Will the results after subcision and fillers be permanent if fillers disappear over time?
Hi, I am planning to go for subcision and fillers for acne scars, and I understand that using fillers will lessen the possibility of acne scar reattachment after subcision. However, I read that fillers usually last for only 1 year. Is there still a possibility of scar reattachment once the fillers are gone? Or will the results be permanent after the initial healing from subcision?
I understand that acne scarring can be distressing. Atrophic (depressed) acne scars can improve using a combination of subcision and fillers (and fractional lasers as well, although these will not be discussed here to avoid confusion).
Firstly, there are many types of fillers in the market available to fill acne scars, ranging from temporary to semi-permanent fillers, the most commonly used being hyaluronic acid fillers.
Whichever the filler used, the current evidence suggests that scars rarely return to their previous state due to the subcision and the collagen growth and repair on a cellular level, even after all the filler material has been degraded (Aesthetics Journal, Jul 2015).
In addition to hyaluronic acid based fillers, there has been a recent move towards the use of long-chain polynucleotide (PN) products, such as Rejuran, instead. PN products not only “fill” up the space of the acne scars, but also improve the skin’s own tissue and collagen regeneration, hence giving permanent results.
PNs have found to have several biological functions in our skin, such as stimulating wound healing, secretion of collagen proteins and growth of fibroblasts (our body’s own collagen-producing “factories”).
Hope this helps! :)
Dr. Joanna Chan
When performing subscision and fillers, I prefer to use collagen-stimulating fillers such as Radiesse (Calcium hydroxyapatite) for more significant and longer lasting results.
Another treatment option is using Rejuran healer (Polynucleotide) during subscision, which also stimulates collagen formation.
Although HA fillers can be used to fill subscised scars, in general, their potential for stimulation of collagen is less and may not yield as optimum results in comparison.
Lastly, not all scars are best treated by subscision +/- fillers. Besides the morphology of scars (e.g box, ice-prick scars), it is important for the scars to be manually felt for distensibility.
I would suggest having a quick evaluation by a doctor who has both the interest and experience in acne scar management.
Hope this helps!
Dr David Deng
Dear Pinkperiwrinkle, I shall not rehash the same information. But the other doctors have rightly pointed out that the effects of subcision (if well done) can lead to good results that are lasting inspite of the fillers having been degraded.
My favourite option is still Radiesse and I have had a good set of patients which have liked the results. Consult your own doctor today!
Dr Winston Lee
Subcision followed by dermal fillers are good for certain, but not all, acne scars and can give rise to long-term improvement due to de-tethering or freeing the skin from the underlying scar tissue caused by acne.
Other common treatments which give long-term results include resurfacing lasers like Fraxel or fractional CO2 lasers. With repeated treatment, these lasers work well for most acne scars. These lasers replace skin affected by irregular acne scars with flatter, smoother skin. They also stimulate collagen production, causing contraction of the acne scars, making them less obvious. I prefer to use Fraxel as it has minimal downtime.
Recently, PicoSure, a US FDA-approved laser, has been shown to be effective in treating acne scars with even less downtime and discomfort. The laser uses photomechanical disruption rather than heat to comfortably improve scars through LIBO or laser induced optical breakdown. Studies have shown resulting new collagen and elastin production without the side effects and downtime of fractional and ablative lasers.
You may want to discuss this with your doctor before deciding. Cheers!
Dr. Terence Tan