At Mingkwan Clinic in Bangkok, Thailand, subcision, also known as subcutaneous incisionless surgery, is a technique for treating acne scars. This effective method complements laser treatments and collagen-stimulating injections. Over the years, subcision has evolved significantly, and we have developed specialized tools and techniques to optimize results. This article explores the details of subcision, its procedure, and its benefits.
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What is Acne Scar Fibrosis?
- In medical terms, fibrosis refers to the formation of excess fibrous connective tissue in an organ or tissue.
- It occurs when deep skin injuries (like surgical wounds) or severe inflammations (such as large, inflamed acne) stimulate the body to repair itself by creating new collagen, but this collagen is often disorganized.
- This leads to the formation of hard, fibrous bands that pull the skin down.
- Patients may recognize this from large scars that feel hard underneath or tough areas in meat, which are examples of fibrosis.
- In the case of large, inflamed acne with pus cavities underneath, once the acne heals, the skin collapses where the cavity was, and the repair process results in fibrous bands that pull the skin down, forming acne scars.

When Does Acne Scar Fibrosis Occur?
Fibrosis starts forming as early as the first month after the acne scar appears. The fibrous bands grow larger and harder over time. After 6-12 months, the fibrosis becomes very hard and difficult to treat. An easy way to identify new versus old scars is by their color; new scars are red or pink and easier to treat, while old scars are the same color as the surrounding skin and have more fibrosis underneath, making them harder to treat.
Is Subcision Needed for Every Acne Scar?
It depends on several factors:- Whether the scar is new or old. New scars may not require subcision and can be treated with lasers alone. However, old scars typically need subcision.
- The location of the scar. Cheeks are easier and safer for subcision, while the forehead and nose are riskier and have thinner skin, making subcision less advisable. (Ultimately, the decision is up to the physician’s judgment.)
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Acne Scar Treatment: Before and After
How is Subcision Done?
- The principle involves inserting a tool through the top layer of skin to cut the fibrous bands underneath the acne scar. During subcision, patients will hear a “snap sound,” indicating the fibrous bands breaking. After subcision, some scars may lift immediately. The effectiveness of subcision depends on the type and severity of the scars, the tools used, the technique, and the time taken for the procedure.
- The tools used for subcision are generally divided into three main groups:
- Sharp needles involve modifying needles to have a blade-like tip. These are highly effective at cutting fibrous bands but can cause significant bleeding and bruising, and if not used carefully, they can damage nerves, salivary ducts, or facial muscles.
- Blunt cannulas are typically used for injecting fillers or collagen stimulants. They are safer for nerves, salivary ducts, and facial muscles but less effective at cutting fibrous bands.
- Specialized tools combine the advantages of sharp needles and blunt cannulas. These tools are specifically designed for subcision, usually imported from abroad. They effectively cut fibrous bands, cause minimal bruising, and have a low risk of damaging nerves, salivary ducts, or facial muscles (when used with the correct technique).

How Many Layers Are Involved in Subcision?
- The skin consists of three layers: 1. The epidermis, which is very thin (less than 0.5 mm) and responsible for cell turnover and skin renewal; 2. The dermis, a strong layer protecting the body; 3. The subcutaneous fat layer.
- Acne scar fibrosis occurs in the dermis and subcutaneous fat layer, especially at the junction between these two layers.
- At Mingkwan Clinic, we perform subcision on the superficial layer (dermis and dermis-fat junction) and the deep layer (within the subcutaneous fat) using different tools for maximum effectiveness.
Subcision: Before and after
The results of subcision depend on several factors, including:- Type of acne scar, with rolling scars showing the best results.
- Age of the patient, with younger patients generally achieving better results.
- Thickness and amount of fibrosis.
- Technique and tools used during the procedure.
- Combination with other acne scar treatments, such as lasers or collagen-stimulating injections, which generally enhance the results.
***Results vary by individual*** ***No Photoshop used to edit scars***

**Note the significant improvement in the forehead area, which is usually difficult to treat, when using the correct subcision technique.



Should Laser or Collagen-Stimulating Injections Be Combined with Subcision?
It is recommended to combine them, as subcision alone cannot stimulate collagen production in the acne scar area effectively. The scars may not thicken or lift as much as desired.
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Acne Scar Treatment: Before and After
Cost of Subcision
Similar to rhinoplasty, which ranges from almost 10,000 THB to over 500,000 THB depending on the technique and duration of the surgery, the cost of subcision varies based on the technique, tools used, and time taken (ranging from 3-5 minutes to 30-60 minutes). Currently, the cost generally ranges from a few thousand to tens of thousands of THB. It is recommended that patients consult directly with the clinic’s physician for more details.
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Cost of subcision in Mingkwan Clinic
Entire face: 7,900 THB
Both cheeks: 5,900 THB
Both temples: 2,500 THB