Subcision in the Treatment of Acne Scar in Iraqi Patients


Background: Acne vulgaris is a very common skin disease among young people which might be associated with scarring that has a great impact on the emotional, psychological and social life of the patients as it will go with them for life. Subcision is a new technique for the treatment of acne scars. Objective: To assess objectively and subjectively the efficacy and safety of subcision in the treatment of depressed acne scars. Patients and Methods: This is an open-label therapeutic trial. A total of 16 patients were enrolled in this study. Twelve were males and 4 were females. Their ages ranged from 19 - 39 with a mean of 26.64 ± 5.64. The duration of scar varied between 6 months and 10 years with a mean of 4.14 ± 2.54 years. subcision was done by introducing a sterile, hypodermic, 18-gauge needle. The needle was held by a three ml syringe for better orientation of the sharp tip of the needle. It was kept horizontal to the skin surface with the bevel up, and was introduced in a high sub dermal plane. The needle was slowly advanced parallel to the skin surface. Initially, rapid, repetitive linear back-and-forth motion of the needle makes the skin free of the underlying scar. This procedure was repeated in all directions in a fan-like manner. Results: According to Modified Sharquies scoring system for grading acne scars, 4 (25%) patients had severe grade, 11 (68.8%) patients had moderate grade and only 1 (6.2%) patient had mild grade. Evaluation at 6 months after treatment revealed that 8 (50%) patients had mild acne scar, 7 (43.8%) had moderate acne scar and only 1 (6.2%) patient still had severe grade. This change in the grades was statistically significant (p-value = 0.01713441). The average score before treatment was 13.13 ± 2.363; it became 9.50 ± 2.944 after 6 months. By paired t-test comparison, the difference in the score was statistically highly significant (p = 0.000044). Regarding the photographic assessment, the difference in the visual analogue scale before and after treatment was statistically significant (p-value = 0.043823). All patients were satisfied regarding subcision as treatment for their acne scars with variable degrees. In general the reported side effects were transient and vanished within 3 - 7 days apart from firm bumps which resolved within 12 weeks in all patients. Conclusion: Subcision appears to be simple, safe, minimally invasive, well-tolerated, and effective surgical procedure that provides significant long-term betterment for depressed acne scars especially for the rolling type.


Subcision, Acne, Scar

Share and Cite:

Al-Hammamy, H. , Mohammad, A. and Al-Turfy, I. (2015) Subcision in the Treatment of Acne Scar in Iraqi Patients. Journal of Cosmetics, Dermatological Sciences and Applications, 5, 125-133. doi: 10.4236/jcdsa.2015.52015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Mohammad, A.F. (2008) Treatment of Acne Scars with Trichloroacetic Acid Chemical Peel Followed by Manual Dermasanding. A Thesis Submitted to the Scientific Council of Dermatology & Venereology, Iraqi Board for Medical Specializations.
[2] Layton, A.M. (2010) Disorders of Sebaceous Glands. In: Tony, B., Stephen, B., Neil, C. and Christopher, G., Eds., Rook’s Textbook of Dermatology, 8th Edition. Blackwell Scientific Publications. Oxford, UK, Chapter 42, 42.1-42.86.
[3] Cunliffe, W.J. (1986) Acne and Unemployment. British Journal of Dermatology, 115, 386.
[4] Cotteril, J.A. and Cunliffe, W.J. (1997) Suicide in Dermatological Patients. British Journal of Dermatology, 137, 246-250.
[5] Sharquie, K., Al-Hamdi, K., Noaimi, A.A. and Al-Battat, R. (2009) Scarring & No Scarring Facial Acne Vulgaris & Frequency of Associated Skin Disease. The Iraqi Postgraduate Medical Journal, 8, 332-338.
[6] Khunger, N. and Monica, K. (2011) Subcision for Depressed Facial Scars Made Easy Using a Simple Modification. Dermatologic Surgery, 37, 514-517.
[7] Orentreich, D.S. and Orenreich, N. (1995) Subcutaneous Incision Less (Subcision) Surgery for the Correction of Depressed Scars and Wrinkles. Dermatologic Surgery, 2, 543-549.
[8] Al-Dhalimi, M.A. and Arnoos, A.A. (2012) Subcision for Treatment of Rolling Acne Scars in Iraqi Patients: A Clinical Study. Journal of Cosmetic Dermatology, 11, 144-150.
[9] Fulton, J.E. and Silverton, K. (1999) Resurfacing the Acne-Scarred Face. Dermatologic Surgery, 25, 353-359.
[10] Alam, M., Omura, N., Omura, M. and Kaminer, M.S. (2005) Subcision for Acne Scarring: Technique and Outcome in 40 Patients. Dermatologic Surgery, 31, 310-317.
[11] Balighi, K., Robati, R.M., Moslehi, H. and Robati, A.M. (2008) Subcision in Acne Scar with and without Subdermal Implant: Clinical Trial. Journal of the European Academy of Dermatology and Venereology, 22, 707-711.
[12] Vaishnani, J.B. (2008) Subcision in Rolling Acne Scars with 24 G Needle. Indian Journal of Dermatology, Venereology and Leprology, 74, 677-679.
[13] Kim, J., Ochoa, M. and Krutzik, S. (2002) Activation of Toll-Like Receptor-2 in Acne Triggers Inflammatory Cytokine Responses. Journal of Immunology, 169, 1535-1541.
[14] Shahira, A., Mohamed, H., Dalia, A. and Seham, A. (2011) Subcision Versus 100% Trichloroacetic Acid in the Treatment of Rolling Acne Scars. Dermatologic Surgery, 37, 626-633.
[15] Jacob, C.I., Dover, J.S. and Kaminer, M.S. (2001) Acne Scarring: A Classification System and Review of Treatment Options. Journal of the American Academy of Dermatology, 45, 109-117.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.