Facial scars, particularly those resulting from acne or injuries, can significantly impact a person's confidence and overall appearance. Among the many treatment options available, subcision and laser resurfacing are two of the most effective and commonly used procedures. However, determining which method suits a particular scar type or skin condition can be challenging without expert guidance. Dr. Sin Yong, a renowned dermatologist specializing in facial rejuvenation and scar revision, offers valuable insights and tailored recommendations to help patients navigate these options and achieve optimal results.
Understanding Facial Scars and Their Variations
Facial scars come in many forms, each with its unique features and challenges. Some scars are shallow and superficial, while others extend deep into the skin layers. Atrophic scars, which are indented or depress into the skin, are often caused by acne or injury and include types like rolling, boxcar, and ice pick scars. Each of these requires specific treatment approaches because of their different depths and textures. Recognizing the particular characteristics of a scar is crucial before selecting a treatment. Dr. Yong emphasizes that a thorough assessment allows him to recommend a strategy that not only improves the skin’s surface but also addresses the deeper tissue damage underlying the scars.
Subcision: Technique and Suitability
Subcision is a minimally invasive procedure that works effectively on scars caused by tethered fibrous bands pulling the skin downward, creating depressions or rolling scars. During the procedure, a fine needle or small-bladed instrument is inserted beneath the skin to sever these fibrous attachments. Once released, the scar lifts, and the skin can regain a more natural contour. Subcision is especially beneficial for rolling scars and shallow boxcar scars with tethered edges. It also stimulates blood flow and encourages the formation of new collagen, which gradually improves skin texture. Dr. Yong recommends subcision for scars with a tethered or pulled appearance and when immediate lifting of the depressed areas is desired, often in combination with other treatments to enhance results.
Laser Resurfacing: Technique and Ideal Candidates
Laser resurfacing, on the other hand, employs focused laser energy to remove damaged skin layers, stimulate collagen production, and smooth irregularities. There are different types of lasers—most notably fractional CO2 and Erbium lasers—that target specific skin depths with minimal damage to surrounding tissue. Laser resurfacing is particularly effective for surface irregularities, shallow scars, and pigmented scars that have darkened or discolor the skin. It also improves overall skin brightness and texture. Dr. Yong advises laser resurfacing for those with superficial to moderate scars, especially when patient downtime is not a major concern. The procedure can be customized to address individual scar severity, skin type, and desired outcomes.
When to Choose Subcision or Laser Resurfacing
Dr. Yong’s expertise lies in evaluating the specific nature of each scar to recommend the most suitable treatment or a combination thereof. If scars are primarily caused by tethering fibers pulling on the skin, subcision is often the first-line choice because it directly releases these bands and lifts the depressed areas. Conversely, if scars are more superficial, with uneven surface texture, laser resurfacing might be more appropriate. For many patients, a combination approach yields the best results—subcision to loosen and lift, followed by laser to refine and smooth the skin surface. Dr. Yong also considers the patient’s skin type, age, and overall skin health when planning these treatments, ensuring that each patient receives a customized plan optimized for lasting, natural results.
Combining Subcision and Laser Resurfacing for Optimal Outcomes
A notable aspect of Dr. Yong’s approach to facial scars is his recognition that most complex scars benefit from a multimodal strategy. Combining subcision and laser resurfacing—either sequentially or concurrently—can maximize the benefits of each technique. The process begins with subcision to loosen fibrous attachments, immediately improving the appearance of depressed scars. Once healing has commenced, laser resurfacing is performed to further stimulate collagen, improve surface texture, and reduce discoloration. This layered approach accelerates skin renewal and provides a comprehensive solution for scars that are resistant to single treatments. Many patients see a dramatic, lasting improvement after just a few sessions, especially when combined with appropriate skincare and sun protection.
Post-Treatment Care and Setting Realistic Expectations
Both subcision and laser resurfacing require proper post-treatment care to ensure safe healing and lasting results. Dr. Yong emphasizes the importance of diligent sun protection, gentle skincare routines, and avoiding unnecessary pressure on the treated areas. Mild swelling, redness, or minor discomfort may occur, but these symptoms typically resolve within days to weeks, depending on the treatment intensity. He also educates his patients about the gradual nature of scar improvement—collagen remodeling and tissue regeneration take time, and multiple sessions may be required for optimal results. Setting realistic expectations upfront helps patients appreciate the incremental improvements and understand that complete.