Blunt Blade Subcision: An Evolution in the Treatment of Atrophic Acne Scars

Procedural and surgical treatment modalities for acne scarring: Part II

The optimal treatment of acne scarring is challenging because several factors need to be considered, including the type and number of scars, Fitzpatrick skin type, and the amount of downtime permissible to the patient. This second article in the continuing medical education series discusses the procedural treatments available for acne scarring, including the use of chemical peels, fillers, radiofrequency microneedling, lasers, and surgical procedures. The indications for each modality, evidence for its benefits, and the adverse effects are discussed. This section aims to help guide the reader select and implement the most appropriate treatment based on the patient's preferences, acne scarring, and skin type.

Investigating the impact of added Profhilo mesogel to subcision versus subcision monotherapy in treating acne scars; a single-blinded, split-face randomized trial

BACKGROUND

Acne scar is an inflammatory condition, which commonly occurs in patients with acne vulgaris, especially in adults. Mesogels have been reported effective in improving atrophic acne scars.

AIMS

We investigated the efficacy of adding Profhilo (a hyaluronic acid-based filler) to subcision as a new treatment method.

METHODS

Twelve patients aged 18-45 years with atrophic acne scars on both sides of the face participated in this single-blinded, split-face, randomized controlled trial. Each side of the face was randomly assigned to one of the treatment methods, including subcision alone and subcision + Profhilo. Patients in the Profhilo arm received mesogel (1 cc) in addition to the subcision procedure. Both methods were carried out two times at 1-month intervals. Assessments were done based on the sonographic depth of scars, and two blinded observers examined photographs at baseline and 3 months after the final session and the results were reported based on an exclusively made formula as the total score. The Global Improvement Scale and Visual Analogue Scale (VAS) (for patient satisfaction) were also used.

RESULTS

The VAS score of patient satisfaction was statistically significant in the Profhilo arm, with a mean improvement of 528.08 and 219.06 in the subcision arm (p = 0.02). No significant difference was seen in total acne scar reduction comparing the two methods (29.74 in the Profhilo arm and 22.27 in the subcision arm, p = 0.56). Sonographic depth reduction was also non-significant, with a mean of 29.21 in the Profhilo arm and 28.53 in the subcision arm (p = 0.4). The mean global improvement was reported as four in both arms, and no statistical significance was observed (p = 0.89). The best response to treatment belonged to the rolling subtype in both methods (p = 0.029 for the Profhilo arm and p = 0.001 for the subcision arm).

CONCLUSION

Despite no significant difference between the methods, Profhilo is more effective due to a higher satisfaction rate and better physiologic effects.

Modern techniques in addressing facial acne scars: A thorough analysis

BACKGROUND

Facial acne scars are a prevalent concern, leading to the development of various treatment modalities.

OBJECTIVES

This review aims to explore the latest advancements in the treatment of facial acne scars, focusing on both surgical and non-surgical methods.

METHODS

The non-surgical treatments reviewed include topical medications (such as retinoids and alpha hydroxy acids) and non-invasive procedures (like microdermabrasion and chemical peels). Surgical options discussed are punch excision, subcision, and fractional laser treatments.

RESULTS

Combination therapy, integrating both surgical and non-surgical approaches, is frequently utilized to achieve optimal results in scar improvement.

CONCLUSION

Recent advancements in the treatment of facial acne scars provide promising options for individuals seeking improvement. However, these treatments have associated risks and potential adverse effects, highlighting the importance of consulting a dermatologist before beginning any treatment regimen.

Surgical Subcision for Acne Scars: A Review of Instrumentation

BACKGROUND

Subcision is a surgical technique for managing atrophic acne scars. Over time, new instruments have emerged to increase the efficiency, efficacy, and safety of the subcision procedure, including sharp, blunt, and energy-assisted devices.

OBJECTIVE

To review the instrumentation used for the subcision of acne scars and to provide clinicians with practical information regarding the selection of instrumentation, with a focus on advantages and disadvantages.

METHODS

A search of PubMed, MEDLINE, and Google Scholar was conducted for articles from January 2000 to June 2022 describing the use of subcision alone for the management of acne scarring. Demographic and clinical data were collected from the included articles.

