Procedure

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Subcision. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

Subcision is what I keep coming back to for rolling scars, and it is the one people have usually never heard of. Pull the skin either side of the scar — if the dip flattens out, it is tethered from underneath, and that is what subcision releases.

Expect proper bruising for one to two weeks, not a faint shadow, so book it around your calendar rather than the week before a wedding.

Releasing the tether is only part of it — something else has to fill the space and keep it filled, whether that is needling, a laser, a little filler or your own healing, and none of it is worth starting while acne is still active.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

−
Also calledSubcutaneous incisionless surgery, Nokor needle subcision, cannula subcision
Best forRolling acne scars — soft, shallow, wavy dips with sloping edges that flatten when the skin is stretched
Not forIcepick scars, sharp-edged boxcar scars, or raised and keloid scars
DowntimeBruising for about 7 to 14 days, and swelling for 2 to 5 days
SessionsUsually 2 to 4, spaced about 4 to 8 weeks apart
Typical costCommonly a few hundred dollars per session in the US, and more when filler or microneedling is done at the same visit. Varies widely by city and provider
Results timelineSome lift is visible immediately, much of it swelling. Judge the real result 2 to 3 months after the last session
PainThe numbing injections sting. After that it is pressure and tugging rather than sharp pain
Skin tone safetySuitable for all skin tones, and it uses no heat or light. The risk is a brown mark left where the bruising was, which is more common on deeper skin tones
Usually combined withFiller, microneedling, radiofrequency microneedling, or fractional laser

What It Is

−

Subcision is a minor in-office procedure done through the skin rather than on it. After local anesthetic, a hollow needle — often a Nokor needle, which has a small angled blade at its tip — or a blunt cannula goes in through a tiny entry point beside the scar and moves back and forth in a fan underneath it, cutting the fibrous strands that anchor the skin down. Nothing is removed and nothing is stitched; the entry point closes on its own. A session takes 15 to 45 minutes depending on how many scars are treated. It treats one specific problem: a scar being pulled down from below. That is why a provider stretches and side-lights the skin first and marks only the scars that respond. Scars with sharp, punched-out edges are not tethered the same way and need something else.

How It Works

−

An indented rolling scar is usually not a hole in the skin. The surface is close to normal thickness; the problem sits underneath.

While a deep, inflamed spot heals, strands of scar tissue form between the underside of the skin and the firmer tissue below. They act like short guy ropes, holding the surface down, so the dip you see is skin being pulled rather than skin that is missing. That is why the dip flattens when you stretch the skin sideways, and why the scar looks far worse under overhead lighting, which casts a shadow into it.

Subcision cuts those strands. The needle is fanned under the scar until the skin releases and glides freely over the tissue below. The surface lifts straight away, partly because it is no longer tethered and partly from swelling and a little bleeding into the space just opened.

The lift lasts only if the space fills in. Healing lays down new collagen there, which is the intended effect, but the cut ends can also reattach and pull the scar back down, which is why some improvement is lost in the weeks after a session. That reattachment is why providers often add filler, microneedling or a laser at the same visit or soon after: to keep the space open long enough to fill with new collagen instead.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNON-ABLATIVE LASERABLATIVE LASERREACHES THE DEEP DERMIS

This goes through the full thickness of the skin, past the collagen and down to where hair bulbs, larger vessels and glands sit. At this depth a treatment can reach structures creams never touch, and it is also where scarring becomes a real risk if it is done badly. Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

−
Close-up of the cheek, nose and mouth of an adult with light skin, turned three-quarters away from the camera against a pale blue background. The surface of the cheek is uneven, dimpled with shallow depressions and small pits that catch the light. There are no active spots — the change here is in the texture of the skin rather than its color.
Acne Scarring
Strong evidence
A needle is passed under a rolling scar to cut the fibrous bands tethering it down, so the floor lifts. It is aimed at rolling scars specifically and does nothing for icepick or boxcar ones. Bruising for a week or two is normal, and it is often done in the same visit as needling or filler.

Not the Best For

−
Icepick and Sharp-Edged Boxcar Scars
Doesn't work
Sharp, vertical-walled boxcar scars change very little, and icepick scars not at all. They are narrow deep tracks rather than tethered dips, so cutting the strands underneath does nothing. These need punch excision or a targeted acid technique.
Red and Brown Marks After Acne
Doesn't work
Subcision does not change the red or brown marks acne leaves behind. Those need a topical treatment or a light-based treatment.

