Acne scars are routinely treated with laser and RF or RF microneedling. However, the optimal benefits are probably not achieved unless subcision is performed. Here’s why –
Acne scars frequently will have collagen scar fibers extending to the subcutaneous fat, fat pads, or fascial layers. These fibers cause tethering of the dermis, leading to the appearance of an atrophic scar.
FACT: RF and laser energy has a propensity to travel through collagen.
FACT: As energy/heat travels through collagen, it heats the collagen and leads to collagen contraction
Theory: When treating tethered scars, there is a possibility that the collagen contracts and actually makes the atrophic scars appear deeper
Theory: When energy/heat travels down the collagen fibers, some of it might be transferred to the surrounding fat and lead to fat atrophy.
Subcision is a process where the tethered collagen fibers are transected. By cutting these fibers, the energy can’t progress to the deeper layers of tissue and thus not cause possible fat atrophy or further deepening of the scars. I perform this on most patients undergoing laser or RF for acne scarring if I feel there is any degree of deeper scarring or tethering. There is also the benefit of subcision even without using energy based devices in improving acne scars.
Source: Dr. Steve Weiner, Facial Plastic Surgeon Blog