Subcision is a minimally invasive procedure that releases tethered acne scars by breaking fibrotic bands underneath the skin. A specialized needle is inserted beneath the scar and moved in a fanning motion to cut the fibrous tissue pulling the scar downward. This allows the skin to lift and smooth out naturally, with new collagen filling the space over time. It is the gold standard treatment for rolling scars.
Subcision (also spelled subcision or subcutaneous incisionless surgery) is a procedure performed under local anesthesia. A tri-beveled needle or Nokor needle is inserted through a small puncture next to the scar.
| Feature | Detail |
|---|---|
| Procedure type | Minimally invasive |
| Anesthesia | Local (numbing injection) |
| Duration | 15–45 minutes per area |
| Downtime | 3–7 days (bruising) |
| Results visible | 1–3 months (as collagen builds) |
Dr. Muya has performed subcision across hundreds of Malaysian patients presenting with rolling acne scars and tethering. His approach combines local anesthesia, precise needle release of fibrotic bands, and adjunct filler when indicated. Typical outcomes show significant cosmetic improvement with minimal downtime, reinforcing patient trust through consistent, documented results.
When acne heals, the body sometimes forms fibrous bands (scar tissue) that connect the epidermis to deeper tissue. These bands pull the skin downward, creating a shadow and the appearance of a rolling or depressed scar.
Subcision mechanism:
Needle inserted beneath the scar
Needle moved side-to-side (fanning)
Fibrous bands are cut
Skin is released and springs upward
Blood pools underneath (hematoma)
New collagen fills the space over 3–6 months
| Treatment | Best For | Mechanism |
|---|---|---|
| Subcision | Rolling scars, tethered scars | Physical cutting of scar tissue |
| Fractional Laser | Boxcar scars, texture, pigmentation | Thermal ablation of surface |
| Microneedling | Mild scars, skin quality | Micro-injuries for collagen |
Lasers cannot cut fibrous bands. Rolling scars will not improve with laser alone because the tethering remains. Subcision physically releases the tether, then lasers can resurface the surface texture.
Rolling scars are broad, depressed areas with sloping edges. They are caused by fibrous bands pulling skin downward. Subcision is highly effective for rolling scars.
Characteristics:
Width: 4–5mm or larger
Depth: Shallow to moderate (0.5–1.5mm)
Edges: Sloping, not sharp
Appearance: Wavy, uneven skin surface
Boxcar scars have sharp, vertical edges and a flat bottom. They resemble chickenpox scars.
| Boxcar Type | Subcision Effectiveness |
|---|---|
| Shallow (0.1–0.5mm) | Low – better with laser |
| Moderate (0.5–1.5mm) | Moderate – may help if tethered |
| Deep (>1.5mm) | Low – consider punch excision or filler |
Subcision helps boxcar scars only if they have some tethering at the base. Most boxcar scars need laser resurfacing (CO2) or TCA CROSS.
Ice pick scars are narrow, deep (1–2mm), V-shaped punctures. Subcision cannot reach the depth effectively.
Better treatments for ice pick scars:
TCA CROSS (chemical reconstruction)
Punch excision (surgical removal)
Microneedling with PRP
Subcision may be performed alongside TCA CROSS but not as standalone treatment.
Most Malaysian patients have mixed scarring: rolling scars + boxcar scars + some ice pick. A combination approach works best:
Subcision first – release rolling scars
TCA CROSS – treat ice pick scars
Fractional CO2 laser – smooth boxcar scars and texture
PRP or filler – enhance volume and healing
GLOJAS Clinical Experience:
Many patients ask: “Why do I need multiple treatments? Can’t one procedure fix everything?” Mixed scarring requires layered treatment. Imagine a wrinkled tablecloth with deep holes. Subcision releases the wrinkles (rolling scars), TCA CROSS fills the holes (ice pick), and laser smooths the entire surface (boxcar/texture). Each treatment addresses a different layer. Skipping one step leaves visible imperfections.
