Did you know that there are different types of acne scars? There are the indented atrophic acne scars such as an ice-pick scar, boxcar scar and rolling scar; and the overgrowing hypertrophic scar and keloid. Atrophic scars are the more common form of acne scars. They are caused by destructive inflammation and loss of collagen tissue in the dermis, resulting in an indented or depressed surface in the skin.
- Ice pick acne scars are narrow and deep scars that appear like pores. They are usually found in areas where the acne breaks out more regularly. Ice pick scars also can occur after picking on whiteheads and blackheads.
- Boxcar acne scars have wider and shallow bases and do not taper down. They usually form after a brutal acne breakout, resulting in a pothole look.
- Rolling acne scars are much wider and have a wave-like appearance. The rise and fall of skin are due to the abnormal fibrous attachment under the skin.
What is subcision?
Different types of scar require different types of treatment. For rolling scars, subcision is the treatment of choice. Subcision is a simple and safe minor surgical procedure that uses a special hypodermic needle to puncture under the acne scar. The sharp edges are manipulated in order to break the fibrous tissue that tethers the scar to the underlying subcutaneous tissue. This results in lifting the depression of the scar surface and inducing new connective tissue formation directly beneath the scar, without injury to the skin surface. Hence, it is also called subcutaneous incision-less surgery. A patient may require multiple sessions of subcision to achieve satisfactory improvement in an acne scar. Complications of subcision treatments for scars include pain, swelling, bruising, bleeding, infection and recurrence.
How much percentage of improvement is achieved through subcision on acne scars?
A study involving 40 patients was conducted in 2015 to assess the efficacy of subcision in treating rolling acne scars. The result was approximate of 50% improvement reported from patients and investigators. Meanwhile, 90% of the patients were satisfied with the improvement. Side effects like pain, bruising and swelling were transient but the first bumps at the treatment site remained permanent.
Several studies were done to further improve this treatment. One study involving 18 patients found that subcision using a blunt blade may be effective when 83.3% of marked improvement was reported. Complications like mild pain, bruising and swelling resolved within a week after the procedure. Another study from the Journal of Cosmetic Dermatology also reported that blunt cannula subcision is more effective than the subcision using needles as it causes fewer and less severe complications. Around 56% of patients were satisfied with blunt cannula subcision as compared to nearly 42% that were treated with needle subcision.
The current subcision method may be valuable to treat rolling acne scars, but due to the high recurrence rates, there was only mild to moderate efficacy. In order to increase the effectiveness of subcision, a complementary treatment was proposed. The study found that by adding repeated suction sessions during the recurrence period of the subsidised scar, 46 of the 58 participants had achieved significant improvement up to 71.73%. Even those who delayed treatments or were inconsistent with the sessions showed an average of 43.75% improvement. This confirms that frequent suctioning at the recurrence period of subcision is able to increase its efficacy remarkably by producing persistent improvement in a short time, without considerable complications. Therefore, the subcision-suction treatment was introduced as the new and effective treatment for rolling acne scars.