Pros and Cons

−
Pros
  • It treats the actual cause Releasing the tether is why the dip lifts.
  • Visible change from one session Rolling scars look better straight after.
  • No device and no resurfacing A needle and local anesthetic. No heat.
  • Safe across skin tones No heat or light, so no burn or pigment risk.
  • Combines well Routinely done at the same visit as filler or microneedling.
Cons
  • Bruising is the norm One to two weeks of it, not a faint shadow.
  • It is not for every scar Icepick and sharp boxcar scars do not respond.
  • Scars can retether Some of the immediate lift is lost over the next weeks.
  • Rarely enough on its own Usually part of a plan rather than the plan.
  • Lumps are possible Over-treating an area can leave a raised or firm patch.

How to Prepare

−
6 months before2 weeks before1 week before
After isotretinoin
6 months before
Most providers wait about 6 months before subcision, though this is debated and some treat sooner.
Sun
2 weeks before
Keep the area out of the sun and use SPF 30 or higher. Sun on bruised skin is what leaves a brown stain behind.
Actives and supplements
1 week before
With your prescriber's agreement, stop blood-thinning supplements such as fish oil, vitamin E and ginkgo. Skip alcohol for a day or two. Stop retinoids and acids 3 to 5 days before.
Before you book
Get active acne under control first, or new scars form beside the treated ones. Book when bruising is acceptable — two clear weeks.

What Happens

−
ArrivingThe treatmentLeaving
Arriving
Photographs first, then the skin is stretched and lit from the side so tethered scars stand out. Each one that flattens on stretching is marked while you sit upright, since scars look different lying down. Numbing cream goes on, then anesthetic is injected under each marked area — stinging for 10 to 30 seconds before it goes fully numb. Your provider will ask about these things.
The 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.
Leaving
Swollen, red and firm, with the treated scars looking temporarily better from the swelling. Bruises appear within hours to a day.

Recovery

−
Days 1 to 3Days 4 to 14Weeks 2 to 12
Days 1 to 3
Deep purple bruising appears and spreads downward with gravity, worst around day two or three. The area is firm and tender, and swelling starts to settle. Short spells of ice help. Treated scars look flatter than they will, so do not judge yet.
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. Most bruising is gone by two weeks, though a yellow tinge can linger.
Weeks 2 to 12
Small firm lumps can be felt as the scar tissue remodels, and most soften on their own. Tell your provider about any lump that is growing or visible rather than only palpable. By week 6 to 12 the real result is clear and the next session is planned.

Aftercare

−
24 hours48 hours5 to 7 days
Ice and makeup
24 hours
Ice in short spells, about 10 minutes at a time, for the first day. Makeup from 24 hours, once the entry points have sealed. Sleep with your head on an extra pillow for two nights if the face was treated.
Exercise and alcohol
48 hours
Heat and raised blood pressure make bruising worse, and alcohol reliably increases bruising and swelling.
Actives
5 to 7 days
Restart retinoids and acids after about 5 to 7 days, or when your provider says.
Sun
SPF 30 or higher every day. Sun on a fresh bruise is what turns it into a lasting brown mark.
Massage
Only if you are told to, and not in the first week.
Picking
Leave the tiny scabs at the entry points alone.

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.

In Deeper Skin Tones

−

Subcision has a real advantage on deeper skin tones: it uses no heat and no light. The complications that make laser resurfacing a careful decision — burns and lasting pale or dark patches driven by heat — do not apply the same way. For rolling scars on a deeper skin tone it often has the best balance of benefit and risk.

The risk that does apply is post-inflammatory hyperpigmentation, a brown mark left by the bruising and the inflammation of healing. It is common, usually temporary, can take a few months to fade, and is largely preventable.

What lowers it: treating fewer areas per session, firm pressure and ice straight afterward to keep bruising down, strict daily sun protection while the bruise is there and for weeks after, and a pigment-lowering cream once the skin has healed if your provider recommends one. Spacing sessions further apart also lets marks clear before the next round.

Keloids are uncommon here: Keloid formation from the tiny entry point is uncommon, but say at the first visit if you have ever formed one, especially on the jawline or neck.

The mark left after bruising is not a scar. It sits in the skin's pigment, it responds to treatment, and it fades. That distinction causes a lot of unnecessary worry.

If You Stop

−

Subcision is not a maintenance treatment. What has been released and filled in stays that way, so the improvement you reach is what you keep.

The first few weeks after a session: That is the exception. Cut strands can reattach in that window, which is why some of the immediate lift fades and why providers often add filler or needling to hold the space open. Stopping after one session leaves whatever survived that reattachment — usually modest but genuine.

Filler is temporary: Filler placed alongside subcision softens over months to a couple of years. If it was doing much of the visible lifting, the scar looks somewhat deeper again as it goes.

Ongoing acne undoes the work: New inflamed spots make new scars, so stopping acne treatment matters more to the long-term result than stopping subcision.