Before subcision, your doctor will:
Examine your scars under bright light
Identify tethered vs. non-tethered scars
Mark treatment areas
Review your medical history (bleeding disorders, medications)
Stop these 7–10 days before:
Aspirin, ibuprofen, NSAIDs
Vitamin E, fish oil, omega-3
Warfarin or blood thinners (consult prescribing doctor)
Retinoids (Retin-A, tretinoin, isotretinoin)
Local anesthesia is used for comfort.
Steps:
Numbing cream (lidocaine) applied for 20 minutes (optional)
Local anesthesia injected beneath each scar area
Anesthesia contains epinephrine to reduce bleeding
After injection, you feel pressure but no sharp pain.
The doctor uses either:
Nokor needle (18G, beveled tip) – most common
Tri-beveled hypodermic needle – alternative
Cannula – newer, less traumatic option
The needle is inserted through a small puncture next to the scar and moved in a radial fanning pattern beneath the depressed area.
As the needle moves, you may hear a snapping or grating sound. This is the fibrous bands breaking. This is expected and indicates the tether is releasing.
Depth of treatment:
Rolling scars: 3–5mm deep
Moderate tethered scars: 5–7mm deep
Immediately after subcision:
Pressure is applied for 5–10 minutes
Antiseptic cream applied to puncture sites
Ice pack for 15–20 minutes to reduce swelling
You will receive written aftercare instructions before leaving.
Subcision is the only non-surgical procedure that mechanically cuts scar tissue. No laser, microneedling, or cream can release a tether. This physical release is permanent.
When the fibrous bands are cut, the body responds by:
Forming a blood clot (hematoma) under the released skin
Activating fibroblasts to produce new collagen
Filling the void with healthy, organized collagen over 3–6 months
Unlike fillers that add foreign material, subcision uses your body’s own healing response.
Once the fibrous bands are cut and new collagen fills the space, results are permanent. The scar will not re-tether because the bands have been physically severed.
However: New acne or aging may create new depressions. Subcision does not prevent future scarring.
| Treatment | Downtime | Anesthesia |
|---|---|---|
| Subcision | 3–7 days | Local |
| Punch excision | 7–14 days | Local |
| Surgical scar revision | 14–21 days | General/Local |
Unlike aggressive lasers (CO2, Erbium), subcision carries minimal risk of post-inflammatory hyperpigmentation (PIH). This makes it ideal for Malaysian skin types (Fitzpatrick III–V).
| Skin Type | Subcision Safety | CO2 Laser Risk |
|---|---|---|
| Fitzpatrick I-II (fair) | Very safe | Moderate |
| Fitzpatrick III-IV (light brown) | Very safe | High |
| Fitzpatrick V-VI (dark brown/black) | Very safe | Very high (PIH) |
Right after subcision, you will notice:
The scarred area looks lifted and smoother
Immediate improvement of 30–50% (due to hematoma filling)
Swelling and redness at treatment sites
This immediate lift is partly from blood pooling. The true result appears after the hematoma resolves.
| Day | Appearance |
|---|---|
| Day 1–3 | Purple/blue bruising, moderate swelling |
| Day 4–5 | Bruising turns green/yellow |
| Day 6–7 | Bruising fades, swelling gone |
| Day 10–14 | Most bruising resolved |
Do not massage or apply pressure to treated areas during this phase.
New collagen slowly fills the treated area. Results appear gradually.
What patients notice:
Scars appear 40–60% improved
Skin texture feels smoother
Previously depressed areas now level with surrounding skin
Peak improvement occurs 3–6 months after subcision.
| Time Point | Improvement |
|---|---|
| 1 month | 30–50% |
| 3 months | 50–70% |
| 6 months | 60–80% |
Some patients continue improving up to 12 months post-treatment.
Results are permanent for the treated scars. The released skin will not re-tether.
However: New wrinkles, volume loss (age), or new acne scars can create new depressions. Maintenance treatments may be needed every 1–2 years for patients with active acne or significant aging.
