Subcision: Indications, adverse reactions, and pearls

Abstract

Background: Subcision, also known as subcutaneous incisionless surgery, is a surgical intervention used to treat a variety of skin conditions including atrophic acne scars, depressed scars, cellulite, and wrinkles. Aims:We plan to prepare a review article about the indications of subcision, its adverse reactions, and pearls. Patients/Methods: We searched the literature for the information about subcision and its applications from papers published up to March 2019. The search was performed through the databases of the National Library of Medicine. Results: After a thorough review of the published papers about subcision, we finally chose to review 40 articles that had proper sample size and design to prepare this review article. Twenty-one papers were related to the application of subcision in the treatment of acne scar and other scars. Four articles were about the application of subcision to treat cellulite, and eight articles were related to other applications of subcision such as the treatment of striae or nasolabial fold. The remaining seven articles include published review papers about subcision or acne scar classification. Conclusion: Subcision seems to be effective on various skin conditions including acne scar, other depressed scars, and cellulite. It is easy to apply and inexpensive with short downtime and no significant complications. Subcision needs proper technique and adequate experience. K E Y W O R D S acne scar, cellulite, scar, subcision, wrinkle

A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring

“…Not surprisingly, the majority of studies revolving around subcision done in isolation or in combination with other therapies have noted considerable risks, such as hematoma formation, ecchymosis, erythema, and hyperpigmentation. 54 Due to the nature of the procedure and the surgical tools involved, subcision always runs the risk of damaging neurovascular structures that can cause the aforementioned side effects. 45 Taylor et al, for instance, recently developed a novel surgical instrument consisting of a long metal rod with a “W-shaped” blunt end.…”

Prospective and randomized comparative study of calcium hydroxylapatite vs calcium hydroxylapatite plus HIFU in treatment of moderate‐to‐severe acne scars

“…The former includes anti‐acne agents, 11,12 chemical peels, 13 microneedling, 14‐17 and ablative 18 and nonablative fractional 19‐22 and nonfractional 23 lasers, as well as autologous growth factors 24‐27 . The latter include subcision, 28‐30 autologous cell regeneration, 31 and autologous adipose‐derived stem cells 32 …”

The Importance of Facial Retaining Ligaments’ Preservation During the Subcision

“…A Nokor needle is generally inserted into the deep dermis, whereas a blunted-tip blade cannot penetrate the dermis and is usually entered into the dermosubcutaneous junction. 2 A blunted-tip blade seems to be a safer option due to the reduced possibility of unintended shifting to too superficial or too deep levels of the skin. 3 …”

“…Long blades and a single entry point have been recommended by some authors. 2 However, in severe cases the use of multiple insertion points and shorter blades is preferable because there is less risk of ligament rupture when the blade movement is limited to 1 or a few facial cosmetic units.…”

“…There are some concerns about vascular and neural injury in this procedure, particularly in the temporal, marginal mandibular, and periauricular regions. 2 Based on the fact that the main vascular and neural trunks are located beneath the superficial muscular aponeurotic system except in the central part of the face, 4 performing the subcision at the proper depth prevents major vascular and neural injury in this procedure.…”