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Dermal Fillers vs Subcision

Dermal Fillers: A gel injected under the skin to replace volume that has been lost, or to add shape. Most are hyaluronic acid and last six months to two years. They do not treat movement lines, loose skin, or skin quality.

Subcision: A needle passed under an indented acne scar to cut the strands holding it down, so the surface can lift. It is aimed at rolling scars specifically, it bruises, and it is almost always combined with something else.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Dermal Fillers, based on the entry’s treatment or equipment reference.Editorial illustration for Subcision, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Dermal Fillers if…

Choose for volume lost at rest — hollow cheeks, deep folds or thin lips.

  • Hollow cheeks, deep smile folds, thin lips
  • You want to see a change right away
  • You want results that last 6–24 months

Choose Subcision if…

Choose for rolling acne scars that are tethered down, usually combined with needling, laser or filler.

  • Soft, wavy rolling scars
  • Scars that improve when you stretch the skin
  • You can hide a week or two of bruising
Often combined

Can you have both?

A common scar pairing: subcision releases the scar and filler props it up so it does not pull back down.

Key differences

● Dermal Fillers
● Subcision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Mild
Moderate
Results showImmediately → 3+ months
Immediately
1–3 months
How long it lastsWeeks → Years or permanent
1–2 years
Years or permanent
Visits neededOne → Every few months
Yearly top-ups
A short series (2–3)
Cost per visit$ → $$$$$
$$$
$$
ReversibleYes, can be undone → No, permanent
Yes, can be undone
No, permanent

What is it?

Dermal Fillers

Subcision

What is it?

They are injectable materials.

Fillers restore soft-tissue contour or soften wrinkles.

Products differ.

Composition, duration and reversibility vary.

They are not Botox.

Fillers add volume rather than relaxing muscles.

They carry vascular risk.

Unapproved products and needle-free devices should be avoided.

It releases scar bands.

Fibrous bands tethering depressed scars are cut beneath the skin.

It suits rolling acne scars.

It is not for every pit, mark or raised scar.

It is minor surgery.

It is performed by a clinician with a needle or blade.

History is reviewed.

Bleeding risk, scarring tendency and isotretinoin use are assessed.

What it treats

Evidence level
Dermal Fillers
Subcision
Strong evidenceMost established uses
Volume Loss on light skin.

Volume Loss

Restores fullness in cheeks and lips.

A relaxed forehead with pronounced deep horizontal furrows.

Deep Wrinkles

Fills deep folds.

Rolling Scars.

Rolling Scars

Releases tethered scars.

Moderate evidenceSome supportive research
Rolling Scars.

Rolling Scars

Lifts soft dips.

Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Best for rolling scars.

Educational illustration of natural shallow dimpling of adult lateral-thigh skin below the hem of shorts on light skin.

Cellulite

Releases dimples.

Little evidence
A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Fine movement lines respond better to Botox.

Educational illustration of healed broad indented scars with defined edges on the left cheek, with the face turned to the person’s right on light skin.

Boxcar Scars

Better treated with resurfacing.

Not effective
Sagging Skin on light skin.

Sagging Skin

Can't replace a lift.

Ice Pick Scars on light skin.

Ice Pick Scars

Too narrow to release.

Treatment areas

Treatment areas

Cheeks and lips; the product and treatment goal determine placement.

Selected facial scars; the highlighted cheeks show the general treatment area.

Skin tones

Skin tone
● Dermal Fillers
● Subcision
Lighter skin
Low risk
Bruises show clearly but fade in about a week.
Low risk
Bruising.
Medium skin
Low risk
Bruising may leave brief darker marks.
Low risk
Bruising may leave brief dark marks.
Deeper skin
Low risk
Bruising can leave darker marks that take longer to fade.
Low risk
One of the lower pigment-risk scar treatments.

How it works

Dermal Fillers

Subcision

How it works
Dermal Fillers mechanism diagram. Material is placed in selected tissue: The product and anatomical site guide injection. The filler supports volume: The material changes the contour of the treated area. The result depends on the product: Material, placement, and tissue structure affect the outcome and duration.
Subcision mechanism diagram. A scar is tethered below skin: Fibrous bands can pull a rolling scar downward. The bands are released: A clinician passes an instrument beneath the scar. Repair follows the release: The depression may improve as the tissue heals and remodels.
Diagram explanation

Material is placed in selected tissue: The product and anatomical site guide injection. The filler supports volume: The material changes the contour of the treated area. The result depends on the product: Material, placement, and tissue structure affect the outcome and duration.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

A scar is tethered below skin: Fibrous bands can pull a rolling scar downward. The bands are released: A clinician passes an instrument beneath the scar. Repair follows the release: The depression may improve as the tissue heals and remodels.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Dermal Fillers
Subcision
Earlier planning
Not specified

6 months before: After isotretinoin: Most providers wait about 6 months before subcision, though this is debated and some treat sooner.

2–4 weeks before

Planning: Timing: Allow 2 weeks for swelling to settle.

2 weeks before: Sun: Keep the area out of the sun and use SPF 30 or higher.

Before you book: Timing: Get active acne under control first, or new scars form beside the treated ones.

The week before

Preparation: Medicines and alcohol: Ask about fish oil, vitamin E and ibuprofen; avoid alcohol for 24 hours.

