Acne Scarring Treatment
Dr Hussein performs a technique known as: Full-Field subcision under tumescent anaesthesia (Taylor Liberator Technique)
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.
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.
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 20ml syringes and 23G needles. Sometimes DrH may use to use a Klein infiltration pump, giving set and a 22G blunt cannula. As the recommended pumps have a high flow rate rapid infiltration can be achieved. This is useful 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 30 minute wait following initial tumescent administration after which a ‘top up’ of tumescent will be given.
A small puncture incision is made with No.15 scalpel blade and the Taylor Liberator 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 (3-4mm) 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 20-30mins after the procedure. If all is well, the patient will be discharged and appropriate follow-up arranged.
BEFORE & AFTER PHOTOS
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 3-4 mm 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?
Taylor Liberator Subcision fully 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 (tumescent 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:
- Haematoma (collection of blood under the skin)
- Temporary or permanent nerve damage
- Swelling or lump from haematoma (blood clot)
- Abnormal skin colour
- Failure to achieve the desired result
- prolonged low grade swelling of subcutaneous fat
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.
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 or gross facial asymmetry may require surgical drainage.
You will be monitored for a period of 20-30mins post procedure before being able to leave the clinic.
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.
Swelling post procedure
Swelling recovery speed is proportional to the amount of bleeding experienced after the procedure is complete.
The greater the bleeding and larger the collection – the longer it takes to resolve. In my practice if I see a large clot/ haematoma I drain it.
Patients in my opinion have an expectation that somehow swelling will resolve quickly within days to weeks. Anaesthetic and bruise swelling settles quickly. Mild soft tissue swelling from Taylor liberator can take up to 6 months or in rare cases a year to settle. But this is low grade swelling confirmed to be soft tissue swelling from surgical subcision trauma on ultrasound.
Numerous ultrasounds many months down the line have shown in the case of mild residual swelling that the cause is simply soft tissue swelling and post-surgical changes. There are no longterm nodules or cysts. Soft tissue swelling is more speedily reduced with diluted triamcinolone steroid injection.
At present although a technical risk we have never incurred motor nerve injury during our liberator procedures. Temporary Sensory loss is not so important – it generally settles by 3 months and no longterm functional deficit is seen.
it is important to expect mild shape change in the cheek – this is because the hypodermis was originally welded to the SMAS layer overlying the muscle causing tethered scarring. Release of the scars will result in slight conformational change of the cheek. This is to be exepected. Remember post liberator the cheek is now in its more natural state – not what you remember your scarred cheek to be like.
If these issues are not encountered post subcision then it is highly unlikely that effective subcision has taken place. This is why blunt cannula subcision recovery is quick. Basically minimal or no effective subcision has been performed
Anaesthetic complications – These are exceptionally rare but can include cardiac arrythmia (irregular heartbeat) and cardiac arrest. Anaphylaxis is a possibility (extreme allergic reaction). It is important to understand that technically anaphylaxis, cardiac arrest, stroke, hypoxia and brain damage are all known complications of anaesthetic drugs and sedation. Technically they could occur with any medical procedure performed under general or local anaesthesia with sedation.
It is normal to experience a sensation of stronger and faster heart beating as the anaesthetic mixture injected contains adrenaline. Fine trembling will also be experienced.. You may be drowsy due to sedation. If you have sedation, you must not drive within the first 24 hours following the procedure
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).
The tumescent anaesthesia used in full field Taylor Liberator subcision causes swelling of the face. This swelling has largely resolved 24-48 hours after the procedure. Facial movements should return slowly following the procedure. A full range of facial motion should be seen on the morning after the procedure. If this is not the case make sure you contact Dr Hussein.
The following precautions should be taken after the procedure:
- No vigorous exercise for 1 week after the procedure
- Avoid any blood thinning medication such as ibuprofen and aspirin for 72hrs post procedure.
- Avoid hot (temperature hot) food and drink for the first 24 hours post procedure.
- Keep the dressings on the entry site wounds on for 24 hours. Change if necessary.
- Do not put pressure, tension or vigorously wash the face for 1 week post procedure.