Subcision

Subcision is a minor in-office surgical procedure that releases depressed acne scars from the fibrous bands pulling them downward. A needle or cannula is passed under the skin to cut these tethers, allowing the scar to lift and triggering new collagen formation during healing. At TLC Skyn in Kollam, the procedure is performed after a detailed scar assessment so the approach matches the specific type of scarring present.

Acne scars in Kollam’s humid, sun-exposed climate often become more noticeable as skin ages and loses elasticity. Patients seek subcision when rolling or bound-down scars no longer improve with topical treatments, and when the depressions visibly flatten on stretching the surrounding skin. TLC Skyn takes a personalised approach: the clinic evaluates scar type, depth, skin tone, and any history of keloid formation before recommending subcision alone or in combination with other modalities.

What Subcision Treats and How It Works

Subcision, also called subcutaneous incisionless surgery, was coined by Orentreich and Orentreich in 1995. The principle is straightforward: fibrotic strands tether a depressed scar to the underlying subcutaneous tissue. Breaking those strands releases the depression, and the controlled micro-injury stimulates connective tissue formation during normal wound healing. Improvement therefore comes in two phases: an immediate lift from the release, and progressive smoothing over the following months as collagen remodels.

The best candidates have rolling scars, which are broad depressions with gentle sloping edges, or depressed distensible scars that disappear or improve when the skin is stretched. Boxcar scars with a tethered base may also respond, though they often need additional treatment. Subcision is not suitable for deep ice-pick scars, which are too narrow and deep and typically require TCA Cross, nor for flat macular scars that involve only colour change. Hypertrophic and keloid scars are a contraindication because subcision can worsen them.

A simple self-check helps determine candidacy: stretch the skin around the scar. If the depression lifts or flattens, the scar is tethered and likely to respond. If it remains unchanged, the depression is caused by volume loss rather than tethering, and fillers or other approaches may be more appropriate. Professional assessment matters because scar patterns are often mixed; most patients have more than one scar type on the same cheek or temple.

Treatment Options and Advantages

Treatment Options

TLC Skyn offers subcision using instruments selected according to scar extent and depth.

Needle subcision uses an 18-gauge or 20-gauge hypodermic needle, or a Nokor needle, which is a 1.5-inch, 18-gauge tri-beveled needle designed specifically for this purpose. The needle is inserted adjacent to the scar with the bevel upwards, parallel to the skin surface, into the deep dermis. It is then moved back and forth in a fan-like motion under the scar to sever the fibrotic bands. This approach suits localised or moderate tethering.

Cannula subcision uses a blunt cannula inserted through a single entry point. The blunt tip reduces bruising and carries a lower risk of nerve injury compared to sharp needles. This technique is preferred by many dermatologists for broader areas or when multiple scars are treated in one session.

Tumescent anaesthesia is used for more extensive subcision, including when a Taylor Liberator is employed. A large volume of dilute lidocaine with adrenaline is injected into the subcutaneous layer. The fluid separates tissue planes, reduces bleeding, and provides prolonged anaesthesia during the procedure. The Taylor Liberator allows more thorough release of fibrotic bands over larger areas and is reserved for severe or widespread tethering.

Treatment Advantages

Subcision offers several meaningful benefits for the right patient:

• It directly addresses the mechanical cause of rolling scars, which lasers and surface treatments cannot reach.
• It is safe for all skin types, including darker skin, where some laser treatments carry pigment risk.
• Downtime is limited; bruising and swelling typically resolve within 7 to 10 days.
• It combines well with other treatments such as fractional laser, TCA Cross, microneedling, and dermal fillers.
• Results are cumulative; each session builds on the previous release and collagen response.
• The procedure is performed in-clinic under local anaesthesia, with no general anaesthetic required.

Frequently Asked Questions