• Subcision

    Acne Scarring

Dr Hussein performs a technique known as: Full-Field subcision under tumescent anaesthesia

He acquired the technique from Dr Mark Taylor in Salt Lake City USA. Dr Mark Taylor first developed this technique. Currently Dr Hussein is the only doctor in the UK capable of offering this technique.

Patient Suitability

Dr Hussein will have assessed your acne scarring type at consultation. If he feels subcision may be appropriate then he will discuss this technique with you. This tends to be suitable where there are scars that are tethered to deeper layers below the skin. This tethering requires separation using a procedure called subcision. Subcising tethered acne scars allows the depressed scars to ‘pop out’ and the skin will as a result appear less dented.

The Procedure

Male clients must shave a day before the procedure. Any beards must be removed to allow good visibility of the area to be treated. Hair must be tied back and headbands applied.

Make up must be removed thoroughly.

The skin will be prepared for surgery with Chlorhexidine.

The entire procedure will be performed with the patient lying flat. If there are issues with lying flat for approximately 1 hour then Dr Hussein must be notified pre procedure.

A dermal marker will then be used to mark the acne scars. This is very important as once high- volume tumescent anaesthesia is administered the subsequent tissue deformation can make landmarks difficult to appreciate.

Individual acne scars can also be marked under tangential illumination and it is also useful to delineate the gross affected area. This facilitates a more targeted subcision without the need to unnecessarily subcise unmarked areas which could result in needless risk to various important structures.

The tumescent solution will now be administered using the pump, giving set and a 22G blunt cannula. As the recommended pumps have a high flow rate rapid infiltration can be achieved. This is crucial for the technique. Rapid infiltration allows the tissues of the subcutis to become turgid with tumescent mix. This separates the underside of the dermis away from important neurovascular structures. Creating this gap dramatically increases the safety of subcision and reduces the risk of nerve damage and vessel disruption/haematoma. Both sides of the face are infiltrated. There will be a 20-minute wait following initial tumescent administration after which a ‘top up’ of tumescent will be given.

A small puncture incision is made with No.11 scalpel blade and the subcision probe can be passed under the skin with relative ease. The forked tip allows for scar bands to be directed towards the blade element of the probe. During passage of the probe under the skin elements of resistance will be encountered. The patient should not feel any discomfort but will feel movement within their cheeks.

Following completion of the subcision the probes will be removed. The entry site is of a small enough diameter (4mm) and not under significant tension hence a suture (stitch) is unnecessary.

The skin will be cleaned and dressings applied over the entry site wounds. The patient will be then asked to apply pressure using gauze pads over the treated area for a further 30-minute period. The patient will be observed for a total of 1 hour after the procedure. If all is well, the patient will be discharged and appropriate follow-up arranged.

Surgical Subcision for Scars

Please view below a copy of the Consent Form that you would be required to sign before undergoing this treatment:

What is surgical subcision?

This is a surgical procedure that is designed to free the tethering fibrous scar bands that pull scars inwards and cause indentation and dimpling of the skin. Subcision is performed with a small dissecting probe that is directed by the surgeon toward the underside of the deeper layer of skin (dermis) to release the scar bands. The probe is introduced into this layer by a small linear incision on the facial skin that is 5mm in size. This should heal spontaneously with minimal scarring. The procedure can be performed on almost all areas of the face (excluding the nose and area around the eye) that are dimpled and depressed by scar bands underneath the skin.

What are the benefits of subcision?

Subcision releases scar bands allowing indented skin to be released and gives skin a smoother appearance.

How is the procedure performed?

Subcision is performed using a dilute mixture of anaesthetic that is injected under the area to be treated. The probe is introduced into the skin and slides along the bottom of the dermis cutting through scar bands that connect the skin to the deeper tissues below.

What are the risks of subcision?

The risks of subcision are similar to other facial surgical procedures and include:

  1. Bleeding
  2. Haematoma (collection of blood under the skin)
  3. Infection
  4. Scarring
  5. Temporary or permanent nerve damage
  6. Swelling
  7. Abnormal skin colour
  8. Failure to achieve the desired result

Informed consent:

I understand the subcision procedure and all of my questions regarding benefits, risks, costs and alternative treatment including no treatment have been answered. I hereby give consent for the subcision procedure to be performed on myself (or legal dependent).

Further Information

Nerve Damage

Nerve damage is a potential consequence of subcision treatment. This type of nerve damage has two types of consequence. The first is sensory disturbance to the skin with patches of altered sensation or numb patches.

The second and more severe consequence is disruption to the facial nerve resulting in partial or complete paralysis of one side of the face.

Although the chances of this are quite low due to the level in the skin at which the subcision takes place it is a foreseeable complication of the procedure.

The numbing injection can temporarily reduce movements and mimic paralysis but this movement will return within 24hrs as the numbing injections wear off.

Bleeding

Subcision will inevitably cause some damage to perforator vessels that supply the skin with blood. Bleeding is minimized with the use of a special anaesthetic mix that reduces bleeding from disrupted vessels. It is however possible for a haematoma (clot) to form below the cheek. Small amounts of clot are acceptable and will result in visible bruising. In the worse case scenario a large clot causing pressure may require surgical drainage.

You will be monitored for a period of 1-2 hours post procedure before being able to leave the clinic.

Infection

Your Doctor may give you antibiotic tablets for a period of a week after the procedure to minimize any infection risk. Developing infection will manifest as painful swelling and heat in the affected area after the treatment. If worsening pain and swelling is encountered after the treatment contact Dr Hussein immediately.