What is subcision?
Subcision is a minimally invasive procedure that treats depressed acne scars by releasing the fibrous bands anchoring them to the tissue below. These bands — formed during the healing process after inflammatory acne — tether the base of the scar downward, preventing the skin surface from smoothing out regardless of what topical treatments or surface lasers are applied.
A cannula or needle is inserted just beneath the scar and moved in a fanning motion, severing these bands. Once released, the scar can rise toward the level of the surrounding skin. The body's healing response then fills the newly created space with fresh collagen — producing gradual, lasting improvement over several weeks.
Subcision has been performed since the 1990s, but the technique has evolved considerably. Cannula subcision — which uses a blunt-tipped instrument rather than a sharp needle — has become the preferred approach because it allows wider tissue release from a single entry point with significantly less bruising and risk of vascular injury.
Subcision alone is rarely the complete answer. The procedure releases the tether — but the space left behind needs to be filled, and the skin surface still needs resurfacing. That is why the combination protocol exists. Subcision without Sculptra, laser, and red-light therapy produces a fraction of the result that the full protocol achieves.
Which scar types does subcision treat?
Not all acne scars are created equal — and subcision is not appropriate for all of them. Understanding your scar type is the first step in building the right treatment plan.
Most patients presenting for acne scar treatment have a mix of scar types — some rolling, some boxcar, some ice pick. A thorough assessment at consultation identifies the distribution and guides which treatments are prioritized in the protocol.
Cannula subcision vs needle subcision
The instrument used makes a meaningful clinical difference. Needle subcision — the original technique — uses a sharp beveled needle, which produces effective release but carries higher risk of bleeding into the tissue, more significant bruising, and requires multiple entry points to cover a larger area.
Cannula subcision uses a blunt-tipped flexible cannula inserted through a single small entry point, allowing the physician to fan across a wider area of tissue from one location. The benefits are significant: substantially less bruising, lower risk of vascular injury, and the ability to treat larger areas in a single session.
At Plump Medical Spa, cannula subcision is the only technique Dr. Mortazavi uses. The reduced downtime and improved coverage make it the clinically superior approach for most patients.
The Plump combination protocol
Subcision releases the tether. But the space created beneath the scar needs to be filled immediately — otherwise the tissue can re-adhere and the fibrous band reforms. This is one of the most important things most patients don't know about subcision: the procedure that follows matters as much as the procedure itself.
The full combination protocol is $1,350. The standard protocol — subcision with Sculptra and red-light therapy, without CO2 laser — is $1,100 and is appropriate for patients with predominantly rolling scars and minimal surface texture concerns.
What to expect — timeline
Subcision results are gradual. Unlike laser treatments where surface improvement is visible within weeks, the collagen remodeling triggered by subcision and Sculptra develops over months. Most patients see meaningful improvement at 6–8 weeks, with continued improvement through 3–6 months as the Sculptra matures.
Realistic expectations matter. A single subcision session will not eliminate all scarring. Most patients require 2–3 sessions spaced 8 weeks apart for optimal results. The combination protocol is designed to compress the number of sessions needed — but a realistic conversation about your specific scars, their depth and distribution, and your expected outcome happens at consultation before any treatment is planned.
Who is a good candidate?
Subcision is appropriate for adults with depressed atrophic acne scars — specifically rolling and tethered scars — who have had their acne controlled for at least 6 months. Patients on isotretinoin (Accutane) should wait 6–12 months after completing their course before undergoing any ablative or subcision procedures.
Patients with active inflammatory acne, bleeding disorders, or keloid scar history require a detailed consultation before proceeding. Subcision is not appropriate for raised or hypertrophic scars — these require steroid injections or laser treatment, not subcision.