Combining Treatments

−
Same day
Filler
Hyaluronic acid is often placed into the released space at the same visit.
Same day
Microneedling
Plain or radiofrequency, same session or a few weeks later.
Same day
Other scar tools
An acid technique for icepick scars and punch excision for boxcar can share the visit.
Same day
Retinoid and sunscreen
A retinoid supports skin quality; sunscreen protects healing skin.
Wait 2 weeks
Peel or laser
Let bruising settle before either over the same area.
Wait 4 weeks
Another subcision
Space sessions at least 4 weeks apart.
Wait 6 months
Isotretinoin
Most providers wait about 6 months after finishing; it is a judgment call.
Wait 2 weeks
Events
Do not book within two weeks of an event where bruising would be a problem.

Insurance Coverage

−

Insurance almost never covers subcision for acne scars, because scar treatment for appearance is cosmetic. Packages are common and usually cheaper per session, but committing to one before you have seen how your own scars respond to a single treatment is worth thinking about.

Ask Your Doctor

−
If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding before booking, including about the numbing medicine and any filler.
If you take a blood thinner
Or have a bleeding disorder. Bruising and bleeding will be heavier and the plan may change. Never stop a prescribed blood thinner without asking the doctor who prescribed it.
If you still have active acne
Ask whether to treat the acne first. New inflamed spots make new scars beside the treated ones.
If you finished isotretinoin recently
Most providers wait about 6 months. Ask what they do and why.
If you have had filler in that area before
Say what was used and when. It changes where and how the needle is passed.
If you get cold sores
Treatment near the mouth can set one off, and antiviral medicine works best started before the appointment.
If you have ever had a keloid scar
Discuss it first, particularly for scars on the jawline and neck.
If you have broken or infected skin
In the area being treated. A cold sore, an eczema flare or open skin must clear first.
If your scars are icepick
Or have sharp punched-out edges. Ask whether subcision is the right procedure at all, because for those it usually is not.
If you cannot be visibly bruised
For the next two weeks. Say so and reschedule rather than hoping.

At-Home Versions

−
Topical retinoid
Good alternative
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
Okay alternative
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.
Silicone gel and scar creams
Bad alternative
Strong evidence for raised scars, no evidence for indented ones. The wrong tool for this problem. Useful for raised scars, not for dips.
Massage, suction cups and vacuum devices
Bad alternative
Pulling on the skin from outside does not cut a fibrous strand underneath it.
Daily sunscreen
Good alternative
Does not change the scar itself, but it stops shadows being deepened by tanning and prevents brown marks after any procedure. Worth doing regardless.
Needling under the skin at home
Bad alternative
Do not. There is no evidence for safe home use. Blind cutting under the skin without sterility, anesthetic or a way to manage bleeding risks infection, blood collecting under the skin, and new scars.

How It Compares

−
MicroneedlingDiagram: how Microneedling works in the skin
Microneedling
Different job
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
Different job
Adds heat to the needles, which suits texture and firmness. More expensive, and often paired with subcision in the same plan.
Fractional laser resurfacing
Different job
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
Worse
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
Different job
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
Different job
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
Different job
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.

Finding a Provider

+

Subcision is done by dermatologists and dermatologic surgeons, plastic surgeons, and in some practices by trained physician assistants or nurse practitioners under supervision. Rules vary by state. It is not an esthetician procedure — it involves cutting beneath the skin and injecting local anesthetic.

Ask how often they do it, needle or blunt cannula and why, whether filler is included and which product, and what they do if a firm lump appears. Ask to see their own before-and-after photographs in matching lighting, ideally at three months rather than straight after a session.

Red flags: promising to clear your scars, offering subcision for icepick scars, doing it without proper local anesthetic, no mention of bruising in the consultation, refusing to name the filler, treating while acne is actively flaring, and pressure to buy a multi-session package before one treatment has been tried.

Myths

+
  • "Subcision fills the scar in." It does not fill anything. It cuts the strands holding the scar down, and the space that opens is filled by your own healing or by filler placed at the time.
  • "The bruising means something went wrong." Bruising is expected. Blood vessels are cut under the skin by design, and a session with no bruising has often not released much.
  • "One session will fix it." Most people need 2 to 4, and some of the first session's improvement is lost to retethering. A single treatment gives a partial result.
  • "It works on all acne scars." It works on tethered rolling scars. Icepick and sharp-edged boxcar scars need different procedures, and subcision achieves little on them.
  • "You can do it at home with a needle." No Cutting blind under the skin without sterile technique, anesthetic or a way to control bleeding risks infection, a collection of blood, and worse scarring than you started with.
  • "People with deeper skin tones cannot have it." They can, and it is often a good choice precisely because it uses no heat or light. The thing to manage is the brown mark left by bruising, not the procedure.

Questions Patients Ask

+

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.

References

+