Types of Subcision

Beverly Hills & Los Angeles

Subcision is a process in which a hypodermic needle is inserted into the skin to manually break fibrotic strands that tether the scar tissue to the subdermal layer. Hypodermic needles of various sizes are used to mechanically break scar tissue residing in the superficial, middle, or deep layers.

Subcision is an outpatient procedure that is usually accomplished within a few hours. A local anesthetic is injected to numb the treatment area. In addition, the patient is given an anti-anxiety medication to make them more comfortable during the procedure. In addition, a special tumescent anesthesia mixture is administered to further numb the area and also prevent excessive bleeding. During this time, a hypodermic needle is inserted into the skin and moved side-to-side to untether the scar tissue from the underlying basement layer. This allows scarred areas to lift to the level of normal skin. This form of “controlled trauma” also stimulates collagen production, which provides support underneath the scarred areas.

Subcision can be performed in several layers: superficial-layer, mid-layer, and deep-layer. 

• Superficial-layer subcision: the skin is infiltrated with a 25-gauge needle right below the epidermis. 
• Mid-layer subcision: a blunt cannula (usually a 22-gauge cannula slightly larger in diameter than a 25-gauge needle) is used to penetrate deeper into the dermis. 
• Deep-layer subcision, a special metal tool, called the Taylor Liberator, is inserted into the deepest parts of the dermis to separate the toughest scars from the underlying tissue. 

Since mid-layer and deep-layer subcision are more invasive than superficial-layer subcision, an “introducer”-needle is inserted into the skin to create a small opening for the cannula or Taylor Liberator to be inserted.

To determine how many layers of subcision need to be performed, we have to examine the depth and severity of your scars. Very mild cases will only need superficial-layer subcision, which only requires local anesthetic injections, whereas more severe cases will require superficial and mid-layer subcision or subcision in all three layers. For these patients, a tumescent anesthetic mixture will be administered.