It creates controlled punctures.
Fine needles puncture the skin in a controlled way.
Microneedling vs Subcision
Microneedling: A pen or roller of fine needles makes thousands of tiny controlled punctures in the skin, which sets off healing and new collagen. It is used mainly for indented acne scars and rough texture. It makes them shallower over a course of sessions, not gone.
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.
Choose Microneedling if…
Choose for indented acne scars and rough texture with little downtime and low pigment risk — shallower, not gone.
- Rolling or boxcar acne scars
- Deeper skin tone, where lasers are riskier
- You can plan 3–6 sessions
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 acne-scar pairing: subcision releases tethered scars and microneedling smooths the surface.
Key differences
● Microneedling
● Subcision
DowntimeNone → 2+ weeks
1–2 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Mild
Moderate
Results showImmediately → 3+ months
1–3 months
1–3 months
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
A longer series (4–6+)
A short series (2–3)
Cost per visit$ → $$$$$
$$
$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent
What is it?
Microneedling
Subcision
What is it?
It treats scars and texture.
Results depend on device, depth and technique.
It differs from RF microneedling.
No radiofrequency energy is involved.
Added substances change the risk.
Devices are not cleared for use with every serum or blood product.
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
Microneedling
Subcision
Strong evidenceMost established uses
Acne Scarring
Improves rolling and boxcar scars.
Rolling Scars
Good results with a series.
Rolling Scars
Releases tethered scars.
Moderate evidenceSome supportive research
Stretch Marks
Softens older marks.
Wrinkles and Fine Lines
Improves texture.
Acne Scarring
Best for rolling scars.
Cellulite
Releases dimples.
Little evidence
Ice Pick Scars
Too deep for needling alone.
Boxcar Scars
Better treated with resurfacing.
Not effective
—
Ice Pick Scars
Too narrow to release.
Can make it worse
Acne
Can spread active breakouts.
—
Treatment areas
Treatment areas
Face; the selected area depends on the concern and treatment plan.
Selected facial scars; the highlighted cheeks show the general treatment area.
Skin tones
Skin tone
● Microneedling
● Subcision
Lighter skin
Low risk
Redness like a mild sunburn.
Low risk
Bruising.
Medium skin
Low risk
One of the safer scar treatments.
Low risk
Bruising may leave brief dark marks.
Deeper skin
Low risk
Lower pigment risk than lasers; dark marks are still possible.
Low risk
One of the lower pigment-risk scar treatments.
How it works
Microneedling
Subcision
How it works
Diagram explanation
Fine needles create tiny punctures: A device makes controlled channels in selected skin. Healing signals are released: The tissue response activates repair processes. Collagen remodels gradually: Healing may improve selected scars and skin texture.
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
Microneedling
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
Pigment cream: On deeper skin tones, some providers start a pigment-blocking cream a few weeks ahead.
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
Actives and hair removal: Do not arrive tanned or sunburned.
Actives and hair removal: Stop retinoids (tretinoin, adapalene, retinol), benzoyl peroxide and acids 3 to 5 days before.
Actives and hair removal: No waxing, threading or hair removal creams.
Actives and supplements: With your prescriber's agreement, stop blood-thinning supplements such as fish oil, vitamin E and ginkgo.
Day of treatment
Microneedling
Subcision
Before you arrive
Clean skin: Come with a clean face and no makeup, and plan not to wear any that day.
Clean skin: If you have active pustules or an infection in the area, move the session.
Not specified
Arrival & prep
Skin is checked and photographed, and you confirm what you have stopped using.
Photographs first, then the skin is stretched and lit from the side so tethered scars stand out.
Treatment
The pen is passed over the skin in overlapping passes, one area at a time, with sterile gel or saline as a glide.
It sounds like a small vibrating motor and takes 20 to 30 minutes for a full face. Pinpoint bleeding is normal at deeper settings over scars. With good numbing it is uncomfortable rather than painful, a scratchy dragging with pressure.
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
Skin is bright red, warm and tight, like a strong sunburn, sometimes with faint tracking lines and dots of dried blood.
Swollen, red and firm, with the treated scars looking temporarily better from the swelling.
After your treatment
Microneedling
Subcision
First 24 hours
Days 1 to 5: Redness turns pink and swelling settles, most noticeably around the eyes the first morning.
Days 1 to 3: Deep purple bruising appears and spreads downward with gravity, worst around day two or three.
Days 2–7
Not specified
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
Weeks 1 to 4: Skin looks normal and nothing appears to be happening.
Weeks 2 to 12: Small firm lumps can be felt as the scar tissue remodels, and most soften on their own.
Beyond 1 month
Months 2 to 6: Texture keeps improving after the visible healing finishes, which is why the photograph that matters is taken months later, not the week after.
Not specified
Time to results
1–3 months after each session
1–3 months
How long results last
Years for scars
Long-lasting
Risks
Risks
- Dark patches
- Tracking lines
- Prolonged redness
- Bumps that will not go
- A cold sore outbreak
- 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 a full-face session usually runs about $200 to $700, with medical offices at the higher end and packages of three to six cheaper per session.
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 microneedling for acne scars, since it is classed as cosmetic.
Insurance almost never covers subcision for acne scars, because scar treatment for appearance is cosmetic.
Questions
Microneedling
Subcision
Individual Questions
Does microneedling get rid of acne scars?
No. It makes indented scars shallower and less noticeable over three to six sessions. Rolling and shallow boxcar scars respond best, icepick scars respond poorly, and improvement is partial in every study. That is worth having; complete clearance is not what this treatment does.
How many sessions will I need?
Three to six for scarring, four to six weeks apart, then a wait. Texture keeps improving for three to six months after the last session, so do not judge the outcome before then.
Does it hurt?
With numbing cream on for 30 to 45 minutes it is uncomfortable rather than painful, a scratchy pressure rather than a sharp pain. The forehead, nose and jawline are the worst part, and deeper settings over scars are sharper.
Is microneedling safe on deeper skin tones?
One of the better options, because there is no heat or light for melanin to absorb. Dark marks are still possible if the settings are aggressive or the skin sees sun afterward, and they fade over months. Choose someone who treats deeper skin tones routinely.
Can I do this at home with a dermaroller?
Anything at 0.5 mm or deeper is a medical depth and should not be used at home. Needles blunt, home rollers cannot be properly sterilized, and serums through fresh channels have caused lasting lumps of inflammation. Rollers at 0.2 to 0.3 mm are mostly harmless and mostly useless.
Is PRP worth adding?
Platelet-rich plasma is your own blood, spun down and applied or injected during the session. The evidence that it improves scar results is mixed, and it often doubles the price. A course without it is a reasonable course.
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.
Related
Procedure
Microneedling
Procedure
Subcision
Compare
RF Microneedling vs Subcision
Compare
Chemical Peel vs Microneedling
Compare
Fractional CO2 Laser vs Microneedling
Compare
Fractional CO2 Laser vs Subcision
Compare
Microneedling vs RF Microneedling
Compare
Tretinoin vs Microneedling
Compare
Clear and Brilliant vs Microneedling
Compare
Dermal Fillers vs Microneedling
Compare
Dermal Fillers vs Subcision
Compare