RESULTS

A total of 417 patients from 17 articles were included; 155 patients underwent sharp subcision, 235 patients underwent blunt subcision, and 27 patients underwent energy-assisted subcision. The main indication for subcision was atrophic facial acne scars. Subcision using sharp, blunt, and energy-assisted instruments were all effective in treating atrophic acne scars. Adverse effects common to all subcision methods included erythema and edema.

CONCLUSION

Subcision is a safe and effective modality for the revision of selected acne scars and is a valuable skill set for dermatologists who perform scar revision to master.

Subcision in acne scarring: A review of clinical trials

Post-acne scarring is the most common permanent consequence of acne vulgaris. Subcision is an intervention in which a needle or blunt cannula is inserted under the scar and moved back and forth to cut fibrotic strands and form new connective tissue, thereby elevating the atrophic scars. In this study, we reviewed the efficacy and adverse effects of different subcision techniques alone or in combination with other modalities to manage acne scars. The terms (subcision), (subcision AND acne scar), and (subcision AND scar) were searched in PubMed and Google Scholar. We included all available reports on clinical trials written in English and published before June 2022. A total of 16 relevant articles were identified after reviewing the abstracts and full texts. Four articles compared blunt cannula-based subcision as a modified technique with needle-based subcision as a conventional method, while the others investigated the combination of subcision with other modalities. According to our findings, subcision is a safe and effective method for treating atrophic acne scars. Needle-based subcision and cannula-based subcision offer comparable efficacy, with the latter causing fewer side effects and inducing greater patient satisfaction. Combining subcision with the application of autologous tissues (platelet gel) or artificial materials (hyaluronic acid gels and threads) as fillers can improve outcomes and prevent the re-depressing of scars, as can its combination with frequent suctioning. Combinations with microneedling or fractionated microneedle radiofrequency have also been safe and effective. We conclude that modifications of the subcision procedure lessen its side effects, and combination therapies improve its efficacy.

Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments

Subcutaneous incisionless surgery, also known as subcision, is a minimally invasive procedure that is commonly indicated for the treatment of atrophic acne scars. In recent years, many new techniques have been developed to maximize results from this procedure. This review article aims to identify an updated list of instruments and combinatorial treatments available for atrophic acne scar patients undergoing subcision. We constructed a comprehensive PubMed search term and performed triple-blinded screening on all resulting studies for mentions of subcision as indicated by acne scarring. Our results show that there are four main categories of subcision tools that are commonly employed to treat atrophic acne scars: needles, cannulas, wires, and blunt-blade instruments. Usage of these devices varies by scar depth, personal preference, and combinatorial treatment options. Overall, subcision is a particularly effective treatment for atrophic acne scars, and there is vast potential for further innovation with this technique.

Single session of combined microfat and subcision in the treatment of Grade 4 atrophic acne scars

BACKGROUND

Severe atrophic acne scars (AAS) remain the "Achilles's heel" of AAS treatment. The combination of microfat and subcision treatment is a potential solution for severe AAS.

AIMS

This study aimed to evaluate the efficacy and safety of combined microfat and subcision treatment for severe (Grade 4) AAS.

METHODS

Data of patients with Grade 4 AAS who underwent combined microfat and subcision treatment between September 2016 and December 2020 were reviewed. Post-treatment evaluation was performed at least 3 months postoperatively. The severity of AAS was graded based on Goodman's qualitative classification. The volume of concavities was measured using an Antera 3D camera. Complications were documented.

RESULTS

A total of 42 patients received a single treatment session. Excellent response was observed in 5 (11.9%) patients, very good in 13 (31.0%), good in 22 (52.4%), and poor response in 2 (4.7%). The average reduction of the total volume of concavities was 28.0%. The most common minor side effects were mild swelling and bruising. No major complications were observed.

CONCLUSIONS

Combined microfat and subcision treatment is a safe and effective treatment for severe AAS. The approach will be a significant treatment for severe AAS.

A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring

Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.

