Subcision for Acne Scars: Results, Recovery and Evidence Limits

Q: What is subcision for acne scars?

Subcision is a clinician-performed procedure that cuts fibrous strands under a depressed acne scar, aiming to release tethering so the scar lifts. Reviews describe it as minimally invasive, but it is still a procedure under the skin with recovery effects. Evidence for how well it works is limited to small studies.

Q: Which scar types were studied?

The primary studies reviewed here mostly enrolled people with rolling scars, which are broad depressions often tethered to deeper tissue. A skin-of-color review notes that the deepest discrete scars respond poorly to resurfacing alone. It describes punch excision or elevation as options to try for those scars. Only a clinician can judge whether a particular scar is tethered.

Q: Does subcision completely remove scars?

The studies reviewed report improvement, not clearance. One uncontrolled series of 40 completers reported about 50% improvement at six months. In that series, 90% of patients said their appearance improved, which is not the same as 90% scar removal. A split-face study reported mostly mild-to-moderate improvement.

Q: Is cannula subcision proven better than a needle?

No. Efficacy results are mixed. A 46-patient split-face study found no significant difference in improvement, while a 100-patient trial abstract favored the cannula but lacked comparator and follow-up detail. The more consistent signal is fewer side effects with blunt cannulas. Instrument choice belongs with the treating clinician.

Q: Do suction, HA or laser combinations work better?

It depends on the comparator and the endpoint. Two suction trials found no objective or blinded-rater difference but some subjective advantages. A Profhilo add-on study found no significant objective benefit. A filler-or-laser study reported better grading, but how its patients were allocated is unclear.

Q: What downtime and side effects are reported?

Reported effects include pain or tenderness, bruising, swelling, redness, infection, lumps under the skin and pigment change. The sources reviewed do not give a reliable return-to-work date or a pooled risk rate across instruments or skin tones. Ask the treating clinician about expected recovery.

Q: Can subcision cause pigment change or lumps?

Yes, both are reported. A safety review lists dyspigmentation and subcutaneous lumps, and one series noted persistent firm bumps. The abstracts reviewed do not provide a universal incidence for pigment change, and nothing here shows any skin tone is protected from it.

Q: Is subcision the same as punch excision or microneedling?

No. Subcision releases tethering beneath a scar. Punch methods remove or lift a discrete deep scar. Microneedling and RF microneedling create controlled injury to remodel texture. Radiofrequency-assisted subcision is a different procedure from RF microneedling. Reliable head-to-head comparisons were not found in the records reviewed.

By Peptide Skincare Editorial Team · Published November 9, 2026 · Updated November 8, 2026 · 12 min read

Start with our pillar guide: Dermal Fillers for Ozempic Face: What the Evidence Shows (and Doesn't), or browse all Aesthetic Treatments articles.

Evidence: Limited. Subcision for acne scars is a procedure done by a clinician. It releases fibrous bands that tether certain depressed scars, especially rolling scars, to deeper tissue. Small studies report improvement, not clearance: one uncontrolled series of 40 completers reported about 50% improvement at six months.[^1] Controlled comparisons show that add-on treatments do not consistently improve objective outcomes.[^2][^3][^4] Bruising, lumps, infection and pigment change remain reported risks.[^5]

What is subcision for acne scars?

Evidence: Description of mechanism, not proof of predictable outcome.

Subcision, short for subcutaneous incisionless surgery, uses an instrument under the skin to cut fibrous strands that pull an atrophic (sunken) scar downward. One review describes the aim as cutting those strands and forming new connective tissue so the scar lifts.[^6] That review covered 16 clinical-trial articles published before June 2022. They were not 16 placebo-controlled trials, and the review gave no pooled probability of lasting success. Its authors are affiliated with universities of medical sciences in Kerman, Shiraz and Gonabad, Iran. The PubMed record lists no grants and no conflict-of-interest statement. That means not stated, not "none."

A second review groups the tools into needles, cannulas, wires and blunt-blade instruments. It says use varies by scar depth, clinician preference and planned combination treatments.[^7] Its authors list the Scar Healing Institute (Los Angeles), Johns Hopkins School of Medicine and Geisel School of Medicine. PubMed and accessible full text (PMC9868281) report no conflicts; no study-funding agency was identified in the material accessed.

That review calls subcision "minimally invasive." That doesn't mean nonsurgical or free of downtime. This article does not describe how the procedure is performed.

Why are rolling scars the main target for subcision?

Evidence: Clinical selection and review; few trials that report results by scar type.

Scar shape matters:

Rolling scars are broad, soft-edged depressions. Bands beneath them often tether the skin down, and that tethering is what subcision aims to release.
Ice-pick scars are narrow, deep pits.
Boxcar scars are depressions with sharp edges.

