What Is Subcision?

Subcision—short for subcutaneous incisionless surgery—is a procedure used primarily to treat depressed or indented scars.

Certain acne scars are attached to deeper tissue by fibrous scar bands. These bands act almost like tiny anchors beneath the skin, pulling the surface downward and creating an indentation.

During subcision, a specialized needle or cannula is carefully passed underneath the scar to mechanically release these fibrous attachments.

Once the tethering is released, the skin has an opportunity to elevate. The controlled healing response created by the procedure may also stimulate new connective tissue and collagen formation in the treated area.

Why Do Some Acne Scars Need Subcision?

This is one of the most important concepts in acne scar treatment.

Microneedling, RF microneedling, laser treatments, and chemical peels can improve many aspects of acne scarring, but they cannot always fully release a scar that is physically tethered to deeper tissue.

Imagine trying to lift a piece of fabric that has been stitched to the surface underneath it.

You can improve the fabric itself, but until you release that stitch, the indentation remains.

Subcision addresses that deeper attachment.

This is why patients sometimes undergo several resurfacing treatments and see substantial improvement overall—but still have several stubborn depressed scars.

Those remaining scars may require subcision rather than simply more resurfacing.

What Types of Acne Scars Respond Best to Subcision?

Subcision is particularly useful for certain atrophic or depressed acne scars.

Rolling Acne Scars

Rolling scars often create broad, shallow depressions and an uneven or wavy skin texture.

They are frequently associated with fibrous attachments beneath the skin and are among the acne scars most likely to benefit from subcision.

Tethered Depressed Scars

A scar that appears to be pulled downward or becomes less noticeable when the surrounding skin is stretched may have a tethered component.

Releasing that attachment can allow the scar to sit closer to the level of the surrounding skin.

Selected Boxcar Scars

Some boxcar scars have deeper attachments and may benefit from subcision as part of a combination treatment plan.

However, not every boxcar scar requires subcision.

Ice Pick Scars

Subcision is generally not the primary treatment for ice pick scars.

These narrow, deep scars often respond better to treatments specifically targeting their depth and structure, such as TCA CROSS, depending on the individual scar.

This is why identifying the type of acne scar is essential before beginning treatment.

How Does Subcision Work?

A small entry point is created near the treatment area after appropriate cleansing and anesthesia.

A specialized needle or cannula is then introduced beneath the depressed scar.

The instrument is carefully moved through the appropriate tissue plane to release the fibrous strands tethering the scar to deeper structures.

Once those attachments are released, the scar has greater freedom to elevate toward the surrounding skin.

The procedure also creates a controlled wound-healing response beneath the scar, which may contribute to collagen remodeling over time.

Subcision + Filler for Acne Scars

One of the most useful combinations for selected depressed acne scars is subcision followed by carefully placed dermal filler.

These two treatments perform different jobs.

Subcision releases the scar.

Filler provides support underneath the released depression.

After a tethered scar is released, a very small amount of filler may be strategically placed underneath selected scars to help elevate them closer to the level of the surrounding skin.

This can be especially helpful when volume loss or a persistent depression remains after the fibrous attachment has been released.

The goal is not to make the face look fuller.

For acne scar treatment, filler is typically used precisely and conservatively, targeting individual depressions rather than creating generalized facial volume.

Learn more about Dermal Fillers at Chrysolite Aesthetics.

Subcision + Microneedling

Subcision and microneedling also complement each other because they work at different levels.

Subcision works underneath the scar to release fibrous attachments.

Microneedling works within the skin to stimulate a controlled healing response and support collagen remodeling.

For patients with a combination of rolling scars, shallow depressions, textural irregularities, and enlarged pores, using different treatments at different stages may provide more comprehensive improvement than relying on one procedure alone.

Learn more about Microneedling at Chrysolite Aesthetics.

Subcision + RF Microneedling

Radiofrequency microneedling combines microneedling with controlled radiofrequency energy delivered beneath the skin.

At Chrysolite Aesthetics, we offer Matrix Pro RF Microneedling as part of our approach to skin remodeling and acne scar treatment.

RF microneedling may help improve overall texture and stimulate collagen remodeling, while subcision addresses scars that remain physically tethered.

For the right patient, these treatments can be used as different stages of a comprehensive acne scar plan.

Learn more about RF Microneedling at Chrysolite Aesthetics 

Subcision and Chemical Peels

Chemical peels can play another important role in acne scar treatment.

Depending on the type and depth of the peel, chemical treatments may improve pigmentation, superficial irregularities, overall texture, and selected acne scars.

But again, they do something different from subcision.

A chemical peel treats the skin from the surface, while subcision physically addresses tethering underneath a depressed scar.

Patients with multiple types of acne scarring often benefit from combining or sequencing these approaches.

Learn more about Chemical Peels at Chrysolite Aesthetics

Why Acne Scar Treatment Usually Requires More Than One Procedure

There is rarely one perfect treatment for every acne scar.

In fact, one patient may have several different types of scars on the same cheek.

You may have:

• Rolling scars

• Boxcar scars

• Ice pick scars

• Tethered scars

• Areas of volume loss

• Enlarged pores

• Post-inflammatory pigmentation

• Uneven skin texture

Trying to treat all of these problems with the same device or procedure can limit your results.

