Why most acne scar treatments don't fully work
The most common acne scar treatments — RF microneedling, laser resurfacing, topical retinoids — work on the skin surface. They stimulate collagen, improve texture, and reduce discoloration. But for rolling and tethered acne scars, the problem is not at the surface. It is beneath it.
Rolling acne scars are caused by fibrous bands that tether the skin to the deeper tissue. These bands physically pull the skin downward, creating a depressed, uneven surface. No amount of surface treatment can release a tether. The skin can remodel as much as it wants, but if the band is still there, the scar stays.
Subcision is the only treatment that addresses this root cause directly. At Plump Medical Spa in Newport Beach, Dr. Mortazavi performs subcision using a blunt cannula technique and pairs it with Sculptra biostimulator and red light therapy for the most comprehensive single-session acne scar protocol available in Orange County.
Treatment protocols at Plump
Standard protocol
Subcision + Sculptra + Red Light
$1,100
Cannula subcision — releases fibrous tethers
Sculptra injection — fills released space, stimulates collagen
Red light therapy — accelerates healing post-procedure
Downtime: 3–7 days swelling & bruising
Best for: rolling scars, patients avoiding laser
Full combination protocol
Subcision + Sculptra + CO2 Laser + Red Light
$1,350
Everything in the standard protocol, plus:
Fractional CO2 laser — surface resurfacing in the same session
Addresses both deep tethering and surface texture together
Downtime: 7–10 days (laser adds surface recovery)
Best for: mixed scar types, patients with available downtime
How subcision works
01
Topical numbing
A topical anesthetic is applied to the treatment area and allowed to take effect. Additional local anesthetic may be used for deeper or more extensive treatment areas.
02
Cannula insertion and fanning motion
Dr. Mortazavi inserts a blunt cannula through a single entry point beneath the depressed scar. The cannula is moved in a controlled fanning motion beneath the skin surface to mechanically break up the fibrous bands pulling the scar downward. The blunt tip reduces trauma to surrounding vessels compared to sharp-needle subcision.
03
Sculptra injection into the released space
Once the fibrous band is released, Sculptra (poly-L-lactic acid) is injected into the space beneath the scar. This serves two functions: it physically fills the void to prevent re-adhesion of the scar band, and it stimulates collagen production in the surrounding tissue over the following 3–6 months.
04
Red light therapy
Immediately after the procedure, red light therapy is applied to the treatment area. Red light (630–660nm wavelength) accelerates cellular repair, reduces inflammation, and supports collagen synthesis — shortening the initial healing phase and improving overall results.
05
CO2 laser resurfacing (full combination only)
In the full combination protocol, fractional CO2 laser is applied in the same session. This addresses the skin surface — improving boxcar scar edges, reducing texture irregularity, and stimulating surface-level collagen remodeling simultaneously with the deep subcision work.
Which scar types respond best
Primary indication
Rolling scars
Wavy, undulating depressions without sharp edges. Soften or disappear when the skin is stretched sideways — the classic diagnostic sign of fibrous tethering. Subcision is the definitive treatment. Responds exceptionally well.
Responds well
Tethered atrophic scars
Any depressed scar where the base is clearly anchored to the tissue below — visible as a central dimple pulling inward. Subcision releases this anchor directly.
Combination approach
Boxcar scars
Sharp-edged, flat-bottomed depressions. The sharp wall edges respond best to CO2 laser resurfacing. If a tethering component is also present, subcision is added. Most patients with boxcar scars benefit from the full combination protocol.
Adjunct treatment
Ice pick scars
Deep, narrow pinhole scars extending into the dermis. These are the most difficult to treat and do not respond well to subcision alone. TCA CROSS is the primary treatment, followed by surface resurfacing. Subcision may be added if a broader tethering component is also present.