The two oldest primary studies here enrolled people with rolling scars.[^1][^8] A skin-of-color review stresses choosing a treatment by scar type. It notes that the deepest (grade 4) scars improve poorly with resurfacing, and that punch excision or punch elevation can be tried for them.[^9] Its authors are affiliated with Skin Aid Clinic (Gurugram) and dermatology departments at AIIMS Bhopal, Vardhman Mahavir Medical College & Safdarjung Hospital and AIIMS New Delhi. Accessible full text (PMC7394107) reports nil financial support and no conflicts of interest.

Not every depression is tethered, and not every boxcar or ice-pick scar responds. Telling tethered scars apart requires assessment by a clinician. Removing or lifting a discrete deep scar is a separate approach, punch excision.

What does subcision for acne scars achieve on its own?

Evidence: Limited.

In one rolling-scar series, 40 patients completed treatment and six-month follow-up.[^1] Patients and investigators reported about 50% improvement, and 90% of patients said their appearance improved. That figure is self-reported improvement in appearance, not 90% scar removal. The series had no untreated or sham comparison. The authors are affiliated with SkinCare Physicians, a practice in Chestnut Hill, Massachusetts. Funding and conflicts are not stated in PubMed.

A split-face study enrolled 22 people with rolling scars, and 20 completed it.[^8] About 60% had mild improvement and about 40% moderate improvement. Adding an absorbable implant to one side gave no significant extra response. The abstract does not specify follow-up length. The authors are from Razi Hospital, University of Tehran. Funding and conflicts are not stated.

Neither study shows that scars are eradicated, that results are permanent, or that a set number of sessions is needed.

Is cannula subcision better than needle subcision?

Evidence: Limited. The tolerability signal is more consistent than any efficacy advantage.

Instruments fall into sharp, blunt and energy-assisted categories. Head-to-head results are mixed:

Parallel randomized trial, 100 rolling-scar patients.[^10] Blinded dermatologists rated about 83% of the cannula group (n=50) as having good or very good improvement, with almost no side effects compared with needles. The abstract gives neither the follow-up length nor the needle group's response rate, so the size and durability of any advantage are unclear. Affiliations: universities of medical sciences in Tehran and Isfahan, and Jordan Dermatology and Hair Transplantation Center. PubMed lists the Skin and Stem Cell Research Center as a grant source. Conflicts are not stated.
Split-face study, 46 patients, stated nine-month follow-up.[^11] Improvement was 73.9% on the needle side vs 65.2% on the cannula side (P=.68), which is not a significant difference. Side effects were significantly greater on the needle side (P=.001). Affiliations: Zagazig University and Sirte University Hospital. Funding and conflicts are not stated.
Within-person study, 34 patients, three months of monitoring.[^12] Satisfaction generally favored the cannula, but one dermatologist rater found no difference between methods at month three (P=.25). The abstract does not establish random allocation. Affiliation: Skin Research Center, Shahid Beheshti University of Medical Sciences, which is also the listed grant source. Conflicts are not stated.

An instrumentation review counted 417 patients across 17 articles: 155 sharp, 235 blunt and 27 energy-assisted. It found all categories effective, with redness and swelling common to all.[^13] Those patients come from separate studies, not one 417-person randomized comparison. Affiliations: Royal Brisbane and Women's Hospital and Cutis Clinic. Funding and conflicts are not stated. A linked comment is indexed, and it is not a retraction.

Choosing an instrument for a given scar is the treating clinician's decision.

Do combinations add benefit to subcision for acne scars?

Evidence: Limited. Results depend on the comparator and the endpoint.

One review concluded that combinations improve efficacy.[^6] The primary trials are more mixed once objective and subjective measures are separated.

Suction (first trial). This was a randomized, split-face trial with blinded evaluators. It analyzed 28 treatment areas, and the abstract gives no clear patient count.[^2] Blinded dermatologists found no difference at one or four months. Participants rated the suction side higher at one month (37% vs 24%, P=.04), but not at four months (P=.37). Affiliations include Northwestern University, Vajira Hospital (Bangkok), University of Illinois-Chicago, Cleveland Clinic and Vivida Dermatology. Funding and conflicts are not stated.

Suction (second trial). This randomized split-face trial had 27 patients and used sham pressure as the comparator. Objective scar measures showed no difference between sides. Physician- and patient-rated improvement scores favored suction (P=.002 and P=.026).[^3] That does not prove suction prevents re-tethering. Affiliations: Latakia University and Warwick University. PubMed records no conflict of interest, and no grants are indexed.

Cross-linked hyaluronic acid filler or fractional CO2 laser. Both combinations graded better than subcision alone (P=.015 for filler, P<.001 for laser), with no difference between the two (P=.171).[^14] However, the abstract and the accessible methods both report 40 patients while describing three groups of 20. How patients or face sides were allocated is therefore unclear. We checked the full text for design and funding. It names a VIVACY STYLAGE XL filler and a Deka laser, not Profhilo. It lists Al-Azhar University and open-access funding from Egypt's Science, Technology & Innovation Funding Authority with the Egyptian Knowledge Bank. Naming a product does not establish company sponsorship. PubMed records no competing interests.

