Background Information:

What are the other Names for the Procedure?

• Subcision of Skin Scars

What is Subcision surgical procedure?

Subcision is a procedure in which scarring of the skin that has become tethered to deeper structures, are freed up from the adhesions holding them down. It is a surgical method to improve the functional and aesthetic aspects of scars.

What part of the Body does the Procedure involve?

• The Subcision procedure involves scars seen on many areas of the body; these scars may be from several sources
• The majority of Subcision surgical procedures are done to improve acne scars on the face

Why is the Subcision surgical procedure Performed?

Subcision is primarily performed for acne scars that are pulled downward below the surrounding skin by collagen scar strands tethered to deeper structures.

What are some Alternative Choices for the Procedure?

An alternative for Subcision includes open surgical cutting of visualized collagen scar bands.

What are the Recent Advances in the Procedure?

Currently, no significant advances specific to Subcision procedure are reported.

What is the Cost of performing the Subcision surgical procedure?

The cost of the Subcision procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Subcision procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://www.aad.org/ (accessed on 05/16/2021)

Prior to Subcision surgical procedure:

How is the Subcision surgical procedure Performed?

The Subcision procedure is performed in the following manner:

• The skin around and under the depressed or tethered scar is infiltrated with local anesthetic 
• A large bore sterile injection needle is pierced under the scar at a 30-45 degree angle into the subcutaneous fat layer. The needle is swept side to side, at changing depth of penetration, such that the sharp tip cuts through bands of scar tissue tethering the scar down
• Successfully cutting these collagen bands leads to elevation of the scar to the proper plane, so the surgeon simply withdraws the needle
• If bruising or a hematoma appears, pressure and cold are used to obtain hemostasis

Where is the Procedure Performed?

The Subcision procedure is usually performed in a clinic procedure room, or outpatient surgical procedure suite.

Who Performs the Procedure?

A physician, trained physician assistant, or advanced practice nurse usually performs the Subcision procedure.

How long will the Procedure take?

The Subcision procedure usually takes about 30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the procedure and helps avoid complications.

• Provide medical history such as diabetes, hypertension, heart disease, etc. (if any)
• Provide a complete list of medications you are currently taking to the physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• Any medical or family history of bleeding disorders or blood clots
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• Any unusual effects of anesthesia from prior surgery
• A list of all previous surgical procedures you have undergone, like for example - removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to the procedure and discuss the details with risks for complications and obtain his/her permission (termed informed consent).

• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Blood work, glucose, and pregnancy tests (if applicable) will be undertaken per physician recommendations
• If anesthesia team is involved in the procedure; then, they too will discuss details of anesthesia with risks for complications and obtain permission from the patient (informed consent)
• Avoid application of any deodorant or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine-based products for a while, before the procedure
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• Individuals with diabetes, hypertension, or other cardiac conditions are required to discuss these (including medications taken) with their attending physician well in advance
• For individuals with diabetes, it is important that the blood sugar stays within the normal range. If not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

Pregnant women and individuals with severe underlying sicknesses are advised not to undertake this procedure.

What is the Consent Process before the Procedure?

The physician will obtain permission for the Subcision procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Subcision surgical procedure?

In many cases, no tests are typically necessary prior to the Subcision procedure. However, if required, the healthcare provider may recommend the following tests such as:

• Blood tests to evaluate clotting
• The physician may suggest further tests depending on the health of the individual and their medical history

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

• What is a Subcision procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Subcision surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, local anesthesia by injection; and occasionally, other systemic types of anesthesia, if Subcision is a part of a more extensive scar revision procedure.

How much Blood will you lose, during the Procedure?

Subcision is considered a minimally-invasive procedure, and there are no risks for bleeding during this procedure.

What are the possible Risks and Complications during the Subcision surgical procedure?

There are general factors that increase one’s risk of getting complications during the Subcision procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Poor immune system due to a variety of causes

Some of the possible risks and complications that may arise during a Subcision procedure include:

• Infection
• Bleeding
• Injury to the neighboring structures
• Pain
• Discomfort
• Anesthetic complications
• Need for further procedures

What Post-Operative Care is needed at the Healthcare Facility after the Subcision surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Subcision surgical procedure:

What are the possible Risks and Complications after the Subcision surgical procedure?

The risks and complications that may arise after Subcision include:

• Excessive bleeding that may sometimes require an additional surgical procedure
• Any symptom that causes uneasiness such as nausea and dehydration

• Infection of the surgical wound

What is the Prognosis after the Surgery?

The recovery from the Subcision procedure is usually excellent. In many cases, the patient is usually discharged right after he/she has recovered.

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Fever and chills
• Severe pain
• Shortness of breath
• Bleeding or fluid discharge from the surgical wound
• Nausea or vomiting
• Signs of infection
• Severe fatigue
• Dizziness

What Post-Operative Care is needed at Home after the Subcision surgical procedure?

At home, the following post-operative care is recommended after a Subcision procedure:

• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild unscented soap
• Replace dressing after showering
• Take the prescribed medications following the procedure
• Avoid any strenuous activity for a period recommended by the physician
• Do not drive (post-procedure) for a period of 24 hours, if additional anesthetic over local anesthesia is used
• Avoid smoking or drinking alcohol post-procedure
• Continue old prescribed medications after checking with your healthcare provider
• Do not sleep on one’s side or one’s face; sleeping in a recliner is preferred instead

How long does it normally take to fully recover, from the Procedure?

A complete recovery from the procedure may take about several weeks to up to two months.

Additional Information:

What happens to tissue/samples (if any), taken during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Subcision surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• The dermatologist
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing before the Subcision procedure is performed.