Subcision

The following charts show the chances of developing various side effects from subcision.2-5 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Swelling immediately after procedure (postoperative edema)up to 100%
SHORT TERM Firm bumps underneath treated scarup to 100%
SHORT TERM Mild pain after procedure38.9 to 100%
SHORT TERM Swelling in the days after procedure27.8% to 100%
SHORT TERM Bruising10% to 100%
SHORT TERM Redness (erythema)2.9% to 100%
SHORT TERM Bleedingincidence not known

Possible/Rare Side Effects

SHORT TERM Skin discoloration due to bleeding under the skin (ecchymoses)up to 16.7%
SHORT TERM or LONG TERM Burning/stinging sensation*up to 100%
SHORT TERM Severe facial swellingup to 5.9%
SHORT TERM Infectionup to 100%
SHORT TERM Increase of acne lesionsincidence not known
SHORT TERM or LONG TERM Excessive formation of skin (hypertrophia)incidence not known
SHORT TERM or LONG TERM Formation of fibrous tissue leading to a bump under the skin (subcutaneous nodule)incidence not known
SHORT TERM or LONG TERM Cysts from disruption of skin oil gland and nearby structures (pilo-sebaceous unit)incidence not known
LONG TERM Additional scar or worsening of scarincidence not known
SHORT TERM or LONG TERM Darkening of scar (hyperpigmentation)*incidence not known

*The risk of hyperpigmentation is smaller with subcision compared to scar treatments such as laser and chemical peels. This is particularly important for people with darker skin, who are at greater risk than light-skinned people for developing hyperpigmentation.

Studies:   

Seven studies have looked at the side effects of subcision.

  • Study 1:

    • Authors: Alam et al.6
    • Total # of patients: 40
    • # of female patients: 29
    • # of male patients: 11
    • Age of patients: Average: 39
    • Duration of treatment and follow-up: 1 session, follow-up at 1 month and 6 months
    • Side effects: Swelling, bruising, pain, slow postoperative recovery, firm bumps in treated area (frequencies not reported)
  • Study 2:

    • Authors: Balighi et al.7
    • Total # of patients: 20
    • # of female patients: 11
    • # of male patients: 9
    • Age of patients: Average: 28.2
    • Duration of treatment and follow-up: 1 session, follow-up at 1 month and 6 months
    • Side effects:

      • Swelling: 65%
      • Mild skin infection: 5%
      • Skin bruising: 10%
  • Study 3:

    • Authors: Vaishnani8
    • Total # of patients: 15
    • # of female patients: 9
    • # of male patients: 6
    • Age of patients: 20-25
    • Duration of treatment and follow-up: 1 session per scar with 3 sessions max, follow-up at 6 months
    • Side effects:

      • Postoperative edema (swelling): 100%
      • Persisting hematoma up to 4 months: 13.3%
  • Study 4:

    • Authors: Ramadan et al.9
    • Total # of patients: 20
    • # of female patients: 14
    • # of male patients: 6
    • Age of patients: Average: 27.6
    • Duration of treatment and follow-up: 1-3 sessions
    • Side effects: Erythema (redness): 10-25%
  • Study 5:

    • Authors: Sage et al.10
    • Total # of patients: 10
    • # of female patients: ?
    • # of male patients: ?
    • Age of patients: Average: 50
    • Duration of treatment and follow-up: 1 session with followup at 1 week, 3 months, and 6 months
    • Side effects: Bruising, pain, erythema (redness), swelling, discoloration, lumps (frequencies not reported)
  • Study 6:

    • Authors: Al-Dhalimi & Arnoos11
    • Total # of patients: 40
    • # of female patients: 19
    • # of male patients: 21
    • Age of patients: Average: 23.5
    • Duration of treatment and follow-up: 1 session with follow-up up to 6 months
    • Side effects:

      • Erythema: 100%
      • Bruising: 100%
      • Swelling: 100%
      • Mild pain: 100%
      • Firm bumps under scar area: 100%
      • Severe facial swelling: 5.9%
      • Erythema on lower eyelid: 2.94%
  • Study 7:

