SUBCISION and SCARS
*making skin surface even by releasing fibrosis under the skin and “ironing” structures under the skin
What is treated with subcision?
Our Melbourne cosmetic doctor will determine the best option for each patient, and the technique can be used to treat a variety of cosmetic problems, but most common are:
- rolling depression scars (acne, after trauma or surgery)
- bound down scars (acne, surgery, chickenpox, trauma).
- wrinkles, except preauricular and mandibular
- cellulite dimples
What are contrindications for scars subcision?
Please, make sure you disclose your full medical information to our cosmetic doctor during your consultation
- active infection
- systemic retinoids within 6-12 months
- kelloid or hypertrophic scars ever
- bleeding or clotting disorders
What to do after the procedure?
Pressure and ice may be applied to reduce the risk of bleeding.
microneedling over the treated area for the best results (as discussed with your doctor prior the procedure).
Soothing post procedure mask with hyaluronic acid and other active ingredients.
antibacterial ointment applied by the doctor to “seal” the micro holes and prevent infection.
Make up can be applied to cover the bruising.
The number and intensity of subcisions should be limited on the first treatment to review the patient’s response, particularly when treating areas with a predilection for a hypertrophic reaction after subcision.
For more information about post procedure home care you can read at the aftercare advise page here
Subcision is a group of minor surgical procedures to treat depressed defects in the skin. Most commonly used for scars and wrinkles. VISTA cosmetic Clinic Melbourne doctor performs the procedure at our office, you do not need a hospital.
it is a minor surgery and cost, downtime and effect would be determined by the extent and severity of skin depressions.
Special incision needle is inserted into skin through a small puncture and then procedure is done under the skin. Local anaesthetic with adrenaline is used to ensure less pain and bruising.
The needle sharp edge or canula used to break the fibrotic tissue, tethering down skin to the underlying layers.
Such release of the scar strands and formation collagen via wound healing mechanism significantly improve appearance of the skin.
How many procedures are needed?
Can vary a lot depending on severity of scars, individual response, intensity of the treatment, location and individual ability to form collagen.
Very rough estimate is form three to six procedure for moderate degree of scars and good response.
What are intervals between the subcision of scar treatments?
At least 1 month between treatments is recommended, ideally 6 weeks because collagen formation by that time would provide additional result and the patient might not need any further treatments. Also, it’s sufficient time to heal.
How subcision procedure is performed?
The procedure of subcision is an office based and include the following steps:
- The treated area is thoroughly cleansed to remove dirt, oil and make-up
- Cosmetic doctor will make a photos and may define scars margins with a surgical marker.
- Local anaesthetic with adrenaline is injected.
- A special needle is inserted at an acute angle adjacent to the scar with the bevel upwards and parallel to the skin surface. Smaller gauge needles (25–27) may be used for small superficial scars and wrinkles.
- The needle is advanced through the dermis and moved back and forth in a fan-like motions. Patient may hear a typical snapping sound as the fibrous bands are transected in the deep skin.
- The needle is removed and doctor will apply pressure on the area to prevent large haematoma formation due to bleeding.
- Filler may be used to inflate the depressed deficiencies and enhance collagen formation.
What are potential complications of scar subcision?
- haematoma (blood collection). Small bruising and lump is normal and enhance growth factors.
- infection – looking like acne and pustules
- pain/tenderness in the treated area
- hypertrophic and kelloid scars in app 5-10% of cases of upper lip, lip commisure, glabella and under eyes.
- injury of nerve or blood vessel, especially in temporal, manibular and around ears
- increased hyperpigmentation – usually due to lack of compliance with post care advice – patient goes to the sun.
- lack of response – individual lack of collagen formation.
What are best combinations of treatment?
- topical retinoids (vitamin A based creams) – there are a lot of them in the market, your cosmetic doctor will advise the best for you.
- peeling. There is some evidence of 15% TCA peel, but the choice of peel is very individual
- microneedling
- TCA cross peel for icepick and other very resistant areas
- filler for inflating the deficiencies.
What are results?
Usually excellent. As we age, maintenance procedures may be needed, but in most of the cases results are permanent.
Book your comprehensive consultation with Dr Miller where your specific situation will be assessed with a few machines and, if active acne, individual treatment plan will be prepared which includes prescription only medications.
KELOID AND HYPERTROPHIC SCARS
What are treatment options for keloid?
Unfortunately, keloids are 1 of the most unpredictable and tricky for treatment conditions. Trauma from treatment may induce more keloid tissues to grow.
Options include:
- sterod injections into keloid to reduce inflamation and shrink the size
- restriction of movement of the keloid by bands, silicone gel pads etc
- moisturizers to keep the keloid tissue soft
- freezing the tissue with Liquid Nitrogen to reduce the tissue and kill growing cells
- radiation
- 5FU is still considered experimental and review results of efficacy is pending (more info here)
- IMM topical application – the prescription only medication (can’t disclose to public the full name to comply with Australian legislation). The medication modifies immune system and used to shrink in size and kill cells in non-aggressive tumors like BCC, actinic keratosis and genital warts. Such treatment is still off label in nature and we don’t have enough data on it’s efficacy.
Earlier treatment started, better prognosis will be.
Please, do not delay to see a cosmetic doctor for the keloid scar, if you suspect you have one. Although we have experience in treating keloid even years after it appeared, VISTA Clinic Melbourne can’t emphasize enough to seek doctor’s advice early.
Keloid and hypertrophic scars occur after the injury is healed and are types of raised scars. Keloid scars keep growing weeks and months after the healed wound.
What is the cause of keloid of hypertrophic scar?
Anything what can cause a scar, can cause keloid – cut, burn, acne, vaccination, tattoo, chickenpox, ear piercing. Keloids are often genetically determined and more pronounced on the areas with more movement.
who more prone to keloids formation:
-people of Asian descent
-people of Latin descent
-pregnant
-under 30 years old.
Can it self improve?
once formed, keloid scars are permanent. Unfortunately, even months and years later, scars still can grow. Our Melbourne clinic and none of experienced cosmetic doctor observed cases of self improvement of keloid scars. Usually, it’s the other way around – the tissues keep growing as time goes by.
What are symptoms of keloid?
keloids are self- diagnosed usually – most of our Melbourne clinic patients ask keloid scar treatment when call. It’s basically overgrowth of scar tissue.
- lumpy or ridged area above the scar, raised.
- red or pink color (also means it would respond to the treatment best)
- continue growing over the injury with time
- itchiness around the injury site.
Keloid scar is larger than the wound itself.
It’s not only cosmetic concern, keloid scar can be irritating and restricting to movements. Keloid can darken under the sun, what makes it more noticable. Sun protection is usually recommended.
Any growing lesion on your body needs to be checked by doctor to exclude cancer.
