Subcision for rolling-type acne scars: what it is and when it is indicated

Rolling-type acne scars are broad, wave-like depressions that give the skin an uneven appearance, especially in raking light. They are often caused by fibrous bands that connect the skin to deeper tissue layers and 'pull' it downward.

Because of this mechanism, techniques that act only on the skin's surface tend to have a limited effect on this type of scar. Subcision is proposed precisely to address those adhesions.

What is subcision?

Subcision is a minimally invasive medical procedure. Under local anaesthesia, a needle or fine cannula is inserted beneath the skin through a small entry point to cut or release the fibrous bands located below the scar.

By releasing these adhesions, the skin is no longer anchored downward and can lift. In addition, the small controlled injury created beneath the scar stimulates the formation of new connective tissue and collagen.

Which scars is it indicated for?

Subcision is used mainly for rolling scars and, in some cases, for certain wide boxcar scars with smooth edges.

It is not the appropriate technique for ice pick scars — narrow and deep — for which TCA CROSS is usually considered.

A simple guide: if gently stretching the skin with your fingers causes the scar to fade, there is likely an adhesion component present. This impression should always be confirmed by a doctor.

How it is performed and what to expect

The procedure is carried out under local anaesthesia. Its duration depends on the number and extent of the scars being treated.

Afterwards it is common for swelling and bruising to appear in the area, which usually subsides within one to two weeks.

Improvement is gradual and several sessions, spaced a few weeks apart, are often needed.

Risks and precautions

Like any medical procedure, subcision can have adverse effects: bruising, prolonged inflammation, infection, pigmentation changes, or the formation of small nodules under the skin.

This is why it must be performed by a professional with training and experience in this technique, following a medical assessment and with realistic expectations.

Subcision and other techniques

Acne scars are often mixed: rolling, boxcar, and ice pick scars can coexist on the same face. This is why treatment must be tailored to the morphology of each scar and not limited to a single technique.

Subcision works in depth on adhesions; TCA CROSS treats ice pick scars in a targeted way; fractional CO₂ laser can improve texture and certain types of scars; and biostimulation can help improve skin quality and firmness.

How we guide you at Clínica Valorian

During the consultation, we analyse the type, depth and distribution of your scars, your skin phototype and your medical history.

We explain which techniques may be suitable in your case: those we carry out at the clinic, such as TCA CROSS, fractional CO₂ laser, medical peeling or biostimulation, and, if subcision may be indicated, we guide you so that you can have it performed by a professional who practises it.