How Subcision Works?
If you’ve struggled with acne, you know that the “aftermath” can sometimes be more frustrating than the breakouts themselves. In Malaysia, where the tropical sun can make shadows on uneven skin more prominent, subcision has emerged as the “gold standard” for treating those stubborn, indented scars that lasers just can’t seem to reach.
Understanding Rolling & Depressed Acne Scars
What Are Rolling Acne Scars?
Rolling scars give the skin a “wavy” or undulating appearance. They aren’t sharp or deep like ice-pick scars; instead, they are broad depressions that become more visible under certain lighting—like when you’re standing under a bright downlight in a mall.
What Are Depressed (Atrophic) Acne Scars?
Atrophic scars occur when the skin cannot regenerate enough tissue during the healing process. This results in “pitted” or sunken areas. Common types include rolling and boxcar scars, which often make the skin surface look aged or rough.
Why Rolling & Depressed Scars Are Tethered to the Skin
The reason these scars look like “craters” is that they are literally being pulled down from underneath. During the inflammatory acne phase, the body creates tough, fibrotic bands of collagen that anchor the top layer of your skin to the deeper subcutaneous tissue. Think of it like a button on a tufted sofa pulling the fabric inward.
What Is Subcision Treatment?
Definition and Medical Background of Subcision
Subcision is a minor surgical procedure performed by aesthetic doctors or dermatologists. It involves inserting a specialized needle or cannula beneath the scar to physically “sever” the bands causing the depression.
Why Subcision Is Effective for Tethered Acne Scars
Most surface treatments like chemical peels or mild lasers only address the top layer. Subcision is unique because it treats the root cause—the mechanical pulling of the skin—making it essential for any real improvement in rolling scars.
How Subcision Works Step by Step
Breaking Fibrotic Bands Under the Skin
The doctor moves a needle or cannula in a fan-like motion. As the instrument cuts through the fibrotic bands, you might hear a “snapping” or “popping” sound. Don’t worry—that’s just the sound of the tethers being released!
Controlled Trauma and Natural Collagen Stimulation
Breaking these bands creates a controlled wound. This triggers your body’s natural healing response, sending growth factors to the area. According to Healthline, this process is vital for long-term skin remodeling.
Skin Elevation and Surface Smoothing Process
Once the bands are cut, the skin is no longer pulled down. It “springs” back up, immediately smoothing the surface. Over the next few months, new collagen fills the space, preventing the scar from re-tethering.
Why Subcision Is Ideal for Rolling & Depressed Scars
Targeting the Root Cause of Scar Indentation
While lasers can polish the surface, they cannot cut the “strings” pulling the skin down. Subcision is the only way to release that tension.
Limitations of Lasers and Topical Treatments
Many patients in Malaysia spend thousands on lasers without seeing results for rolling scars. This is because the heat from lasers often cannot penetrate deep enough to break the thick fibrotic bands.
When Subcision Works Better Than Other Acne Scar Treatments
If your scars disappear when you stretch your skin with your fingers, they are likely tethered. This is a clear sign that subcision is the most effective starting point for your treatment plan.
Subcision Techniques Used in Malaysia
Needle Subcision vs Cannula Subcision
Nokor Needle: A sharp, blade-like needle ideal for precise cutting of individual, tough bands.
Cannula: A blunt-tipped tool that is generally preferred in many Malaysian clinics as it reduces bruising and the risk of hitting blood vessels.
Single-Entry vs Multiple-Entry Techniques
Using a cannula often allows the doctor to treat the entire cheek through a single entry point, which minimizes visible marks and speeds up recovery.
Doctor Skill and Technique Importance
Subcision is highly “operator-dependent.” In Malaysia, ensure your doctor is MMC registered and has specific experience in scar revision to avoid complications like “nodule” formation.
What Happens During a Subcision Procedure
Pre-Treatment Assessment and Marking
Your doctor will use “tangential lighting” (shining a light from the side) to identify every shadow and mark the scars with a surgical pen.