The most common consultation scenario
The majority of acne scar patients who come to Plump Medical Spa have already had 3–6 sessions of RF microneedling elsewhere and feel they've plateaued. RF microneedling cannot release fibrous tethers. It stimulates collagen in the dermis but cannot reach the bands pulling the skin downward. Subcision is the missing treatment in almost every one of these cases — and patients who have been treated with RF alone almost always have undertreated rolling scars.
Safe for all skin tones
One of the most important advantages of subcision is that it is safe for all skin tones — including Fitzpatrick V and VI. Unlike ablative CO2 laser, subcision does not deliver energy to the skin surface, so there is no risk of post-inflammatory hyperpigmentation (PIH) from the procedure itself.
For patients with darker skin tones who cannot safely undergo CO2 laser resurfacing, the standard subcision protocol — subcision + Sculptra + red light — delivers meaningful improvement without the PIH risk that aggressive surface treatments carry. This is one of the most underserved patient groups in aesthetic medicine, and subcision is one of the few effective scar treatments that is genuinely safe for them.
What to expect — timeline
Day 1–3Swelling and bruising peak
Expect significant swelling and bruising in the treated areas. This is normal and expected — it is partly the result of the Sculptra deposit and partly the trauma of the release. Apply cold compresses. Avoid heat, exercise, and alcohol.
Day 3Begin Sculptra massage
Starting day 3, gently massage the treated areas for 5 minutes, five times per day for 5 days. This distributes the Sculptra evenly and prevents nodule formation. Use a clean fingertip with gentle circular pressure.
Day 5–7Comfortable in public
Most patients feel comfortable returning to social settings by day 5–7. Some residual redness or subtle bruising may be visible but is easily covered with makeup.
Weeks 2–8Progressive improvement begins
As Sculptra begins stimulating collagen production, gradual improvement in scar depth becomes visible. The released scars that previously pulled inward begin filling in. This process continues for 3–6 months post-treatment.
Month 3–6Full result assessment
The full result of a subcision session is assessed at 3–6 months. At this point, Dr. Mortazavi evaluates whether a second session would produce additional improvement, or whether complementary surface treatments such as RF microneedling or CO2 laser are appropriate as the next step.
Explore related guides
Frequently asked questions
What is subcision for acne scars?
Subcision uses a blunt cannula to break up fibrous bands tethering depressed acne scars to the underlying tissue. The release allows the scar to lift and creates space for collagen remodeling. It is the primary treatment for rolling and tethered acne scars — the only treatment that addresses the root cause.
How many subcision sessions do I need?
Most patients need 1–3 sessions spaced 6–8 weeks apart depending on scar severity. Mild to moderate rolling scars often show significant improvement after a single session. Severe or widespread scarring typically benefits from 2–3 sessions.
I've had RF microneedling with limited results. Will subcision help?
Almost certainly yes. RF microneedling stimulates collagen but cannot release fibrous tethers. Patients who plateau with RF almost always have undertreated rolling scars. Subcision reaches the root cause that RF cannot address. This is the most common profile we see in acne scar consultations.
Is subcision safe for dark skin tones?
Yes. Subcision does not deliver energy to the skin surface, so there is no PIH risk from the procedure itself. Patients with Fitzpatrick V–VI skin who cannot safely undergo CO2 laser can still receive the standard subcision + Sculptra + red light protocol with full benefit.
What is the downtime after subcision?
Expect 3–7 days of swelling and bruising. Most patients are comfortable in public by day 5–7. Avoid intense exercise, heat, and sun for 48 hours. Begin gentle Sculptra massage starting day 3 for 5 days.
What is the difference between the standard and full combination protocol?
The standard protocol ($1,100) is subcision + Sculptra + red light. The full combination ($1,350) adds fractional CO2 laser in the same session to address the skin surface simultaneously — best for patients with mixed scar types and available downtime for the additional laser recovery.
How much does subcision cost at Plump Medical Spa in Newport Beach?
The standard subcision protocol is $1,100. The full combination protocol is $1,350. Cherry Financing and CareCredit are accepted. Located at 4667 MacArthur Blvd, Suite 310, Newport Beach, CA 92660. (949) 568-7544.