Some depressions in the skin are not missing volume, they are being held down. A fibrous band beneath the surface tethers the skin to the tissue underneath, and no amount of resurfacing above it will lift what is anchored below. Subcision addresses that directly by releasing the tether.
Sam Assassa, MD is a member of the American Society of Liposuction Surgery, which is where the cannula technique subcision depends on comes from. He founded Beverly Hills Aesthetics in 1995, is board certified in Internal Medicine, and has performed more than 25,000 aesthetic procedures.
“Subcision is the step most people skip. You can resurface a rolling scar forever and it will keep sitting down, because something underneath is holding it there.” — Sam Assassa, MD
How Subcision Works
Subcision is a minor surgical procedure performed under local anesthesia. A specially designed needle or a blunt cannula is introduced through a small puncture and passed beneath the depression, then moved in a fan pattern to divide the fibrous strands anchoring the skin to the deeper tissue.
Once those bands are cut, the skin is free to rise to its natural level. The controlled bleeding that follows forms a small clot in the released space, and the healing that occurs there produces new connective tissue that helps maintain the elevation.
Two applications, same principle. In acne scarring, the tethers pull down rolling and some boxcar scars. In cellulite, the fibrous septae create the dimples, and releasing them allows the skin to smooth.
Subcision for Rolling Acne Scars
Rolling scars are the type subcision suits best. They are broad, shallow, and sloped rather than sharply defined, and they are held down from beneath.
Subcision is rarely the whole plan. It releases the tether, and resurfacing or microneedling then addresses the surface texture, while filler or fat can be placed where a depression does not fully resolve. Sequencing matters, since treating the surface before releasing the tether wastes the surface treatment.
Subcision is less effective for deep boxcar scars and generally not the right tool for ice pick scars, which are covered on the acne scar treatment page.
Subcision for Cellulite Dimples
The same fibrous septae that tether acne scars create cellulite dimpling, and the same release applies. After the bands are divided, fat in the surrounding area can be shifted to fill the released divot, or fat can be harvested and injected where the dimple is deep enough that shifting will not fill it.
Cellulite is multifactorial and appears in people of every body type, including those who are very lean, since the underlying cause is structural rather than related to body weight.
What to Expect After Subcision
Local anesthetic is used and the procedure is performed in the office. Expect bruising, and expect more of it than most treatments here produce, since the procedure works by dividing tissue beneath the skin. Bruising typically peaks in the first days and resolves over one to two weeks. Swelling and tenderness in the treated area are normal.
Improvement is visible as the bruising resolves and continues developing over the following months as the healing response matures. More than one session is often needed, particularly for extensive scarring, spaced to allow full healing between treatments.
Subcision Risks and Safety
Subcision is a surgical procedure and it carries more than the risks of an injectable appointment.
Expected effects include bruising, which is substantial and unavoidable, swelling, tenderness, and temporary firmness. Risks include hematoma, meaning a collection of blood beneath the skin that may require drainage, nodule formation where healing tissue overcorrects, infection, post-inflammatory hyperpigmentation, which is more likely in deeper skin tones, and recurrence, since released bands can re-tether over time and some patients need repeat treatment.
Patients on blood thinning medication or with bleeding disorders should discuss this before scheduling. Individual results vary and no outcome can be guaranteed.
Frequently Asked Questions About Subcision
How much bruising should I expect after subcision?
More than you are expecting, and this is the single most common surprise. The procedure works by dividing tissue beneath the skin, and bleeding into that space is part of the mechanism rather than a complication, since the clot that forms contributes to the correction. Bruising typically peaks in the first few days and resolves over one to two weeks. Plan treatment well away from anything you care about being photographed at.
How many subcision treatments will I need?
Often more than one, particularly for extensive scarring or widespread cellulite dimpling, with sessions spaced to allow full healing between them. Some patients see substantial improvement from a single treatment. Others need two or three. The number depends on how many areas are tethered and how much fibrous tissue is involved, which is assessed at consultation rather than estimated in advance.
Is subcision permanent?
The released bands do not reattach exactly as they were, and the healing response that follows helps maintain the correction, so results are durable for most patients. Recurrence does happen, since tissue can re-tether over time, and some patients return for maintenance. Combining subcision with resurfacing or with volume replacement tends to produce a more durable outcome than subcision alone.
Does subcision hurt?
Local anesthetic is used, so the procedure itself is uncomfortable rather than painful, with most patients reporting pressure and a pulling or scraping sensation as the bands are divided. Afterward there is soreness and tenderness in the treated area for several days, comparable to a deep bruise, which is essentially what it is. Discomfort is manageable and settles well before the bruising does.
Can subcision treat all acne scars?
No, and matching it to the right scar is what makes it work. Subcision is the treatment of choice for rolling scars and tethered depressions, and it helps with some boxcar scars. It does little for ice pick scars, which are narrow and deep rather than tethered, and it is not appropriate for raised hypertrophic or keloid scars, which need the opposite approach. Most patients have several scar types and need a combined plan.
Is subcision surgery?
It is a minor surgical procedure, and describing it accurately matters for how you plan around it. It is performed in the office under local anesthesia, requires no general anesthesia and no facility stay, and you go home immediately. But an instrument is passed beneath the skin to divide tissue, which places it in a different category from an injectable appointment in terms of recovery, bruising, and consent.
Why Patients Choose Beverly Hills Aesthetics for Subcision
- Cannula Technique: Blunt cannula work drawn from three decades of liposuction practice.
- Physician Performed: Dr. Assassa performs every subcision himself.
- Correct Scar Selection: Subcision recommended for tethered scars rather than applied indiscriminately.
- Sequenced Planning: Release performed before surface treatment, so neither is wasted.
- Both Applications: Acne scarring and cellulite dimpling treated with the same underlying technique.
Schedule a Subcision Consultation in Beverly Hills
If your acne scars have not responded to resurfacing, or your cellulite dimples persist regardless of weight and exercise, the reason may be that something beneath the surface is holding them down. Dr. Assassa will assess whether tethering is the cause and whether releasing it would change what you see. Beverly Hills Aesthetics serves patients from Beverly Hills, Los Angeles, West Hollywood, and Century City. Request a consultation or schedule your appointment online.