3 to 5 days before: Bruising: Never stop a prescribed blood thinner on your own.

Actives and supplements: With your prescriber's agreement, stop blood-thinning supplements such as fish oil, vitamin E and ginkgo.

Day of treatment

Dermal Fillers
Subcision
Arrival & prep

You are assessed sitting upright, because faces look different lying down.

Photographs first, then the skin is stretched and lit from the side so tethered scars stand out.

Treatment

The skin is cleaned.

Filler goes in in small amounts through a fine needle or a blunt cannula threaded from one entry point. The injector pauses to mold it and sits you up to check symmetry. It takes 15 to 45 minutes. Expect pressure and pinching, not sharp pain. Lips hurt most; a cannula hurts less than needle passes.

A tiny entry point is made beside the scar, and the needle or cannula is passed underneath and moved side to side in a fan until the skin releases.

You feel pressure, tugging and a faint crunching as the strands give way. Firm pressure follows to limit bruising, and filler or microneedling may follow. Usually 15 to 45 minutes, and once numb it is pressure, not pain.

Before you leave

Pinpoint red marks, some swelling, maybe a bruise starting.

Swollen, red and firm, with the treated scars looking temporarily better from the swelling.

After your treatment

Dermal Fillers
Subcision
First 24 hours

First 4 days: Puffiness and tenderness build through the first day; ice in short spells helps.

Days 1 to 3: Deep purple bruising appears and spreads downward with gravity, worst around day two or three.

Days 2–7

Day 5 to 14: Swelling drops, bruises turn yellow and fade, and lumps soften.

Days 4 to 14: The bruises turn green and yellow, and concealer covers them reasonably well from about day three, once the entry points have sealed.

Weeks 2–4

Week 2: What you see now is what you paid for.

Weeks 2 to 12: Small firm lumps can be felt as the scar tissue remodels, and most soften on their own.

Time to results

Right away, final at 2 weeks

1–3 months

How long results last

6–24 months

Long-lasting

Risks

Risks
  • A lump or firm area
  • A bluish tint under thin skin
  • Swelling weeks or months later
  • Under-eye puffiness that lingers
  • Asymmetry
  • A cold sore outbreak after lip filler
  • When to contact your provider
  • A firm lump that is growing
  • Bruising that keeps expanding
  • A new brown mark
  • A cold sore outbreak
  • A scar that looks deeper afterward

Cost

Per session

In the US, hyaluronic acid filler usually runs about $600 to $1,200 per syringe, with structural and longer-lasting products at the higher end.

In the US, subcision commonly runs a few hundred dollars per session, and the price rises when filler, microneedling or radiofrequency needling is added — filler is often the larger part of the bill.

Insurance

Insurance does not cover cosmetic filler.

Insurance almost never covers subcision for acne scars, because scar treatment for appearance is cosmetic.

Questions

Dermal Fillers

Subcision

Individual Questions
How long does filler last?

Six to twelve months in the lips, often twelve to twenty-four in structural areas like cheeks, chin and jaw. Movement breaks it down faster, and some persists longer than expected without being visible.

Does it hurt?

Pressure and pinching more than sharp pain, and most fillers contain local anesthetic so it eases as it goes in. Lips are worst by a distance. Numbing cream is standard.

Can filler be removed if I do not like it?

Hyaluronic acid dissolves with an enzyme, usually within days. Calcium hydroxylapatite, poly-L-lactic acid and permanent fillers do not, a strong argument for starting with hyaluronic acid.

What is vascular occlusion, and how likely is it?

Filler blocking a blood vessel and cutting off the blood supply to skin, or rarely the eye. Uncommon, and it is why filler belongs with a trained medical injector who keeps hyaluronidase on site. Warning signs are severe or increasing pain, skin turning white then blotchy and dusky, and any vision change. Treated urgently, the sooner the better.

Why does filler sometimes look obvious?

Almost always how much was used and where, not the product. Volume added year after year without reassessment, or gel too close to the surface, is what people recognize.

Will filler help my dark circles?

Only if the darkness is a shadow cast by a hollow. If it comes from pigment, or thin skin showing the vessels underneath, filler will not brighten it — and under-eye filler risks lasting puffiness. Ask what is causing yours.

How do I know if my scars are the right type?

Stretch the skin either side of the scar, or press gently beside it. If the dip flattens out, it is tethered, and that is the scar subcision treats. Scars with sharp punched-out edges that stay put when you stretch are icepick or boxcar scars and need something else.

How long does the bruising last?

Usually 7 to 14 days. It looks worst around day two or three, then turns green and yellow, and concealer works from about day three. Plan for two clear weeks, not one.

Will one session be enough?

Usually not. Most courses are 2 to 4 sessions, 4 to 8 weeks apart. Some of the immediate improvement is lost as cut strands reattach, and the gain builds over the course.

Do I need filler with it?

Not always, but many providers add it. Filler holds the released space open while new collagen forms, which reduces retethering. Ask what would be used, how much, and what it adds to the cost.

Does it hurt?

The numbing injections sting for a few seconds and are the worst part. After that it is pressure and tugging, not sharp pain. The area is sore for a day or two, like a deep bruise.

Is it safe on deeper skin tones?

Yes, and it is often a good choice, because it uses no heat or light. The thing to manage is a temporary brown mark where the bruising was. Sun protection, limiting the bruising and spacing sessions all help.

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