Subcision

The principle of this procedure is to break the fibrotic strands, which tether the scar to the underlying subcutaneous tissue. It is useful mainly for rolling scars. The scars are marked with a marking ink or pen. Local infiltration anesthesia with 2% xylocaine is desirable. A no. 18 or 20 gauge needle is inserted adjacent to the scar with the bevel upwards parallel to the skin surface, into the deep dermis and moved back and forth and in a fan-like motion under the scar, to release fibrous bands. Individual depressed scars are treated using multiple puncture sites. Hemostasis is achieved by applying pressure. Care is taken to avoid the preauricular, temporal and mandibular areas in order to avoid injury to branches of the facial nerve and major vessels. Postoperative hematoma is a common complication after this procedure and may need application of ice and administration of non-steroidal antiinflammatory drugs (NSAIDs).