    • Authors: Balikbin et al.12
    • Total # of patients: 18
    • # of female patients: 7
    • # of male patients: 11
    • Age of patients: Average: 25
    • Duration of treatment and follow-up: 1 session with follow-up at 6 months
    • Side effects:

      • Pain/tenderness: 38.9%
      • Swelling: 27.8%
      • Ecchymoses (discoloration caused by bleeding under skin): 16.7%

Study 1: In a study published in 2005 in the journal Dermatologic Surgery, Alam and colleagues performed subcision on 40 patients with rolling acne scars and followed up with the patients 1 month and 6 months after treatment.6 The researchers noted that most side effects had disappeared after 1 month. On a scale of 1 to 10, the patients rated their side effects as follows:

Study 2: In a study published in 2008 in the Journal of the European Academy of Dermatology and Venereology, Balighi and colleagues performed subcision on one side of the face in 20 patients. Sixty percent of the patients experienced no side effects from subcision. After a month, all side effects had disappeared.7

Study 3: In a study published in 2008 in the Indian Journal of Dermatology, Venereology and Leprology, Vaishnani performed subcision on 15 patients. All patients experienced swelling and bruising which disappeared by 4 months after the treatment.8

Study 4: In a study published in 2011 in Dermatologic Surgery, Ramadan and colleagues treated 20 patients with subcision. Only two patients were still experiencing significant erythema (redness) at the time of follow-up.9

Study 5: A study published in 2011 in Dermatologic Surgery by Sage and colleagues treated 10 patients with subcision. The researchers did not observe any severe side effects.10

Study 6: A study published in 2012 in the Journal of Cosmetic Dermatology by Al-Dhalimi and Arnoos tested subcision on 40 patients. All patients experienced erythema (redness), swelling, mild pain, and bruising after the procedure. In most patients, these symptoms disappeared in 3-4 days. All patients also developed firm bumps underneath the scar, but after 12 weeks, all bumps had disappeared.11

Study 7: In a study published in 2017 in Dermatologic Surgery, Barikbin and colleagues performed subcision on 18 patients. Most of the patients experienced tenderness, swelling, and/or ecchymoses (discoloration due to bleeding under the skin), but these symptoms disappeared after 3 weeks.12

References
  1. Zaleski-Larsen LA, Fabi SG, McGraw T, and Taylor M. Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type. Dermatol Surg. 42 Suppl 2, S139-49 (2016).
  2. Rivera, AE. Acne scarring: a review and current treatment modalities. J Am Acad Dermatol 59, 659-676 (2008).
  3. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  4. Jacob CI, Dover JS, and Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 45(1), 109-17 (2001).
  5. Uptdate.com. Management of acne scars. Available from: https://www.uptodate.com/contents/management-of-acne-scars?source=search_result&search=subcision&selectedTitle=1~4. Last retrieved on 16 May, 2017.
  6. Alam M, Omura N, and Kaminer MS. Subcision for acne scarring: technique and outcomes in 40 patients. Dermatol Surg. 31(3), 310-7 (2005).
  7. Balighi K, Robati RM, Moslehi H, and Robati AM. Subcision in acne scar with and without subdermal implant: a clinical trial. J Eur Acad Dermatol Venereol. 22(6), 707-11 (2008).
  8. Vaishnani JB. Subcision in rolling acne scars with 24G needle. Indian J Dermatol Venereol Leprol. 74(6), 677-9 (2008).
  9. Ramadan SA1, El-Komy MH, Bassiouny DA, and El-Tobshy SA. Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars. Dermatol Surg. 37(5), 626-33 (2011).
  10. Sage RJ, Lopiccolo MC, Liu A, Mahmoud BH, Tierney EP, and Kouba DJ. Subcuticular incision versus naturally sourced porcine collagen filler for acne scars: a randomized split-face comparison. Dermatol Surg. 37(4), 426-31 (2011).
  11. Al-Dhalimi MA, and Arnoos AA. Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study. J Cosmet Dermatol. 11(2),144-50 (2012).
  12. Barikbin B1, Akbari Z, Yousefi M, Dowlati Y. Blunt Blade Subcision: An Evolution in the Treatment of Atrophic Acne Scars. Dermatol Surg.43 Suppl 1, S57-S63 (2017).