Dr. Sam Lam Plastic Surgery Forum

I apologize if you've discussed this subject here in the past, but I was interested to know your thoughts on subcision (with or without saline injected at the same time) to treat depressed, rolling acne scars. Do you ever perform this procedure, and have you seen any significant results (or any beneficial result at all) with acne scars from this procedure?

i find that it does not work well and that it is not necessary with the two major methods that i use to help acne scarring: silicone and CROSS.
best,
sml

With regards to the issue of subcision. Do you sometimes perform right before silicone injections? If for example a depressed rolling type scar seems to be bound down - how would the silicone go where it needs to go? Would the silicone simply go around the bound down tissue and donut? Or maybe the silicone almost has a tissue expander effect and there is really no need for subcision?

not only is there no need to do subcision with silicone as mentioned in my opinion but it is very DANGEROUS to do it right before silicone. my silicone is placed as microdroplets. it would coalesce into a lump if you subcised first. i believe that the silicone goes into micro scars since it is placed as punctate injections so donuting should not occur as far as i have seen.
best,
sml

Thank you very much for the response. Do you believe there is any danger to doing subcision a few weeks or even days (as opposed to the same day/right before) before having a filler (such as silicone) injected for acne scars?

i believe it is dangerous doing a subcision anytime less than a month before silicone. however, that is not the case with restylane. sometimes, it can help restylane but it will hurt silicone if done shortly before silicone injections for the aforementioned reasons IMHO.
best,
sml

dr. lam wrote:i find that it does not work well and that it is not necessary with the two major methods that i use to help acne scarring: silicone and CROSS.
best,
sml

Hi Dr. Lam,

I apologize for bumping an old thread, but I have a few follow-up questions on the topic of subcision. What is it about subcision that keeps it from "working well" in your opinion? Is it because multiple sessions of subcision would be needed to match the effectiveness of your other methods? And would it be a viable option for someone with scars that are too shallow for silicone droplets and skin too dark for CROSS? Thank you for your help.

What is it about subcision that keeps it from "working well" in your opinion? THE DERMIS IS SCARRED AND THE COLLAGEN IS WARPED WITH A HOLE UNDER IT SO JUST RELEASING A SCAR WITHOUT FILLING THE HOLE TO LIFT THE SCARRED DERMIS UPWARD IS OFTENTIMES INSUFFICIENT. Is it because multiple sessions of subcision would be needed to match the effectiveness of your other methods? NO, YOU CAN ONLY CREATE SO MUCH COLLAGEN REMODELING WITH SUBCISION. REMEMBER, YOU ARE NOT FILLING THE HOLE BUT TRYING TO RELEASE A SCAR. IT MIGHT NOT BE A TETHERED SCAR BUT JUST A BUCKLED DERMIS AND A HOLE UNDERNEATH IT. And would it be a viable option for someone with scars that are too shallow for silicone droplets and skin too dark for CROSS? SURE, IT IS AN EASY PRETTY SAFE METHOD TO START WITH. Thank you for your help.