A minor dermatological surgical procedure to release tethering of skin from deeper tissue. Treatments start from S$450 per area.
Subcision is performed when skin is tethered to deeper subcutaneous tissues and can improve the appearance of tethered atrophic scars (from acne, chickenpox and so on) as well as cellulite.
Tethering of skin to deeper structures basically results in the anchoring of the upper layers of skin; it is unable to stretch freely and depression is seen. Lasering such scars will improve the texture of the skin but will not improve the dimple caused by the tethering.
This is seen in acne scars from deep-seated and severe forms of acne, or in cellulite.
The best option in such circumstances would involve surgical subcision of these anchoring scar tissue, allowing the upper layer of skin to stretch free from these anchors.
This is performed using either needles or blunt tip cannulas. The needle/cannula is introduced under the skin and moved back and forth or from side to side to cut these retaining bands of scar tissue.
Immediate lifting and improvement of the dimple are seen after the procedure.
The number of sessions of subcision will depend on the method of treatment.
Patients undergoing purely subcision might require 1 to 3 sessions – scars freed from underlying tissue can potentially re adheres and require a repeat procedure 6 to 8 weeks later.
As such, it is recommended that patients combine subcision procedures with immediate filler placement (Hyaluronic Acid, Rejuran S, or collagen stimulators like Radiesse) into the space created by the subcision. This prevents immediate adhesion of the skin, increases collagen stimulation, and reduces the need for repeat subcision later on.
Not all scars require subcision, but all atrophic scars have poor skin quality.
Lasers target and improve the quality of the upper layers of skin. So, while they do not free anchored scars, they improve the elasticity and quality of overlying skin.
As such, even those who are planning or have undergone subcision will still benefit from lasers to improve the overlying skin quality.
Patients with scars typically need a varying combination of treatments, and the decision on which to choose should be made after a careful clinical consult and examination.
The procedure is tolerable and usually involves initial numbing with numbing cream for 15 to 20 minutes over the sites of injection. For better pain control, a local anaesthetic is injected into the sites of treatment.
Depending on the size of area to be treated, the procedure can take between 10 to 30 minutes
Bruising is to be expected and can last between 7 to 12 days.
More bruising is common with a needle subcision than a cannula subcision, but the choice between the two is made during the clinical consult.
Subcision of scars results in the release of their anchoring and smoothening of the skin. The result is largely permanent as long as the re-anchoring does not happen during the healing period immediately after the procedure.
As such, to prevent such re-adhesion, combination of fillers are used. These fillers fill the space temporarily and allow healing of the tissue without re-adhesion of the skin to deeper structures. The filler is degraded by the body over time and collagen replaces the filler material, resulting in a permanently lifted scar.
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