Repeat Suction Enhances Subcision Efficacy for Depressed Facial Scars

A novel technique that combines subcision and suction proved safe and effective for promoting significant and lasting improvement of mild to severe depressed facial scars in a study of 58 patients.

In 46 patients who strictly followed the study protocol of subcision followed by frequent suctioning at the time of postsubcision depression recurrence, the depth and size of scars decreased significantly by a mean of nearly 72% at 6-month follow-up, according to assessment by two investigators, and by 75% according to patient assessment.

An improvement of at least 80% occurred in about 28% of patients, according to investigator assessment, and in 42%, according to patient assessment, Dr. S. Aalami Harandi of the Parsian Laser Clinic, Bandar Abbas, Iran, and colleagues reported online in the June 9 issue of the Journal of the European Academy of Dermatology and Venereology.

Mean improvement at 6 months in 12 patients who started suction late or had long intervals between suction sessions was 44% by investigator assessment and 49% by patient assessment, the investigators reported (J. Eur. Acad. Dermatol. Venereol. 2010 June 9 [doi:10.1111/ j.1468-3083.2010.03711.x]).

The study participants - 34 women and 24 men aged 16-44 years - had depressed acne scars of various types, including rolling, superficial boxcar, deep boxcar, and pitted, as well as scars from chicken pox, trauma, and surgery. Superficial dermal undermining was performed on 1-70 scars per patient using mainly 23-gauge needles. Suctioning was initiated on the third day following subcision, and was performed at least every other day for 2 weeks, per protocol.

The best results (80% or better improvement) were seen in 24 of the 46 patients on protocol who had the most frequent suctioning (almost daily versus every other day interval in the first week of suction period), the investigators noted.

Although subcision is a safe, valuable, and practical method in itself, it has only mild to moderate efficacy because of the frequency of depression recurrence. In the investigators' experience, recurrence with subcision alone generally starts 2-5 days after subcision, with rapid progression of re-depression for up to 10 days, and gradual progression of re-depression for about 1 week more; therefore, the protocol for this study involved repeated suctioning at the recurrence period.

The addition of suctioning, which prevents redepression by "induction of repeated haemorrhage in dermal pocket, delay in healing, and more new connective tissue formation at the scar area," appears to improve the efficacy of subcision alone.

The combined subcision and suction treatment in this study was associated with "significant" (greater than 60% improvement) and "excellent" (80% improvement or greater) efficacy, the investigators said.

Bruising occurred in all cases, but resolved within 12 days, and any discoloration that occurred resolved within 2 months; hypertrophic scarring occurred in 1.7% of treated scars (22 scars in six patients), which was mostly due to sub-epidermal like undermining( technical error), and was managed successfully in all cases; and hemorrhagic papules and pustules occurred in 5.6% of subcised scars, and were treated successfully with drainage and topical antibiotics or steroids.

Advantages of the subcision-suction method include ease of application, low cost, short down-time, applicability for various skin types (most had type III in this study), applicability for various scar types, lack of significant complications, and "remarkable and persistent improvement in short time without injury to the skin surface," the investigators reported.

"It seems that this method has the potential to be used as the first step for acne and other depressed scars management," they wrote, adding that since multistep treatment is necessary for optimal correction of acne scars, treatment may involve the use of other techniques or repeat subcision-suction after several months.

Further study of this technique is warranted, particularly given the prevalence of the problem of depressed scars of the face, they noted.

The investigators had no conflicts of interest to declare.

A novel technique that combines subcision and suction proved safe and effective for promoting significant and lasting improvement of mild to severe depressed facial scars in a study of 58 patients.

In 46 patients who strictly followed the study protocol of subcision followed by frequent suctioning at the time of postsubcision depression recurrence, the depth and size of scars decreased significantly by a mean of nearly 72% at 6-month follow-up, according to assessment by two investigators, and by 75% according to patient assessment.

An improvement of at least 80% occurred in about 28% of patients, according to investigator assessment, and in 42%, according to patient assessment, Dr. S. Aalami Harandi of the Parsian Laser Clinic, Bandar Abbas, Iran, and colleagues reported online in the June 9 issue of the Journal of the European Academy of Dermatology and Venereology.

Mean improvement at 6 months in 12 patients who started suction late or had long intervals between suction sessions was 44% by investigator assessment and 49% by patient assessment, the investigators reported (J. Eur. Acad. Dermatol. Venereol. 2010 June 9 [doi:10.1111/ j.1468-3083.2010.03711.x]).

The study participants - 34 women and 24 men aged 16-44 years - had depressed acne scars of various types, including rolling, superficial boxcar, deep boxcar, and pitted, as well as scars from chicken pox, trauma, and surgery. Superficial dermal undermining was performed on 1-70 scars per patient using mainly 23-gauge needles. Suctioning was initiated on the third day following subcision, and was performed at least every other day for 2 weeks, per protocol.

The best results (80% or better improvement) were seen in 24 of the 46 patients on protocol who had the most frequent suctioning (almost daily versus every other day interval in the first week of suction period), the investigators noted.

