Subcision is a minor procedure used for treating depressed and atrophic cutaneous scars. Scars occur as a result of disorganised healing following dermal destruction and can either be elevated (hypertrophic) or depressed (hypotrophic).
Acne scars are the most common type of scars that affect the general population. Acne scars can be deep and anchored by fibrotic bands, called ice pick scars. This variety is the hardest to treat and require subcision to be performed to release the fibrotic bands. Other types of acne scars, such as rolled or boxed scars, are shallow and wider, hence giving the skin a rippled, wave-like appearance.
Hypotrophic scars are best treated with subcision followed by either skin needling or sublative laser.
Meanwhile, hypertrophied scars are commonly caused by injury, post-operative or trauma and can be either keloidal or non-keloidal. Hypertrophied scars are best treated with intralesional steroids.
All types of scars need to be treated carefully as incorrect treatment may worsen the scar. A doctor will be able to make a clear distinction between hypertrophied and hypotrophied scars and determine the correct treatment modality.
Subcision is performed using a special hypodermic needle inserted through a puncture in the skin surface. The sharp edge of the needle is used to break fibrotic strands that are tethering the scar to the underlying tissue.
The release of the fibrotic strands and new collagen deposition caused by wound healing leads to cosmetic improvement of the scar. Subcision can be safely performed in the outpatient setting and is usually well tolerated. Topical anaesthesia may be applied for added comfort.
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