Is it normal to see no improvement three weeks after subcision?
This is entirely normal. At three weeks the bruising has usually settled and the initial swelling has resolved, which frequently leaves the scars appearing exactly as they did beforehand, or briefly worse. The improvement from subcision arises from new collagen forming where the tethering bands were divided, and this takes months rather than weeks.
For the first one to two weeks there is bruising and swelling. Between the third and sixth weeks the appearance returns to something close to the starting point, which is the stage at which most patients become concerned. From around two to three months new collagen has formed and the scars begin to lift, and remodelling continues for up to a year afterwards.
The reason the result appears to go backwards is that swelling and bruising temporarily fill out a depressed scar, so the first few days after treatment often look excellent. That is not the result of the procedure, and when it settles the apparent loss of improvement can be disheartening if it has not been anticipated.
Three months is the earliest point at which a judgement should be made, and six months is preferable. Assessing at three weeks is assessing the swelling rather than the treatment. Photographs taken in consistent, indirect daylight are considerably more reliable than memory, since the change is gradual and lighting alone can make the same scars look completely different.
Where there is genuinely no change at six months this is worth reviewing, as it may indicate that the scars were not tethered in the manner expected and that a different approach is required.
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