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2026.10.19
For Those Who Feel "Is the Subcision Not Working?"—Identifying the Reasons, Strategies to Prevent Re-adhesion, and Determining the Optimal Number of Treatments
As an Assistant Professor, Associate Ward Director, and Chief of Dermatopathology at the university hospital dermatology department, I deepened my expertise through academic presentations and paper publications both domestically and internationally. I have handled a wide range of treatments, from birthmark therapy in children to adult pigmentation concerns, utilizing various lasers and injection therapies, while also contributing to community healthcare. Through encountering numerous cases, I strongly felt the potential and necessity of aesthetic medicine, resolving to pursue further expertise. Building upon my solid dermatological knowledge and meticulous diagnostic skills, I value treatments that gently support each individual's skin while bringing out its inherent beauty.
It’s natural to feel anxious when you’ve had a subcision but feel like “it hasn’t changed as much as I expected” or “maybe the subcision didn’t work.”
Actually, there are several common reasons for this, and there are also areas where improvements can be made.
In this article, we’ve compiled key considerations to help you make an informed decision—including the types of scars (such as indented acne scars), the risk of re-adhesion, the optimal timing for evaluation, and strategies for utilizing non-crosslinked or low-crosslinked hyaluronic acid.
Subscription services often don’t end after just one session, so it’s realistic to think of them as a process that takes several sessions to reach a point of satisfaction. I hope this helps you find a focus that aligns with your own concerns.
[Doctor’s Note]
Subcision is a treatment that releases the subcutaneous fibrous adhesions that are pulling down the indentations caused by acne scars.
If you are having difficulty noticing the effects, you should reassess factors such as the type of scar, the severity of adhesions, whether re-adhesions have occurred, and the timing of the evaluation.
In the case of narrow, deep indentations, subsection alone may not provide sufficient improvement, so we consider combining it with other treatments.
The number of treatments and the intervals between them are not fixed; it is important to adjust them according to each individual scar while monitoring the patient’s progress.
Main Reasons Why It's Hard to Notice the Effects of Subsidion
Subcision is a treatment based on the concept of loosening fibrous adhesions beneath the skin to lift the depressed area. However, if the following factors occur simultaneously, the effects may not be fully apparent.
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Mismatch in Scar Type: The response differs between wide, shallow indentations (rolling) and narrow, deep indentations (ice-pick-like). Deep, narrow indentations may show little change with subsection alone.
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Strength and Range of Fiber Bundles: If adhesions are strong and multi-layered, a single treatment is often insufficient to release them.
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Re-adhesion: During the wound healing process following the procedure, the removed tissue may be pulled back into place.
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Discrepancy in the Timing of Evaluations: Even if it appears "swollen" immediately afterward, the true appearance becomes clear once the swelling subsides. Early assessments tend to have a higher margin of error.
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Concomitant findings: If the dermis remains thin (the skin itself is thin), pores remain enlarged, or uneven skin tone persists, it’s easy to get the overall impression that “nothing has changed.”
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The Gap in Expectations: Once your eyes get used to high-magnification "Before & After" images, you may find that the changes under everyday lighting seem minor.
Key Points for Preventing Recurrent Adhesions
Recurrence of adhesions is a major factor in the feeling that “it worked, but then it came back.”
As a precaution, measures should be considered to ensure adequate space while avoiding excessive inflammation from immediately after the procedure until the wound has healed.
Specifically, non-crosslinked or low-crosslinked hyaluronic acid may be used to prevent re-adhesion.
The idea is to use a relatively soft gel to provide light support, softening the shadows cast by the indentations while preventing the tissue from retracting too much during the early stages of healing.
There are individual differences in suitability, dosage, and duration; we make decisions on a case-by-case basis, taking into account skin thickness, scar characteristics, and the patient’s tolerance for downtime.
Approaches to Frequency and Pace
Subcision is not a treatment based on the assumption that it will "cure the problem in one session"; rather, it is a procedure that is completed in stages.
The more severe the adhesions, the more realistic it is to divide the treatment into several sessions.
