Although laser treatments are a popular way to get rid of acne scars for patients with lighter skin, those with dark skin tones are often poor candidates for such a procedure. These patients are more likely than any other group to experience significant, long lasting changes in pigment (resulting in either darker or lighter spots). Areas of hyperpigmentation may or may not respond to treatment with bleaching agents.
Undesirable alterations in skin texture are also reported in patients with darker skin. Often, laser treatment doesn’t actually work that well to reduce the appearance of scarring for this patient demographic. Existing acne breakouts may also become worse as the result of post-treatment inflammation. Non-ablative lasers are still used to treat some of these patients, but dermatologists also turn to other solutions that tend to have more predictable results.
Subcutaneous Incision Offers an Alternative
Subcutaneous incision (also called subcision or subdermal manipulation) is a minimally invasive surgical procedure that can be done on an outpatient basis to reduce the appearance of acne scars. It is used to lift scars that have caused depressions in the skin – specifically rolling scars that make the skin look rippled. With these blemishes, the scar tissue has adhered to the lower layers of the dermis (deep skin tissue). The goal of subcision is to break the scar tissue free from the dermis so the surface of the skin is no longer stuck in a dimpled, contracted position.
The treatment area is numbed with Lidocaine and epinephrine to dull pain and control bleeding. The dermatological surgeon then inserts a special needle with a beveled, blade-like tip under the skin to scrape the fibrous connective tissue free from the area beneath the acne scar. This can result in the surface of the skin evening out as tissue grows in to fill the gap under the scar. The technique can be used more than once if it appears that subsequent procedures will offer additional improvement.
Even with excellent results, subcision doesn’t totally get rid of acne scars. There is usually still some irregularity in the skin; but it is less noticeable. Bleeding and the formation of small bumps in the treated area are potential but manageable side effects of this procedure.
Some dermatologists may also inject the area with a dermal filler to help improve the contour of the scar. This filler is added after the surgical site has a chance to heal from the subcision surgery. The injectable fillers used for this purpose (e.g. HA, collagen, and Radiesse) aren’t permanent and require ongoing treatment sessions to maintain results.