Atrophic acne scars: subcision combined with PRP

Why the tissue underneath is released first

Where inflammation ran deep, fibrous tissue forms beneath the skin. It pulls the surface downward and holds the depression in place.

Subcision passes a fine needle under the skin to divide that tissue. With less downward pull, the surface has room to lift.

PRP separates the platelet-rich fraction of the patient’s own blood and reinjects it, used alongside to support recovery at the released site.

Forty-four patients, three sessions at four-week intervals

Forty-four patients with grade 2 or higher atrophic scarring took part. Each received three sessions four weeks apart, and three independent assessors rated photographs one month after the third session.

Scars were on the cheeks in almost all cases, and 96% were mixed-type scarring from acne.

96% good or better

A statistically significant improvement was found on the scar grading scale. 96% showed a good to very good response, and the same proportion were satisfied.

The more interesting question is which scars responded. Results were better where scarring was more severe at baseline and where rolling scars were present.

A rolling scar is tethered broadly from below, which suits a treatment that divides the tethering. Narrow, deep scars need a different approach.

Side effects

Pain was reported by 93%, mild swelling by 41% and redness by 34%. All were transient.

That almost everyone reported pain is worth keeping in mind. Dividing tissue under the skin with a needle is not a light procedure.

What this study does not answer

• No control group. There was no comparison against subcision alone or PRP alone
• So how much of the 96% owes to the combination cannot be determined
• Assessment was from photographs, where lighting and angle cannot be fully excluded
• Follow-up ended one month after the final session. Durability is unknown
• The cohort was Vietnamese patients; a different skin type may give a different result
• Forty-four is a small number

The authors themselves note at the outset that trial results for this combination are not yet consistent.

The practical takeaway

The figure to look at is not 96% but which scars responded.

Broad, rolling depressions did well, because the tethering below pulls the surface widely and dividing it suits that. Narrow, deep scars are a loss of tissue rather than a tethering problem and need a different approach.

In practice both types are usually mixed. Working out which yours is closer to comes before choosing a treatment.

Frequently asked questions