Subcision Acne Scar Treatment in Bangkok: How It Works.

  At Mingkwan Clinic in Bangkok, Thailand, we provide subcision as a key treatment for atrophic (depressed) acne scars. Subcision can be combined with other modalities such as laser resurfacing, hyaluronic acid, or collagen-stimulating injections to enhance overall results through a synergistic approach.

What Is Acne Scar Fibrosis?

  Acne scars form when deep inflammation damages the normal skin structure. During the healing process, disorganized collagen develops and forms fibrous bands beneath the skin surface.

  These fibrotic strands can tether the skin downward, creating indented or depressed scars that are often difficult to improve with surface treatments alone.

When Does Acne Scar Fibrosis Occur?

  Fibrosis can begin forming as early as the first month after an acne lesion heals. Over time, these fibrous bands become thicker and firmer. After approximately 6–12 months, the fibrosis may become dense and more resistant to treatment.

  A simple way to distinguish newer scars from older scars is by their color:

• New scars are typically red or pink and tend to respond more easily to treatment.
• Older scars usually match the surrounding skin tone and contain more established fibrosis underneath, making them more challenging to treat.

Why Subcision Is a Key Acne Scar Treatment

  Subcision (short for subcutaneous incisionless surgery) is a well-established medical technique used to release fibrous bands beneath the skin.

  By carefully breaking these tethering bands, subcision allows the depressed scar to elevate toward the surface. This improves the contour and reduces the depth of rolling or tethered scars.

  Unlike laser treatments that primarily resurface the skin, subcision addresses the structural cause of depressed scars beneath the surface.

Types of Subcision

  At Mingkwan Clinic, we classify subcision into two main categories:

1) Traditional Subcision (Deep-Level Release)

  Traditional subcision mechanically releases fibrosis at the dermo-subcutaneous junction, approximately 2–3 mm beneath the skin surface. This technique is suitable for deeper acne scars.

  Releasing fibrosis at this level helps lift the depressed scar.

  The tools used in traditional subcision include:

• Sharp needles: Modified needles with blade-like tips (such as the Nokor needle). These are highly effective at cutting fibrous bands but may cause more bruising or bleeding.
• Blunt cannulas: Typically used for filler injections. They are safer and cause less bruising, but they are less effective at cutting dense fibrous bands.
• Specialized subcision instruments (e.g., Taylor’s Liberator): Specifically designed for subcision procedures. They help release fibrous bands with controlled movement while minimizing unnecessary trauma.

2) Upper-Skin (Superficial) Subcision

  This technique targets fibrosis within the dermis, typically within 2–3 mm from the skin surface.

  Traditional subcision tools may not effectively separate fibrosis in this layer because the dermis behaves like elastic tissue and can reattach within a few days after treatment.

  One method used for superficial fibrosis is a needle-free jet injector. This device delivers high-pressure fluid into the skin to mechanically separate fibrotic attachments and create controlled subcision. This technique is particularly suitable for shallow acne scars and has been supported by medical publications. Click for the reference >>> Medical Publication

Is Subcision Needed for Every Acne Scar?

Not necessarily. The decision depends on several factors:

• Scar age: New scars may improve with laser treatment alone. Older scars with established fibrosis usually benefit from subcision.
• Cause of depression: If the indentation is primarily caused by fibrous tethering, subcision is beneficial. If the depression is mainly due to volume loss, collagen-stimulating treatments or fillers may be more appropriate.
• Scar location: The cheeks are generally safer and more suitable for subcision. Areas such as the forehead and nose have thinner skin and higher risk, so subcision may be less advisable.

Subcision: Before and after

• Type of acne scar (rolling scars typically respond best)
• Age of the patient (younger patients often respond more favorably)
• Density and thickness of fibrosis
• Technique and instruments used
• Combination with other treatments such as laser resurfacing or collagen-stimulating injections

  ***Results vary by individual*** ***No Photoshop used to edit scars***

Should Laser or Collagen-Stimulating Injections Be Combined with Subcision?

Combination treatment is often recommended.

Subcision releases fibrotic bands but does not significantly stimulate collagen production by itself. Without additional collagen stimulation, the scar may not thicken or elevate as much as desired.

Laser treatments and collagen-stimulating injections help promote new collagen formation, enhancing overall improvement in scar texture and depth.

Cost of Subcision

• Cost of subcision alone at Mingkwan Clinic
  Entire face: 10,900 THB
  Both cheeks: 8,900 THB
  Both temples: 5,500 THB
• Cost of subcision combined with other treatments (such as laser or biostimulator injection)
  Entire face: 7,900 THB
  Both cheeks: 5,900 THB
  Both temples: 2,500 THB