Does subcision cause sagging?
Very extensive subcision can potentially cause sagging if supportive ligaments are divided, however the risk depends almost entirely upon how extensively the procedure is performed. Undermining large areas of the face, particularly with a broad instrument such as a Taylor Liberator, carries a genuine risk of laxity. Targeted subcision of individual scars with a fine Nokor needle carries very little. The two procedures share a name but are not the same operation.
Targeted subcision releases the fibrous bands beneath one scar at a time through a small entry point, and the area of skin lifted away from the tissue beneath is measured in millimetres. Extensive subcision passes a broader instrument across a wide region to release large confluent areas in a single sitting. It can achieve more at once where tethering is widespread, and it undermines a considerably greater volume of tissue in order to do so.
The reason extent matters is anatomical. The fibrous bands that tether an acne scar sit immediately beneath the skin, whereas the ligaments that support the structure of the face lie a good deal deeper. Releasing a few square millimetres beneath an individual scar is very unlikely to disturb facial support. Releasing large areas is a different proposition, particularly across the lower face and particularly in a patient who already has some laxity.
Generally I favour targeted subcision of individual scars with a Nokor needle, staged across several sessions rather than attempting a whole face at once. I will frequently combine this with dermal filler at the same visit, placed to restore volume within the space that has been created. This is a deliberate trade: progress is slower than with extensive undermining, but the risk of laxity and of the other complications associated with treating large areas is lower.
If extensive subcision is being proposed, it is worth asking specifically which instrument is to be used and how large an area is to be treated, since the risks being consented to are not the same. If you already have noticeable facial laxity this should be raised at consultation.
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