Local Anaesthesia and Patient Comfort
A local anesthetic (lidocaine) is injected into the area. Most patients report that once the numbing kicks in, the procedure is quite comfortable—you’ll feel pressure and tugging, but no sharp pain.
Procedure Duration and Sensation
The entire process usually takes 20 to 40 minutes, depending on the number of scars being treated.
Subcision Results for Rolling & Depressed Acne Scars
Immediate vs Progressive Improvement
You will see an immediate “lift” because of the swelling and the release of the bands. However, the real, permanent results show up around the 3-month mark as collagen matures.
Expected Improvement Percentage
Most patients see a 30% to 60% improvement after a series of sessions. It’s rare to get 100% “perfection,” but the change in how makeup sits on the skin is usually dramatic.
Factors Affecting Subcision Results
Your age, smoking habits, and skin’s ability to produce collagen all play a role. Older skin may require more sessions as collagen production naturally slows down. For more on collagen, WebMD offers a great overview.
Subcision Recovery and Healing Process
Swelling, Bruising and Downtime Explained
Expect to look a bit “puffy” for 3–5 days. Bruising is common and can range from yellow to deep purple, but it is easily covered with concealer after the first 48 hours.
Healing Timeline for Rolling & Depressed Scars
Day 1-3: Peak swelling and bruising.
Day 7: Most bruising has faded; skin looks much smoother.
Week 4: Initial collagen starts to form.
Post-Subcision Aftercare Guidelines
Avoid strenuous exercise for 5 days to prevent further bruising. Use a cold compress in the first 24 hours to keep swelling down.
How Many Subcision Sessions Are Needed?
Single Session vs Multiple Sessions
While one session helps, most Malaysian doctors recommend 3 to 6 sessions for deep, long-standing scars.
Treatment Intervals and Collagen Remodeling
Sessions are usually spaced 4 to 8 weeks apart to allow the skin to fully remodel before the next round of “lifting.“
Combining Subcision with Other Treatments
Subcision is rarely done alone. It is often the “foundation” for a multi-layered approach:
Subcision with RF Microneedling
RF Microneedling (like Sylfirm X or Potenza) tightens the skin from the top while subcision works from the bottom.
Subcision with Laser Treatments
Once the scars are lifted, a Fractional CO2 Laser or Pico Laser is used to “sand down” the edges and improve the skin’s surface texture. DermNet provides excellent clinical details on how these lasers function.
Subcision with Dermal Fillers or Skin Boosters
Injecting a filler like Rejuran S or Hyaluronic Acid immediately after subcision acts as a “spacer,” preventing the bands from re-attaching while the area heals.
Is Subcision Safe for Acne Scars in Malaysia?
Doctor Qualifications and Clinical Standards
Always choose an LCP-certified clinic. In Malaysia, medical aesthetic procedures must follow strict MOH guidelines.
Possible Side Effects and Risks
Minor risks include temporary lumps (hematomas) or infection. Choosing a sterile, professional clinic minimizes these risks significantly.
Who Should Avoid Subcision
If you have active cystic acne, you must treat the breakouts first. Subcision is also not recommended for those on blood thinners or with a history of keloid scarring. For safety profiles, the American Academy of Dermatology is a reliable source for procedural risks.
Cost of Subcision in Malaysia
Average Price Range in Malaysia
Typically, subcision costs between RM 800 to RM 2,000 per session.
Factors That Influence Treatment Cost
Area size: Full face vs. just the cheeks.
Technique: Cannula subcision is often slightly more expensive than needle subcision.
Combination: Most clinics bundle subcision with lasers or fillers, which provides better value.
FAQs About How Subcision Works
Does Subcision Permanently Release Acne Scars?
Yes! Once the fibrotic band is severed and the space is filled with new collagen or filler, the “tether” is gone for good.
Can Subcision Make Acne Scars Worse?
If performed by an untrained individual, there is a risk of sagging or nodules. However, in the hands of a professional, it is one of the safest scar treatments available.
When Will I See Final Results?
Final results are typically visible 3 to 6 months after your last session, as that is how long it takes for the “remodeling” phase of collagen to finish.
