Comparison of Two Methods of Subcision in Acne Scar Treatment
abstract
This abstract is available on the publisher's site.
Access this abstract nowCONTEXT
Subcision is a simple surgical method that can be effective in treatment of acne scars.
AIMS
This study was conducted to evaluate and compare the two methods of Nokor needle and blunt blade (BB) subcision in treatment of acne scars.
SETTINGS AND DESIGN
This clinical trial study was conducted on 28 patients with acne scars.
PATIENTS AND METHODS
One side of the face was treated with BB subcision method, and the other side was treated with Nokor needle method. Followed up period was 6 months after treatment.
STATISTICAL ANALYSIS USED
Data were analyzed by Statistical Package for the Social Sciences (version 20) software using independent sample t test, Mann-Whitney test, Friedman test, and Fisher's exact test.
RESULTS
In follow-up period, the improvement of acne scars was comparable in both groups (P > 0.05). Complications were lower in BB method than another method (P < 0.05). The patient satisfaction was higher in BB method (P < 0.05).
CONCLUSIONS
Both of modalities offered similar improvement, but the complication rate was lower and the patient satisfaction was also higher in the BB method than another method.
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Additional Info
Disclosure statements are available on the authors' profiles:
Comparison of Two Methods of Subcision Nokor and Blunt Blade in Acne Scars Treatment
J Cosmet Dermatol 2019 May 18;[EPub Ahead of Print], A Asilian, G Faghihi, A Asemi Esfahani, F Mokhtari, M Nilforoushzadeh, S MozafarpoorFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patients commonly present to our practice with acne scarring. The modality utilized to treat acne scars in our practice is determined by the type of scarring. Often, we utilize a combination of techniques for achieving optimal results. For bound-down scars, subcision is routinely used with or without fillers. This may be in addition to microneedle RF treatments, fractional CO2 laser, peels, and other modalities. Topical retinoid therapy is also initiated since it has been shown to help remodel acne scars.
Subcision is generally performed using a sharp instrument, such as a large-bore needle to inject a filler or a Nokor needle, which is like an 18-gauge needle with a small 11 blade at its tip. With either approach, a sweeping or stabbing motion is utilized to sever the fibrous tissue tethering down a depressed scar. This allows the overlying skin to pop back up. Fillers may be utilized to fill the space created beneath the scar that has been released.
In this study, the authors compare utilization of a Nokor needle versus a custom-designed, blunt-bladed cannula to release the bound-down acne scars. It was a split face study where tumescent anesthesia was used to anesthetize and tumesce the treatment fields on both sides of the face.
In this small study, satisfaction rates were similar for both techniques; however, more bruising and hematomas occurred on the sides treated with the Nokor needles, although they were delayed. In addition, there was more pain reported on the Nokor side. The dermatologists performing the study were also concerned about the difficulty in controlling the Nokor needle because it did not have a handle.
In our experience, both the Nokor needle and the standard needle technique have proven to be safe and effective for treating bound-down acne scars with maximum comfort for the patient. Our technique is a bit different as it utilizes local infiltrative anesthesia in and around the acne scars being treated. The Nokor needle can then be introduced painlessly. To permit better control of the Nokor needle, we mount the needle on a Luer-Lok 5-cc syringe, which acts like a handle, allowing precise severing of the fibrous tissue pulling down on the acne scars. We have tried the blunt blade technique, but the patients found it very uncomfortable due to the pressure required to push the blunt blade through severe acne scars. In addition, scars are often incompletely released using the blunt blade technique.
This study does, however, demonstrate that both methods are viable options for improving acne scarring. There are multiple ways to skin a cat, and the results may simply depend upon the technical skill and experience of the surgeon utilizing their favored procedure.