Instead, Dr. Abu-Zeitoon evaluates the individual scar patterns and develops a treatment plan based on what each scar actually needs.

That may include:

Subcision for tethered scars.

Filler for selected persistent depressions or volume loss.

Microneedling or RF microneedling for collagen remodeling and overall texture.

Chemical peels or TCA CROSS for selected superficial or deep narrow scars.

This multimodal approach allows us to target acne scars at different depths rather than repeatedly performing the same treatment.

What Happens During a Subcision Treatment?

Before treatment, your scars are carefully evaluated to identify which depressions appear to be tethered and appropriate for subcision.

The treatment area is cleansed, and local anesthesia is used to improve comfort.

A needle or cannula designed for subcision is introduced beneath the skin through a small entry point.

Dr. Abu-Zeitoon then carefully releases the fibrous attachments beneath selected scars.

Depending on your treatment plan, subcision may be followed by another treatment such as filler, or additional procedures may be performed during separate appointments.

Does Subcision Hurt?

Local anesthesia is used to minimize discomfort.

Patients may feel pressure, movement, or pulling during portions of the procedure, but treatment is generally well tolerated.

Tenderness and soreness afterward are possible and usually improve as the area heals.

What Is Recovery Like After Subcision?

Subcision typically produces more bruising and swelling than routine microneedling because treatment occurs beneath the skin and intentionally disrupts fibrous scar tissue.

Common temporary effects include:

• Bruising

• Swelling

• Tenderness

• Redness

• Soreness

• Small areas of firmness

• Temporary discoloration

Bruising can sometimes be significant, so patients should consider upcoming work, social events, or photographs when scheduling treatment.

Individual recovery varies depending on the number of scars treated and the extent of the procedure.

What Are the Risks of Subcision?

Subcision is a medical procedure and carries potential risks.

These may include:

• Bruising

• Bleeding

• Swelling

• Tenderness

• Infection

• Temporary numbness or altered sensation

• Hematoma

• Persistent lumps or firmness

• Pigment changes

• Incomplete improvement

• Re-tethering of scars

• New scar formation

• Injury to underlying structures

Careful patient selection, knowledge of facial anatomy, and appropriate technique are important when performing subcision.

How Many Subcision Treatments Will I Need?

There is no standard number.

Some patients may see meaningful improvement after one treatment, while others with more extensive or severe tethering may benefit from additional sessions.

Acne scar improvement is usually gradual.

The goal is not necessarily to eliminate every scar. Instead, treatment aims to reduce scar depth, soften transitions between scars and surrounding skin, and create a smoother overall appearance.

When Will I See Results?

Some improvement may become noticeable after swelling and bruising resolve, particularly when a deeply tethered scar has been successfully released.

However, collagen remodeling takes time.

Improvement may continue to develop over the following weeks and months.

If filler is used at the same time, some additional correction may be visible immediately, although swelling must resolve before evaluating the final result.

Can Acne Scars Come Back After Subcision?

A successfully released scar may remain improved, but scar tissue can sometimes re-form or re-tether during healing.

This is one reason some patients require more than one treatment or benefit from combining subcision with another modality.

Acne itself should also ideally be controlled before aggressively treating acne scars, since new inflammatory acne can create new scars.

Who Is a Good Candidate for Subcision?

You may be a candidate if you have:

• Rolling acne scars

• Tethered depressed scars

• Selected boxcar scars

• Scars that remain despite previous resurfacing treatments

• Depressions that improve when the surrounding skin is stretched

• Realistic expectations about gradual scar improvement

Subcision is not appropriate for every acne scar.

An in-person examination is important because scar depth, tethering, skin type, previous treatments, active acne, medications, and medical history can all affect the treatment plan.

Why Choose Chrysolite Aesthetics for Acne Scar Treatment in Houston?

Acne scar treatment is rarely about choosing a single machine.

The first step is determining what type of scars you actually have and why they are depressed.

At Chrysolite Aesthetics in Houston, Texas, Dr. Rawan Abu-Zeitoon takes a multimodal approach to acne scar treatment.

Rather than repeatedly performing the same procedure, treatments may be layered and sequenced based on the individual scar:

Release what is tethered.
Restore what has lost volume.
Remodel what needs collagen.
Resurface what needs texture improvement.

Subcision, filler, microneedling, RF microneedling, chemical peels, and other scar treatments can each have a different role.

The goal is to use the right treatment for the right scar at the right stage of the acne scar journey.

Schedule a Subcision Consultation in Houston

If you've undergone microneedling, chemical peels, laser or RF treatments and still have several stubborn depressed acne scars, those scars may need a different approach.

They may be tethered underneath the skin.

Schedule a consultation with Dr. Rawan Abu-Zeitoon at Chrysolite Aesthetics to determine whether subcision should be incorporated into your acne scar treatment plan.

Chrysolite Aesthetics
10130 Louetta Rd, Suite A1
Houston, TX 77070
832-698-1157

Frequently Asked Questions About Subcision

What is subcision for acne scars?

Subcision is a minimally invasive procedure used to release fibrous bands beneath certain depressed acne scars. Releasing these