Clinical and Histopathological evaluation of different tools for the Subcision of Atrophic Acne Scars

BACKGROUND

Acne scarring can lead to social and psychological distress.

OBJECTIVE

To compare the safety, efficacy, and long-term improvement of subcision using tri-beveled hypodermic (Th) needle versus cannula for the treatment of atrophic post-acne scars.

METHODS

Forty-six patients with atrophic post-acne scars were treated with subcision using (Th) needle on one side of the face and a blunt cannula on the other side of the face for 6 sessions one month apart. The primary outcome was based on the clinical improvement and patient satisfaction score. Skin biopsies were taken at baseline and 3months after the final session. Follow-up was 9 months.

RESULTS

Three months after the final session, a statistically highly significant difference was detected in both sides from the baseline (p < 0.001). The overall improvement was 73.9% on the (Th) needle side versus 65.2% on the cannula side (p = 0.68). There was no significant difference in acne severity scarring grade between both sides (p = 0.86). The mean number of sessions was significantly less in the (Th) needle side (p < 0.001). Collagen deposition and reorganization were achieved with both modalities. Patient satisfaction showed no significant difference between both sides. The side effects were mild and significantly higher in the (Th) needle side (p = 0.001).

CONCLUSION

Both modalities are effective and economic techniques. However, using a cannula is associated with much fewer side effects, more convenient for the patients and physicians compared to the (Th) needle.

Subcision: Indications, adverse reactions, and pearls

BACKGROUND

Subcision, also known as subcutaneous incisionless surgery, is a surgical intervention used to treat a variety of skin conditions including atrophic acne scars, depressed scars, cellulite, and wrinkles.

AIMS

We plan to prepare a review article about the indications of subcision, its adverse reactions, and pearls.

PATIENTS/METHODS

We searched the literature for the information about subcision and its applications from papers published up to March 2019. The search was performed through the databases of the National Library of Medicine.

RESULTS

After a thorough review of the published papers about subcision, we finally chose to review 40 articles that had proper sample size and design to prepare this review article. Twenty-one papers were related to the application of subcision in the treatment of acne scar and other scars. Four articles were about the application of subcision to treat cellulite, and eight articles were related to other applications of subcision such as the treatment of striae or nasolabial fold. The remaining seven articles include published review papers about subcision or acne scar classification.

CONCLUSION

Subcision seems to be effective on various skin conditions including acne scar, other depressed scars, and cellulite. It is easy to apply and inexpensive with short downtime and no significant complications. Subcision needs proper technique and adequate experience.

Comparing cannula-based subcision with the common needle method: A clinical trial

OF TRIAL DESIGN

Treatment of depressed acne scars requires multiple modalities. Although needle subcision is a valuable method, it exhibits mild to moderate efficacy in treatment of deep acne scars owing to the high recurrence rate and other side effects. A total of 100 patients with rolling acne scars were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision in two parallel groups, and the effect of cannula subcision instead of needle subcision was evaluated in the treatment of rolling acne scars.

METHODS

A total of 100 patients were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision. The outcomes of these procedures were assessed by three blinded dermatologists and by patients' satisfaction.

RESULTS

Subcision using the cannula showed good and very good improvement in about 83% of patients (n = 50, P < .05) based on dermatologists investigation and almost no side effects were observed in compared with needle subcision. The response rate was significantly different while using cannula subcision.

CONCLUSION

Cannula subcision appears to be a safe and practical technique that can enhance the efficacy of subcision without considerable complications.

A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques

Acne is a common condition that can result in permanent scarring. We have performed a comprehensive literature search of the last 10 years in order to determine the efficacy and side effects of commonly used treatments against post-acne scarring. A total of 36 relevant articles were identified on the following interventions: subcision (10), dermabrasion (one), microneedling (eight), dermal fillers (five), and chemical peeling (12). Post acne scarring is a common and challenging condition with no easy and definitive solution. The above interventions have been used with varying degrees of efficacy, each having both pros and cons. All have been deemed to be safe with few and transient adverse reactions. However, further trials with larger number of patients are necessary in order to reach more concrete conclusions regarding their efficacy.