What is the best treatment for rolling acne scars?

Part of: Acne

When rolling scars are tethered by fibrous bands under the skin, subcision treats the mechanism itself: it releases the bands that pull the surface down. The available studies are small, but they showed a clear improvement in many patients, and in a comparison study the improvement was greater than with TCA CROSS. This supports the principle, but it does not mean every rolling scar needs subcision or that the result is guaranteed.

Key numbers

  • 5 sessions every 4 weeks — A newer small trial

When does subcision really make sense?

  • When the scar improves as the skin is stretched sideways, or tethering is found on examination, the fibrous component matters.
  • If the scar is shallow and not tethered, resurfacing or microneedling/RF may matter more than releasing under the skin.
  • Deep, narrow ice pick scars are not the classic target for subcision and need a different strategy.
  • Combining with resurfacing, RF or filler depends on what remains after the bands are released, not on stacking procedures in one session.

Key takeaways

  • Tethered rolling scar = treat the fibrous pull before only chasing the surface.
  • Subcision has direct data for rolling scars, but the result varies with depth, number and technique.
  • The scar type matters more than the device name or the price of a session.

Acne Scars: Choose the Treatment by Scar Type

Medical references

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