A combined approach of subcision with either cross‐linked hyaluronic acid or threads in the treatment of atrophic acne scars

Abstract

Acne scars are a very common cutaneous problem dermatologists face in daily practice. Early treatment of acne vulgaris can minimize the incidence of scarring. 1,2 It was demonstrated that acne scars can be resulting from the interplay of multiple factors, including inflammation, degradation of the extracellular matrix, and abnormal granulation tissue formation. [3][4][5] Treatment of acne scarring continuously represents an innovative area for research. Subcision is one of the most common techniques that can give good results in atrophic acne scarring either alone or in combination with other modalities.Subcision is a minimally invasive procedure in which a tribeveled hypodermic needle entered under the scarred tissues to cut the fibrous band. It is usually used in rolling types of scars. Subcision improve the scars by lifting up the scarred tissues attached deep to the dermis. [6][7][8][9] Polyl-lactic acid (PLLA) mono threads are newer threads that can last longer and generate more collagen than the other types. These threads developed after the polydioxanone types are made from the same ingredients that are found in the absorbable stitches. They are effective in improving wrinkles, reduce the sagging, pores size, and induce lifting. The threads act as foreign material creating microinjuries that trigger body cells to induce new collagen formation. ,10

Asplit‐face, blind, randomized placebo‐controlled clinical trial investigating the efficacy and safety of hyaluronic acid filler for the correction of atrophic facial scars

“…Our study showed that HA filler was superior to saline, therefore based on this previously mentioned study, it can be inferred that is likely superior to subcision. A more recent study showed subcision with HA filler was superior to subcision with threads or subcision alone (improvements in 94.1%, 82.4%, and 67.3% of patients, respectively) 48 . In our study, HA filler alone yielded a similar result in patient‐rated improvement (93%) as the subcision with HA filler arm of that study 48 signifying that subcision may not be necessary.…”

“…A more recent study showed subcision with HA filler was superior to subcision with threads or subcision alone (improvements in 94.1%, 82.4%, and 67.3% of patients, respectively) 48 . In our study, HA filler alone yielded a similar result in patient‐rated improvement (93%) as the subcision with HA filler arm of that study 48 signifying that subcision may not be necessary. Therefore, we believe HA filler should be used as a first‐line stand‐alone treatment for distensible atrophic rolling scars.…”

Triple steps acne scar revision technique: A new combination therapeutic modality for atrophic acne scars

“…Our findings outperformed those of a previous study that used microfat after subcision to treat severe atrophic acne scars and avert the reconnection of fibrous bonds 43 . Furthermore, using hybrid H‐HA/L‐HA after subcision produced better results than using HA or threads after subcision, and with fewer sessions 44 . In severe atrophic acne scarring, TSASRT outperforms platelet‐rich plasma as an adjunctive therapy to a combined subcision and needling treatment 45 .…”

“…In severe atrophic acne scarring, TSASRT outperforms platelet‐rich plasma as an adjunctive therapy to a combined subcision and needling treatment 45 . When compared to other studies, this study yielded excellent results, fewer sessions, a simple technique, and higher patient satisfaction 43–45 …”

Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review

“…Forty men and women took part in this study based on 3 sessions conducted at 1-month intervals. Subcision combined with hyaluronic acid or threads gave better clinical improvement than subcision alone [ 63 ].…”