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RF Microneedling vs Subcision

RF Microneedling: Microneedling with heat added. Insulated needles carry radiofrequency energy to a set depth in the skin, so the healing response comes from both the puncture and the heat. It is used for indented acne scars, texture, and mild sagging.

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 RF Microneedling, 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 RF Microneedling if…

Choose for acne scars and texture with some tightening, with a lower pigment risk than resurfacing lasers.

  • Rolling or boxcar acne scars
  • Mild sagging too
  • Deeper skin tone where lasers are riskier

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 RF microneedling smooths the surface.

Key differences

● RF Microneedling
● Subcision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Moderate
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 short series (2–3)
A short series (2–3)
Cost per visit$ → $$$$$
$$$
$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

RF Microneedling

Subcision

What is it?

It combines needles and energy.

Radiofrequency energy is delivered into or beneath the skin.

It is a medical procedure.

It differs from conventional microneedling and home rollers.

Serious complications are reported.

The FDA has noted burns, scarring, fat loss and nerve damage.

Device and depth matter.

These should be discussed before consenting.

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
RF Microneedling
Subcision
Strong evidenceMost established uses
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

Improves rolling and boxcar scars.

Rolling Scars.

Rolling Scars

Heat remodels soft dips.

Rolling Scars.

Rolling Scars

Releases tethered scars.

Moderate evidenceSome supportive research
Sagging Skin on light skin.

Sagging Skin

Mild tightening.

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.

Limited evidenceEarly or small studies
Enlarged Pores on light skin.

Enlarged Pores

May shrink pores.

—
Little evidence
Ice Pick Scars on light skin.

Ice Pick Scars

Needs TCA CROSS or punch excision.

A relaxed forehead with pronounced deep horizontal furrows.

Deep Wrinkles

Modest change on deep folds.

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
—
Ice Pick Scars on light skin.

Ice Pick Scars

Too narrow to release.

Treatment areas

Treatment areas

Face and neck; depths and coverage depend on the treatment plan.

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

Skin tones

Skin tone
● RF Microneedling
● Subcision
Lighter skin
Low risk
Redness and swelling for days.
Low risk
Bruising.
Medium skin
Low risk
Insulated needles protect the surface.
Low risk
Bruising may leave brief dark marks.
Deeper skin
Some risk
Lower pigment risk than lasers; grid marks or dark spots possible.
Low risk
One of the lower pigment-risk scar treatments.

How it works

RF Microneedling

Subcision

How it works
RF Microneedling mechanism diagram. Needles enter the skin: A device places fine electrodes at a selected depth. RF energy heats nearby tissue: Controlled heating occurs around active needle segments. Repair remodels tissue: The healing response can change collagen and skin texture.
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

Needles enter the skin: A device places fine electrodes at a selected depth. RF energy heats nearby tissue: Controlled heating occurs around active needle segments. Repair remodels tissue: The healing response can change collagen 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

RF 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 and sun: Do not arrive tanned or sunburned.

Pigment cream and sun: On deeper skin tones, many providers prescribe a pigment-blocking cream for two to four weeks first.

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: Stop retinoids, benzoyl peroxide and exfoliating acids about 5 days before.

Actives and hair removal: No waxing or hair removal creams on the area.

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

Day of treatment

RF Microneedling
Subcision
Before you arrive

Clean face: Clean face, no makeup.

Clean face: If injected anesthetic is planned, expect a long appointment and a ride home if anything sedating is used.

Not specified
Arrival & prep

Skin is examined and photographed, and the provider maps depths for each area — shallower around the eyes and forehead, deeper over scarred cheeks and the jaw.

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

Treatment

The handpiece is pressed on the skin and fired one stamp at a time in a grid, not glided.

A full face takes 20 to 45 minutes, often with passes at several depths. With cream alone the sting is sharp, worst on the forehead and jaw; with injected anesthetic it is mostly pressure and heat.

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

Red, hot and swollen, with a visible grid of small dots.

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

After your treatment

RF Microneedling
Subcision
First 24 hours

Days 1 to 2: Swelling is worst the first morning, especially around the eyes and jaw, enough to change how your face looks.

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

Days 2–7

Days 3 to 10: Swelling drops, redness fades to pink, and the skin feels sandpapery with the grid faintly visible.

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
Not specified

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 1 to 6: Firmness and texture keep changing after the visible healing.

Not specified
Time to results

1–3 months, improving to 6

1–3 months

How long results last

Years for scars

Long-lasting

Risks

Risks
  • Dark patches
  • A visible grid that will not fade
  • Prolonged swelling or redness
  • A hollow or a change in face shape
  • 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 generally runs about $700 to $1,500, and a package of three commonly falls between $2,000 and $4,000.

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 it, since it is classed as cosmetic.

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

Questions

RF Microneedling

Subcision

Individual Questions
Is Morpheus8 the same as RF microneedling?

Morpheus8 is one brand of radiofrequency microneedling device. Profound, Vivace, Genius, Secret RF, Scarlet and Sylfirm X do the same job. Needle insulation, depth, energy and the operator determine the outcome.

Does it work on acne scars?

Partly, and over a course. Rolling and boxcar scars become shallower across about three sessions. Icepick scars respond poorly. Expect improvement, not clearance.

Will it tighten my jawline?

Modestly, if the laxity is mild and early. It firms rather than lifts. Skin that visibly hangs will not respond, and a surgical consultation is the more honest next step.

How much does it hurt?

More than plain microneedling. Numbing cream alone leaves a sharp hot sting, so many providers add injected anesthetic or nerve blocks at deeper settings. With those it is mostly pressure and heat.

Is it safe on deeper skin tones?

Generally safer than ablative lasers, since melanin does not absorb the energy. Dark marks are still possible from the heat, sometimes in the grid pattern, and they fade over months. Ask about insulated needles and conservative starting settings.

Can it cause fat loss in the face?

Yes, and it is the risk worth understanding. Deep, high-energy settings in a thin face can shrink the fat under the skin, leaving a hollow that does not reliably return. Conservative settings built up over sessions, and a provider who takes the question seriously, are the protection.

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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