What to expect:
Significant bruising (like a bad hickey) – normal
Swelling that may extend beyond treatment area
Soreness when touching treated areas
Small scabs at needle puncture sites
What to do:
Apply ice packs (15 minutes every 2–3 hours)
Sleep with head elevated
Avoid touching or massaging the area
Take paracetamol for discomfort (avoid ibuprofen)
Bruising changes color as it heals:
Day 1–3: Dark purple/blue
Day 4–5: Greenish
Day 6–7: Yellow
Swelling decreases significantly by day 5. Most patients can return to work by day 4–5 with makeup covering residual yellow bruising.
| Activity | When to Resume |
|---|---|
| Office work | 24–48 hours |
| Light exercise (walking) | 5–7 days |
| Heavy exercise/gym | 10–14 days |
| Swimming | 14 days |
| Sun exposure (with SPF) | 7 days |
Do:
Apply arnica cream or take oral arnica (reduces bruising)
Use cold compresses frequently for first 48 hours
Sleep on your back with head elevated
Wear SPF 50+ daily (even indoors)
Stay hydrated
Avoid:
Ibuprofen, aspirin, naproxen (increase bleeding/bruising)
Hot showers, saunas, steam rooms (increase swelling)
Alcohol (thins blood, worsens bruising)
Massaging or picking at scabs
Retinoids for 7 days
| Side Effect | Frequency | Duration |
|---|---|---|
| Bruising | 100% | 5–14 days |
| Swelling | 90% | 3–7 days |
| Tenderness | 100% | 3–10 days |
| Small scabs | 80% | 3–5 days |
| Redness | 70% | 2–7 days |
All these are normal and expected. Bruising is not a complication – it is part of the healing process.
| Complication | Risk | Treatment |
|---|---|---|
| Infection | <1% | Antibiotics |
| Large hematoma | <1% | Drainage by doctor |
| Post-inflammatory hyperpigmentation | 2–5% | Hydroquinone, sunscreen, laser |
| Keloid/hypertrophic scar | <1% (rare in Asian skin) | Steroid injections |
| Nerve injury (temporary) | <1% | Spontaneous resolution |
Choose an experienced, LCP-certified doctor to minimize risks.
Avoid subcision if you have:
Active acne (breakouts in treatment area)
Blood clotting disorders (hemophilia, thrombocytopenia)
Active skin infection or cold sores
Keloid tendency (rare in Asians)
Pregnancy or breastfeeding
On blood thinners (cannot stop due to medical necessity)
Active isotretinoin (Accutane) use – wait 6 months
| Pricing Model | Range |
|---|---|
| Per scar (small area) | RM50 – RM150 per scar |
| Per treatment area (e.g., one cheek) | RM400 – RM800 |
| Full face | RM1,000 – RM1,800 |
| Scar Severity | Recommended Sessions |
|---|---|
| Mild rolling scars | 1–2 sessions |
| Moderate rolling scars | 2–3 sessions |
| Severe, deep rolling scars | 3–4 sessions |
| Mixed scars (rolling + boxcar) | 2–3 subcision + other treatments |
Sessions are spaced 4–6 weeks apart to allow healing and collagen formation.
Area size: Full face > cheeks only > single scar
Doctor expertise: LCP-certified specialist > general practitioner
Clinic location: Kuala Lumpur > Penang > smaller cities
Technology: Cannula-based subcision > needle-based (slightly higher)
| Package | Average Cost (RM) | Savings |
|---|---|---|
| Single session | RM800 – RM1,200 | – |
| 2 sessions | RM1,400 – RM2,000 | 10–15% |
| 3 sessions | RM1,800 – RM2,800 | 15–20% |
| Subcision + PRP | RM1,200 – RM2,200 | Varies |
| Subcision + filler | RM2,000 – RM3,500 | Varies |
Subcision works best when combined with other treatments that address surface texture and volume.
How it works:
Subcision releases the tether
Filler (hyaluronic acid) is injected into the same space
Filler provides immediate lift while collagen forms
Best for: Deep rolling scars, atrophic scars with volume loss
Cost: RM2,000 – RM4,000 per session (subcision + filler)
Results: Immediate lift + permanent improvement
PRP (platelet-rich plasma) is injected after subcision to supercharge healing.
Benefits:
Faster recovery
More collagen production (30–50% better than subcision alone)
Reduced downtime
Suitable for all scar types
Cost: RM900 – RM1,600 (subcision + PRP)
This combination treats both the tether (subcision) and surface texture (laser).