Profhilo. This randomized split-face study had 12 patients. Three months after the final session, the Profhilo side showed no significant added benefit in scar score (P=.56), ultrasound-measured depth (P=.4) or global improvement (P=.89). Satisfaction favored Profhilo (P=.02).[^4] The abstract's conclusion is more positive than these efficacy results. Affiliation: Tehran University of Medical Sciences, which is also listed as a grant source. Conflicts are not stated.

These samples overlap with the reviews, so they should not be added together. The evidence does not support "combinations always work better."

How does subcision compare with TCA CROSS, punch methods and microneedling?

Evidence: Review and context, not direct proof that any one is better.

These approaches target different problems, and unrelated single-arm studies can't settle head-to-head questions.

Approach	Main target	Intended action	Evidence caveat
Subcision	Tethered rolling scars	Releases bands beneath the scar	Limited: small, short trials with mixed endpoints[^1][^5]
TCA CROSS	Ice-pick scars	Focal chemical treatment inside the pit	Limited here: supported in this pack only by a review-level mention[^9]
Punch excision or elevation	Discrete deep scars	Removes or lifts the scar	Expert opinion here: the review lists it as an option to try[^9]
RF microneedling and microneedling	Mild-to-moderate textural scars	Controlled injury to remodel texture	Limited here: one review grades it among the better-evidenced options for these scars, but it has not been compared with subcision[^9]

Radiofrequency-assisted subcision falls in the energy-assisted category. It is not RF microneedling.[^9][^13]

What recovery and complications does subcision for acne scars involve?

Evidence: Limited for complication frequencies and recovery timelines.

A safety review drew on ten monotherapy articles plus the authors' clinical experience. It listed pain or tenderness, bruising, infection, lumps under the skin and dyspigmentation (pigment change), and said complications occur more often with sharp instruments.[^5] It did not pool frequencies or define a standard downtime. Its "safe" conclusion does not establish low risk for everyone. Affiliations: Mater Hospital Brisbane and Cutis Clinic. PubMed records no conflicts. Accessible full text (PMC11743319) states the authors received no specific funding for this work.

The primary studies add some detail: persistent firm bumps,[^1] transient infection, swelling and bruising,[^8] and bruising and nodules after needle treatment.[^12]

The abstracts reviewed do not provide a reliable return-to-work date or a risk rate across instruments and skin tones. They also give no incidence of post-inflammatory hyperpigmentation (PIH, darkening after inflammation). The skin-of-color review says side-effect profiles can vary by skin type. It does not say darker skin is protected from pigment effects.[^9] Skipping lasers does not mean skipping PIH risk. Concerns about healing, bumps or pigment belong with the treating clinician.

How long do subcision results last?

Evidence: Limited.

Only the follow-up each study actually observed can be reported:

six months in the 40-completer series[^1]
a stated nine months in the instrument split-face study[^11]
four months in both suction trials[^2][^3]
six months after the last session in the filler-or-laser study, per its full text[^14]
three months in the Profhilo study[^4]

Improvement that lasts to the end of a study does not prove the release is permanent or that scars never re-tether. No study here establishes a required number of sessions.

Where the evidence stops

Evidence: Limited.

Trials are small and short, and they use inconsistent grading scales.
Satisfaction often diverges from objective measures.
Technique and scar selection vary between studies, so it is hard to separate the effect of the operator.
Gaps remain: one suction trial's patient count, the 100-patient trial's follow-up, the filler-or-laser study's allocation, PIH incidence and long-term recurrence.
Few large, long-term controlled studies appeared among the records selected.
Academic or private-clinic affiliations do not prove the absence of industry ties, and a missing funding statement does not mean there was no funding.

No retraction or expression-of-concern notice was indexed for the 14 PubMed records checked. Nothing here is advice to start, avoid or change any treatment. Discuss options with a qualified clinician.

FAQ

What is subcision for acne scars?

Subcision is a clinician-performed procedure that cuts fibrous strands under a depressed acne scar, aiming to release tethering so the scar lifts. Reviews describe it as minimally invasive, but it is still a procedure under the skin with recovery effects. Evidence for how well it works is limited to small studies.

Which scar types were studied?

The primary studies reviewed here mostly enrolled people with rolling scars, which are broad depressions often tethered to deeper tissue. A skin-of-color review notes that the deepest discrete scars respond poorly to resurfacing alone. It describes punch excision or elevation as options to try for those scars. Only a clinician can judge whether a particular scar is tethered.

Does subcision completely remove scars?

