What can go wrong with subcision?
Subcision is a surgical procedure and does carry risks, however which risks apply depends heavily upon how extensively it is performed. Localised subcision of individual scars with a fine Nokor needle, which is what I mainly perform, carries bruising, swelling, tenderness and occasionally nodules or infection. Extensive subcision across large areas adds sagging and nerve injury to that list.
Bruising should be expected. It typically lasts one to two weeks, sometimes longer, so it is important to plan the timing around anything socially important. A degree of bruising is in fact desirable, since the blood clot that forms within the space created beneath the scar contributes to the volume that lifts it. Very occasionally bruising is extensive enough to require surgery to remove the clot "haematoma", although this is unusual.
Firm nodules or lumpy scars can form beneath the skin some weeks after treatment, where the healing response has been more vigorous than intended. Most settle spontaneously over a few months. Where one persists it can potentially be improved with a steroid injection, which flattens it. Nodules are more likely following aggressive undermining over a wide area, which is one of the reasons I stage treatment rather than attempting a whole face in one sitting.
Extensive subcision, using a broader instrument such as a Taylor Liberator to release large confluent areas at once, carries a materially different risk profile. Sagging becomes a genuine possibility, as does nerve injury causing numbness or, rarely, weakness, since longer passes travel further from the entry point. Larger collections of blood beneath the skin are more common and occasionally require drainage, and recovery is correspondingly longer.
Subcision can occasionally worsen a scar, usually in one of two situations. The first is over-treatment, where excessive undermining in one area produces an irregular or lumpy result. The second is in patients with a tendency to hypertrophic or keloid scarring, in whom any procedure creating a wound risks triggering the very problem being treated.
Before the procedure it is worth establishing which instrument is to be used and how large an area is to be treated, since this determines the risks that are actually being consented to. The full risk list is set out on the subcision page.
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