37 year-old Hispanic male underwent a single subcision session on his cheeks. After photos are 1 year after one subcision treatment.
Of note on his Before photos, this patient already had 1 full CO2 laser resurfacing ($8000) and a series of Fraxel Restore sessions ($6000 total). This patient did feel that the texture and color improved with the lasers, but did nothing “pop out” the acne scars after the multiple laser treatments. The single subcision session “popped out” the indented rolling scars more than the combine efforts of multiple laser session including a full CO2 laser resurfacing (considered the Gold standard for laser skin resurfacing.) Although his skin is not perfect after a single session, the improvement surpassed the promises of his prior laser sessions. This patient had a second subcision session at his 1 year follow up.**
Dr. Yang’s feels that the laser skin resurfacing help to buff the acne scarred skin out if there are sharp edges (boxcar type edges) and also reduce redness which can mark the deepest part of these rolling scars, but does little to “pop out” the rolling acne scar. Why? Laser skin resurfacing is performed evenly across the skin, yet we expect the deepest part of the rolling scar to pop out, when the same laser resurfacing is performed on the normal skin surrounding the rolling scar as the rolling scar itself. It just doesn’t make sense to our practice. Each rolling scar typically forms from an acne cyst inflammation. It is understandable that the inflammation from the acne cyst may have caused some fat and soft tissue necrosis, and when the acne resolves, there is a soft tissue loss, which we see as an indented rolling scar with lack of physical support under the skin. Fillers and subcision attempt to treat the indented areas differently from the surrounding normal skin. After the skin is smoother, with customized treatments for the indented areas, then lasers can be used to further improve skin texture and reduce pigmentation and redness which is causing uneven skin coloring.
**This patient’s immediate post-procedure photos are available for viewing during a consultation to prepare a potential patient both mentally, as well as logistically. Being able to scheduling recovery time without worrying about needing to rush back to work or school while the swelling and bruising is at it’s worst, will help to reduce stress after the procedure. At the 2 week mark, the worst of the swelling is resolving, and there may be a “honeymoon swelling” or micro-swelling which can make the skin look smoother than the final result.