The studies reviewed report improvement, not clearance. One uncontrolled series of 40 completers reported about 50% improvement at six months. In that series, 90% of patients said their appearance improved, which is not the same as 90% scar removal. A split-face study reported mostly mild-to-moderate improvement.

Is cannula subcision proven better than a needle?

No. Efficacy results are mixed. A 46-patient split-face study found no significant difference in improvement, while a 100-patient trial abstract favored the cannula but lacked comparator and follow-up detail. The more consistent signal is fewer side effects with blunt cannulas. Instrument choice belongs with the treating clinician.

Do suction, HA or laser combinations work better?

It depends on the comparator and the endpoint. Two suction trials found no objective or blinded-rater difference but some subjective advantages. A Profhilo add-on study found no significant objective benefit. A filler-or-laser study reported better grading, but how its patients were allocated is unclear.

What downtime and side effects are reported?

Reported effects include pain or tenderness, bruising, swelling, redness, infection, lumps under the skin and pigment change. The sources reviewed do not give a reliable return-to-work date or a pooled risk rate across instruments or skin tones. Ask the treating clinician about expected recovery.

Can subcision cause pigment change or lumps?

Yes, both are reported. A safety review lists dyspigmentation and subcutaneous lumps, and one series noted persistent firm bumps. The abstracts reviewed do not provide a universal incidence for pigment change, and nothing here shows any skin tone is protected from it.

Is subcision the same as punch excision or microneedling?

No. Subcision releases tethering beneath a scar. Punch methods remove or lift a discrete deep scar. Microneedling and RF microneedling create controlled injury to remodel texture. Radiofrequency-assisted subcision is a different procedure from RF microneedling. Reliable head-to-head comparisons were not found in the records reviewed.

References

[^1]: Subcision for acne scarring: technique and outcomes in 40 patients. PMID 15841633. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^2]: Subcision with and without suction for acne scars: a split-faced, rater-blinded randomized control trial. PMID 38847979. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^3]: Subcision Versus Subcision With Suction for the Treatment of Atrophic Acne Scars: A Randomized, Split-Face Clinical Trial. PMID 42054473. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; PubMed records authors indicated no conflict of interest; full text not verified. [^4]: Investigating the impact of added Profhilo mesogel to subcision versus subcision monotherapy in treating acne scars; a single-blinded, split-face randomized trial. PMID 38429946. PubMed abstract and metadata reviewed. Funding/COI: PubMed grant listing names Tehran University of Medical Sciences and Health Services; COI not stated; full text not verified. [^5]: Complications of Subcision for Acne Scarring: Experience From Clinical Practice and Review of the Literature. PMID 39492124. PubMed abstract, metadata and accessible full text (PMC11743319) reviewed. Funding/COI: full text states the authors received no specific funding for this work; PubMed and full text declare no conflicts of interest. [^6]: Subcision in acne scarring: A review of clinical trials. PMID 36315903. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^7]: Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments. PMID 36698445. PubMed abstract, metadata and accessible full text (PMC9868281) reviewed. Funding/COI: PubMed and accessible full text report no conflicts; no study-funding agency was identified in the material accessed. [^8]: Subcision in acne scar with and without subdermal implant: a clinical trial. PMID 18341538. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^9]: Evidence-based Surgical Management of Post-acne Scarring in Skin of Color. PMID 32792773. PubMed abstract, metadata and accessible full text (PMC7394107) reviewed. Funding/COI: full text reports nil financial support and no conflicts of interest. [^10]: Comparing cannula-based subcision with the common needle method: A clinical trial. PMID 31373077. PubMed abstract and metadata reviewed. Funding/COI: PubMed grant listing names Skin and Stem Cell Research Center; COI not stated; full text not verified. [^11]: Clinical and Histopathological evaluation of different tools for the Subcision of Atrophic Acne Scars. PMID 34806274. PubMed abstract and metadata reviewed. Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^12]: Blunt cannula subcision is more effective than Nokor needle subcision for acne scars treatment. PMID 29524284. PubMed abstract and metadata reviewed. Funding/COI: PubMed grant listing names Skin Research Center, Shahid Beheshti University of Medical Sciences; COI not stated; full text not verified. [^13]: Surgical Subcision for Acne Scars: A Review of Instrumentation. PMID 36943759. PubMed abstract and metadata reviewed; linked comment indexed (not a retraction). Funding/COI: no grants indexed; COI not stated in PubMed; full text not verified. [^14]: A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment. PMID 36564573. PubMed abstract, metadata and accessible Europe PMC full text checked for design, funding and COI. Funding/COI: full text lists Al-Azhar University and open-access funding from STDF in cooperation with EKB; PubMed records no competing interests; named filler and laser products do not establish manufacturer sponsorship.

For educational purposes only; not medical advice. See our disclaimer and research method.