Protocol:
Subcision first (release tethers)
Wait 4–6 weeks for initial healing
Fractional CO2 laser for smoothing
Best for: Mixed rolling + boxcar scars
Cost: RM2,500 – RM4,500 (both treatments)
RF microneedling heats the dermis, stimulating deep collagen. Combined with subcision, it treats two layers.
Best for: Moderate to severe scarring
Cost: RM1,500 – RM2,800
Rejuran (salmon DNA polynucleotide) accelerates skin repair and improves quality.
Best for: Patients with thin, fragile skin or slow healing
Cost: RM1,500 – RM2,500
| Feature | Subcision | Microneedling |
|---|---|---|
| Mechanism | Cuts tethers | Creates micro-injuries |
| Best for | Rolling scars | Mild scars, texture |
| Depth | 3–7mm | 0.5–2.5mm |
| Sessions needed | 1–3 | 3–6 |
| Works on tethered scars? | Yes | No |
| Feature | Subcision | Fractional CO2 |
|---|---|---|
| Treats tethers? | Yes | No |
| Downtime | 3–7 days | 7–14 days |
| PIH risk (Asian skin) | Very low | Moderate to high |
| Cost per session | RM600–1,800 | RM1,500–3,500 |
| Best for | Rolling scars | Boxcar scars, texture |
| Feature | Subcision | TCA CROSS |
|---|---|---|
| Best for | Rolling scars | Ice pick scars |
| Mechanism | Cutting tethers | Chemical cauterization |
| Downtime | 3–7 days | 5–10 days |
| Number of sessions | 1–3 | 2–4 |
These treatments are complementary, not competitive. Use both for mixed scarring.
| Feature | Subcision | Dermal Fillers |
|---|---|---|
| Mechanism | Releases tethers, stimulates collagen | Adds volume |
| Permanence | Permanent | Temporary (6–18 months) |
| Cost long-term | Lower (few sessions) | Higher (repeated) |
| Best for | Moderate to deep rolling scars | Deep, volume-deficient scars |
Aisha LimDr. Venu treated my rolling acne scars. My skin looks much smoother now, and the healing was quicker than I expected. So happy with my results!
Hafiz RahmanI went to Dr. Muya for my acne scars. Within a few weeks, I noticed real improvement. The recovery was fast, and my skin feels healthier.
Melissa GohDr. Venu worked on my deep acne scars. Now my skin looks even and smooth. There was very little discomfort, and the results are amazing!
Nazira YusofDr. Muya helped lift my depressed acne scars. My skin looks natural and smooth now. The whole process was quick and surprisingly comfortable.
Benjamin LauDr. Venu really knows his stuff. My acne scars have visibly improved. My skin looks more natural, and the results are lasting months later.
Cassandra LimDr. Muya treated my tethered acne scars. The treatment worked great, healing was fast, and my skin looks lifted, fresh, and much smoother.
Farhana AzmiThanks to Dr. Venu, my rolling acne scars have improved so much. The collagen-building process gave me natural, lasting results. Highly recommend!
Siti NorainiDr. Muya is very gentle and professional. My acne scars are fading beautifully. My skin texture has improved so much after just two sessions.
Raymond TanFinally found a solution for my deep scars. Dr. Venu explained everything clearly. My confidence is back now that my skin looks smoother.
Lina AbdullahThe team at GLOJAS is amazing. Dr. Muya treated my acne scars with care. My skin feels firmer and looks so much healthier now.
Kenny LowWorth every ringgit. Dr. Venu’s technique for acne scar treatment is top notch. My skin has never looked this smooth and even.
Nadia RosliDr. Muya transformed my skin. My depressed scars are lifting nicely. The recovery was easy and the results keep getting better each week.
Jason CheongHighly recommend GLOJAS for acne scar treatment. Dr. Venu is professional and honest. My skin texture has improved dramatically.
Aina ZahiraSo glad I chose Dr. Muya. My rolling scars are almost gone. My skin looks radiant and feels so much healthier now. Thank you!
With over 30 years of compassionate care, GLOJAS Specialist Clinic’s MOH and LCP-certified doctors use advanced techniques to gently release tethered scars. Your safety is our priority. We help you achieve smoother, healthier skin safely, effectively, and confidently.
