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Subcision and Excision in Boston
Skin texture irregularities such as acne scars, cellulite, traumatic scars and deep facial lines or folds tend to cast unflattering shadows and age the appearance of skin. Subcision is a simple and safe office surgery procedure performed by Dr. Edwin Ishoo for treatment of depressed lines and scars. It can easily be combined with other treatments such as dermal fillers and fat transfer, LASER resurfacing, dermapen and scar revisions for maximum efficacy.
Subcision is a treatment for pitted scars such as atrophic acne scars, skin folds such as nasolabial folds and irregularities such as cellulite where the scar or bands tethering the skin down are freed from the underlying tissue, allowing it to float back toward the surface of the skin and creating a smoother visual appearance. The procedure is performed in our Boston or Marshfield offices. After the site heals, people can receive skin treatments to make the scar itself smoother and less visible.
Limited Scar Subcision Technique (Traditional Subcision)
In Dr. Ishoo’s experience, regular subcision works best with rolling acne scars and nasolabial folds. Rolling acne scars have normal skin over the rolling scar, but have fat loss due to cystic acne that burst and caused fat loss under the skin. The traditional subcision technique works best when the tissue loss is under the skin within the subcutaneous fat, and the collagen build up from the blood clot is in the subcutaneous layer.
Large Area Scar Subcision (Laser-assisted subdermal release)
In patients with extensive deeply indented face or body acne scarring, large traumatic scar or extensive cellulite, Dr. Ishoo can perform a minor surgical procedure to release the scarred down pits and folds and make them less indented using an Nd:Yag LASER fiber introduced under the skin after a solution of dilute anesthetic is injected in the area to cause lysis of the fibrotic attachments tethering the dimpled scar to the underlying tissue. Dr. Ishoo uses the Smartlipo Triplex LASER machine for this treatment in his joint commission accredited surgical facility. This procedure can be combined with autologous fat transfer, PRP and dermal fillers to improve volume as well as dermapen, fractional LASER skin resurfacing and plasma or serum topical treatment to further improve skin texture in a large area such as entire face, back, thighs or chest.
Subcision with Fillers or Autologous Fat Transfer
Injecting acne scars and nasolabial or marionette lines with fillers or person’s own fat can be a very satisfying procedure with relatively minimal downtime. However, because scars and skin septae may tether down the skin, some of these indented scars cannot be smoothed out with filler alone. Because the center portion of the indented acne scar is tethered down with collagen fibers, the filler tends to extrude around the tethered area to create a “doughnut effect.” In other words, the indentation barely improves, and the edges of the acne scar become filled and rise up higher, worsening the overall appearance.
In these cases, some subcision is helpful in untethering the collagen fibers to allow the filler to lift up the central portion of the indented scar. Without subcision, the filler does not have enough “hydraulic” pressure to push out the indentation. Typically Dr. Ishoo will attempt to conservatively fill the indented acne scars, and if the scar does not lift easily, Dr. Ishoo will perform some light subcision with the same small needle used to inject the filler to release the collagen fibers before adding more filler. This helps avoid the “doughnut effect.” This technique allows patients to experience the benefits of subcision with relatively little recovery time.
Alternatively depressed scars can be treated with punch excision of the most depressed and tethered segment after which, the defect may be filled by a punch graft. Harvested from another area, commonly the post auricular sulcus, a punch graft is pressed into the created defect and either sutured or glued in place. Punch grafting creates a secondary defect and risks poor color and texture match between donor and recipient sites. However, by filling the dead space at the excision site, punch grafting may reduce the likelihood that scar excision and closure will fail because of excessive tension in the closure.