Although subcision is a safe, valuable, and practical method in itself, it has only mild to moderate efficacy because of the frequency of depression recurrence. In the investigators' experience, recurrence with subcision alone generally starts 2-5 days after subcision, with rapid progression of re-depression for up to 10 days, and gradual progression of re-depression for about 1 week more; therefore, the protocol for this study involved repeated suctioning at the recurrence period.

The addition of suctioning, which prevents redepression by "induction of repeated haemorrhage in dermal pocket, delay in healing, and more new connective tissue formation at the scar area," appears to improve the efficacy of subcision alone.

The combined subcision and suction treatment in this study was associated with "significant" (greater than 60% improvement) and "excellent" (80% improvement or greater) efficacy, the investigators said.

Bruising occurred in all cases, but resolved within 12 days, and any discoloration that occurred resolved within 2 months; hypertrophic scarring occurred in 1.7% of treated scars (22 scars in six patients), which was mostly due to sub-epidermal like undermining( technical error), and was managed successfully in all cases; and hemorrhagic papules and pustules occurred in 5.6% of subcised scars, and were treated successfully with drainage and topical antibiotics or steroids.

Advantages of the subcision-suction method include ease of application, low cost, short down-time, applicability for various skin types (most had type III in this study), applicability for various scar types, lack of significant complications, and "remarkable and persistent improvement in short time without injury to the skin surface," the investigators reported.

"It seems that this method has the potential to be used as the first step for acne and other depressed scars management," they wrote, adding that since multistep treatment is necessary for optimal correction of acne scars, treatment may involve the use of other techniques or repeat subcision-suction after several months.

Further study of this technique is warranted, particularly given the prevalence of the problem of depressed scars of the face, they noted.

The investigators had no conflicts of interest to declare.

A novel technique that combines subcision and suction proved safe and effective for promoting significant and lasting improvement of mild to severe depressed facial scars in a study of 58 patients.

In 46 patients who strictly followed the study protocol of subcision followed by frequent suctioning at the time of postsubcision depression recurrence, the depth and size of scars decreased significantly by a mean of nearly 72% at 6-month follow-up, according to assessment by two investigators, and by 75% according to patient assessment.

An improvement of at least 80% occurred in about 28% of patients, according to investigator assessment, and in 42%, according to patient assessment, Dr. S. Aalami Harandi of the Parsian Laser Clinic, Bandar Abbas, Iran, and colleagues reported online in the June 9 issue of the Journal of the European Academy of Dermatology and Venereology.

Mean improvement at 6 months in 12 patients who started suction late or had long intervals between suction sessions was 44% by investigator assessment and 49% by patient assessment, the investigators reported (J. Eur. Acad. Dermatol. Venereol. 2010 June 9 [doi:10.1111/ j.1468-3083.2010.03711.x]).

The study participants - 34 women and 24 men aged 16-44 years - had depressed acne scars of various types, including rolling, superficial boxcar, deep boxcar, and pitted, as well as scars from chicken pox, trauma, and surgery. Superficial dermal undermining was performed on 1-70 scars per patient using mainly 23-gauge needles. Suctioning was initiated on the third day following subcision, and was performed at least every other day for 2 weeks, per protocol.

The best results (80% or better improvement) were seen in 24 of the 46 patients on protocol who had the most frequent suctioning (almost daily versus every other day interval in the first week of suction period), the investigators noted.

Although subcision is a safe, valuable, and practical method in itself, it has only mild to moderate efficacy because of the frequency of depression recurrence. In the investigators' experience, recurrence with subcision alone generally starts 2-5 days after subcision, with rapid progression of re-depression for up to 10 days, and gradual progression of re-depression for about 1 week more; therefore, the protocol for this study involved repeated suctioning at the recurrence period.

The addition of suctioning, which prevents redepression by "induction of repeated haemorrhage in dermal pocket, delay in healing, and more new connective tissue formation at the scar area," appears to improve the efficacy of subcision alone.

The combined subcision and suction treatment in this study was associated with "significant" (greater than 60% improvement) and "excellent" (80% improvement or greater) efficacy, the investigators said.

Bruising occurred in all cases, but resolved within 12 days, and any discoloration that occurred resolved within 2 months; hypertrophic scarring occurred in 1.7% of treated scars (22 scars in six patients), which was mostly due to sub-epidermal like undermining( technical error), and was managed successfully in all cases; and hemorrhagic papules and pustules occurred in 5.6% of subcised scars, and were treated successfully with drainage and topical antibiotics or steroids.

Advantages of the subcision-suction method include ease of application, low cost, short down-time, applicability for various skin types (most had type III in this study), applicability for various scar types, lack of significant complications, and "remarkable and persistent improvement in short time without injury to the skin surface," the investigators reported.

"It seems that this method has the potential to be used as the first step for acne and other depressed scars management," they wrote, adding that since multistep treatment is necessary for optimal correction of acne scars, treatment may involve the use of other techniques or repeat subcision-suction after several months.

Further study of this technique is warranted, particularly given the prevalence of the problem of depressed scars of the face, they noted.

The investigators had no conflicts of interest to declare.