We will monitor the resolution of swelling and bruising, as well as the progress of collagen remodeling, and make fine adjustments at each visit, spacing them out over a period of several weeks to several months.
If you factor into your schedule from the outset that it may take several sessions to achieve satisfactory results, it will make the process easier both mentally and practically.
Criteria for Deciding How to Combine Treatments
I don't think in terms of which is better or worse; I consider whether it's a good fit for my concerns.
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Focus on wide, shallow indentations: When subcision is used to loosen the underlying tissue while simultaneously incorporating treatments designed to improve skin texture (such as those involving micro-heat energy or skin boosters), this combination tends to contribute to smoother skin.
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Narrow, deep indentation at the center: If there is little improvement with subcision alone, we may consider pinpoint ablation or more intensive spot treatment (e.g., topical application of high-concentration acid).
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The skin is very thin: Sometimes it’s best not to push too hard, but rather to build up the routine gradually by prioritizing gentle stimulation, moisturizing, and soothing while monitoring your skin’s response.
In each case, adjustments are made based on your lifestyle (plans to be in public, tolerance for downtime) and skin type.
Who This Is For / Who Should Consider It Carefully
People Who Might Be Suited for This
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People with noticeable horizontal indentations (a tendency to roll)
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People who want to make steady improvements, even if it takes several attempts
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Someone who doesn't rely solely on "Before & After" photos, but places importance on how things look in everyday light
People who want to consider this carefully
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People with predominantly deep, narrow indentations (though these may show little variation on their own)
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People Prone to Severe Post-Inflammatory Hyperpigmentation
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People who can't afford much downtime
Basics of Risks and Aftercare
Bleeding, bruising, swelling, tenderness, edema, unevenness, and temporary changes in skin color may occur.
Since individual responses vary widely, it is important to apply cold compresses, keep the area clean, and avoid friction and strong sunlight after surgery. If you experience any concerning symptoms, please consult your doctor as soon as possible.
Frequently Asked Questions
Q. Is there really no subscription effect, and when should I make that determination?
We recommend holding off until the swelling subsides. Review the results in a few weeks to a few months; objectively assessing them through photos and by touch will help minimize discrepancies.
Q. How many sessions does it usually take to notice a difference?
While some people notice results after just one session, it’s more realistic to expect that results build up over multiple sessions. The number of sessions required varies depending on the affected area and the severity of the adhesions.
Q. How can I prevent re-adhesion?
Depending on the situation, one option is to apply a thin layer of non-crosslinked or low-crosslinked hyaluronic acid in combination to prevent re-adhesion. The appropriateness of this approach is determined on a case-by-case basis.
Q. Can a subcutaneous abscess get worse?
In rare cases, temporary unevenness or changes in color may occur. These issues usually resolve with observation and proper care, but please contact us as soon as possible if you notice anything unusual.
Q. What are some tips for interpreting "Before & After" images?
Check to see if the lighting, angle, and facial expressions are consistent across all photos. We recommend looking not only at close-up shots but also at photos taken from a normal viewing distance to get a sense of the overall composition.
How to Seek Advice
It helps make the consultation go more smoothly if you specify exactly “which indentations you want to improve and by how much” and bring a few photos taken in natural light.
Be sure to share your treatment history, how much downtime you’re willing to tolerate, and your preferred frequency of visits.
It’s important that we work together to create a plan you’re comfortable with—not one that’s forced upon you. If you’d like to find out if this is right for you, please feel free to contact us for a consultation.
Summary
Factors such as the type of scar, re-adhesion, and discrepancies in the timing of evaluation often contribute to cases that appear to show “no response to subcision.”
By using non-crosslinked or low-crosslinked hyaluronic acid to prevent re-adhesion, or by taking a planned approach involving multiple sessions, it is possible to achieve realistic improvements.
Choose a plan that fits your lifestyle, skin type, and preferences without putting undue strain on yourself, and feel free to ask an expert if you have any questions. If you’d like to know if it’s right for you, please feel free to consult with us.
