scars (5–10%) or keloid scars, which are most likely in periorbital skin, glabella, labial commissure and upper lip
• Infection; this usually presents as localised acneform papule or pustule
• Temporary post-inflammatory hyperpigmentation (advise sun protection/avoidance)
• Sub-optimal response or lack of improvement in scarring
• Injury to nerve or blood vessel, which is most likely in mandibular, temporal and pre-auricular sites

Treatments Combined With Subcision

Subcision as an acne scar treatment can be effectively combined with:

• Topical retinoids
• Microneedling- Dermaroller, Dermapen, which may be safely performed > 1 day after subcision
• Acid peels, eg 15% trichloracetic acid applied every 4 weeks
• TCA CROSS
• Dermal fillers
• Skin Boosters

Why choose Medikas?

 

• Our professional team work closely together to ensure our customers receive the highest quality care and customer service
• We provide a comprehensive range of services and solutions to promote good skin health and treat the signs of ageing
• We believe that through natural enhancement we can make our customers look and feel their best
• We treat our customers with respect and discretion so that they feel safe in our care
• We are highly trained experts and innovators within the aesthetic field dedicated to the safety and care of our patients
• We believe in a duty of care to ensure our patients make informed choices via our trusted advice

SaveSave

*Disclaimer: Results and patient experience may vary. These are dependent on a number of factors such as age, medical history and lifestyle.

Meet the Staff

Dr Beatriz Molina Dr Beatriz Molina is the founder and medical director of Medikas Ltd. She is a fellow of the British College of Aesthetic Medicine and a Key Opinion Leader for Galderma Global, teaching and lecturing around the world. Originally from Spain, Beatriz came to England on a surgical rotation during her medical training and worked at Frenchay Hospital in Bristol. She then went on to become a GP for ten years during which time she developed an interest in cosmetic surgery. She undertook extensive training in many treatments and procedures in the aesthetics spectrum and in 2005 set up her first clinic in Somerset offering high quality, medically- backed cosmetic procedures. Beatriz believes cosmetic surgery can help with issues around depression, can increase confidence and it’s that aspect of her work which she finds the most satisfying.

Millie Millie Simcox is a qualified beauty therapist who has worked at Medikas since 2011. Millie works in both the Bristol and Street clinics. She became a beauty therapist in 2010 and has since trained in advanced treatments in laser, chemical peels, skin tightening and body contouring.

Cassie Cassie is a fully qualified beauty therapist with a wide range of experience gained over the last 3 years. It feels great as a therapist to see a result as this makes her feel that she has made a difference and made a client much happier. She has got a special interest in lasers. She also loves our pro facial facial rejuvenation treatment. She is very fun loving and loves the outdoors making her like an adventure.

Julie Julie has been a qualified Beauty therapist since 2009. She join our Medikas team in 2016. She enjoys performing all the advance aesthetic treatments, particularly cryolipolysis. She is based at our Bristol Clinic.

Michelle Michelle has been a therapist since 2005 and started working in our Street clinic in 2010. She’s based at the Somerset clinic and specialises in skincare, laser treatments, chemical peels and skin tightening. She sees herself as part of a company with family ethics providing the safest most effective treatment while making customers feel at home.

Vicky Vicky has been a fully qualified Beauty Therapist since 2007. She recently moved to Dorset, having gained a wide range of experience working in Surrey. This included advanced treatments such as laser hair removal and skin rejuvenation. She is especially passionate about performing facial and skin care treatments. She takes great satisfaction in getting results and making people feel good about themselves. Vicky joined the team at the Street clinic in 2017.

Ellisha Ellisha has been working in the Beauty industry for over 10 years, starting her my career on the cruise ships where she performed holistic body and face therapies as well as skin tightening. From there Ellisha went to work in her first clinic, developing onto aesthetic treatments, where she discovered a passion for advanced skin care, facial techniques and various lasering. Ellisha then progressed onto Senior Practitioner, assisting doctors with minor Operations and overseeing client care. Ellisha's vast knowledge of ingredients, skin anatomy and physiology and treatment recommendations, along with her enthusiasm towards the ever evolving industry, allows her to deliver the best and personalised results to each, and every client.