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.
Key facts
Treats
Tethered rolling acne scars
Recovery
Bruising for 1–2 weeks
Treatment plan
Often 1–3 sessions
Typical cost
Per-session quote
What is it?
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
Rolling Scars
Releases tethered scars.
Acne Scarring
Best for rolling scars.
Cellulite
Releases dimples.
Ice Pick Scars
Too narrow to release.
Boxcar Scars
Better treated with resurfacing.
Treatment areas
Subcision
Selected facial scars; the highlighted cheeks show the general treatment area.
Subcision
Selected facial scars; the highlighted cheeks show the general treatment area.
Skin tones
Lighter skin
Low risk
Bruising.
Medium skin
Low risk
Bruising may leave brief dark marks.
Deeper skin
Low risk
One of the lower pigment-risk scar treatments.
How it works
Diagram explanation
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.
Types
Subcision can be done with a needle or a blunt cannula. Both release the bands that pull scars down.
Before your treatment
Earlier planning
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
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 supplements: With your prescriber's agreement, stop blood-thinning supplements such as fish oil, vitamin E and ginkgo.
Day of treatment
Arrival & prep
Photographs first, then the skin is stretched and lit from the side so tethered scars stand out.
Treatment
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
Swollen, red and firm, with the treated scars looking temporarily better from the swelling.
After your treatment
First 24 hours
Days 1 to 3: Deep purple bruising appears and spreads downward with gravity, worst around day two or three.
Days 2–7
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 2 to 12: Small firm lumps can be felt as the scar tissue remodels, and most soften on their own.
Time to results
1–3 months
How long results last
Long-lasting
Risks
Bruising, swelling and tenderness are expected, not complications. Real complications are uncommon; a few are worth recognizing early.
A firm lump that is growing
A raised or hard nodule at a treated site, usually in the first weeks. Most settle, some need injecting, and early is easier.
Bruising that keeps expanding
Or a tense, painful swelling. This can be a collection of blood under the skin rather than an ordinary bruise.
A new brown mark
Staining where the bruise was, most often on deeper skin tones. Treated early it clears faster.
A cold sore outbreak
Any procedure near the mouth can trigger one, and antiviral medicine works best started early.
A scar that looks deeper afterward
Rare, and needs review rather than another session.
Cost
Typical cost
Per session
Pricing
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 almost never covers subcision for acne scars, because scar treatment for appearance is cosmetic.
Alternatives
Microneedling
Works on the surface and on shallow texture. It does not reach or cut the tethers, so a firmly tethered rolling scar improves less with it. Commonly used alongside subcision rather than instead of it.
Radiofrequency microneedling
Adds heat to the needles, which suits texture and firmness. More expensive, and often paired with subcision in the same plan.
Fractional laser resurfacing
Better than subcision on boxcar edges and on general texture and tone, with more downtime, more cost, and more care needed on deeper skin tones.
Dermal filler alone
Lifts the dip immediately with almost no downtime, but a tethered scar tends to stay dimpled because the tether is still holding it. Temporary, and it needs repeating.
Punch excision
For the right scar. Cuts out a single deep boxcar or icepick scar and closes it, trading a pit for a small line. Aimed at individual scars rather than an area.
TCA CROSS
A drop of strong acid placed into an icepick scar to make it contract. A different scar type entirely, and often done at the same visit as subcision on different scars.
Doing nothing
Rolling scars do not resolve on their own, but they also do not worsen once acne is controlled. Good lighting habits, sunscreen and a retinoid keep skin looking better without any procedure.
Topical retinoid
Improves texture and helps prevent new scars by controlling acne. It will not lift a scar that is tethered from below.
At-home microneedling rollers and pens
The needle lengths sold for home use are far too short to reach the tethers under a scar, so they cannot do what subcision does. They also carry an infection risk if not kept clean.
Daily sunscreen
Does not change the scar itself, but it stops shadows being deepened by tanning and prevents brown marks after any procedure. Worth doing regardless.
Questions
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
Acne Scarring
Microneedling
Tretinoin
RF Microneedling
Microneedling vs Subcision
RF Microneedling vs Subcision
Dermal Fillers vs Subcision
Fractional CO2 Laser vs Subcision
Fraxel vs Subcision
Scar Revision vs Subcision
Subcision vs TCA Peel
