Subcision combined with hyaluronic acid (HA) or popoly-L-lactic acid (PLLA) threads may better reduce the appearance of atrophic acne scars than subcision alone, suggests study data published in the Journal of Cosmetic Dermatology.

This split-face study enrolled patients with atrophic post-acne scars who presented to a university clinic in Egypt from 2019 to 2020. All patients received 3 sessions of subcision on both sides of the face at 4-week intervals. Afterwards, patients were randomly assigned to receive either HA filler or PLLA threads on the right side of the face only. In each patient, the left side of the face served as the control condition. Clinical improvement was assessed at 3 months post-treatment using a quartile grading scale. Patient satisfaction was also captured at 3 months post-treatment. Safety events were monitored throughout the trial duration.

A total of 40 patients were enrolled, of whom 18 were men and 22 were women. Mean age was 26.7 ± 6.8 years. Compared with subcision alone, clinical improvement was greater with the addition of HA fillers or PLLA threads. Specifically, 52.9% of patients achieved improvement with subcision alone, compared with 82.4% of patients with added PLLA threads and 94.1% of patients with added HA fillers (P <.0001). Patient satisfaction was higher with the combined treatments compared with subcision alone (P <.0001). Side effects included edema, pain, and ecchymosis, which were mild and resolved with time. The prevalence of side effects did not differ by treatment condition.

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As study limitations, investigators noted the small study cohort; further research is necessary to better explore treatment options for acne scars.

“A combination of HA or threads with subcision is a highly effective and favoured therapeutic option [compared with] subcision alone for improving acne scars,” investigators wrote. “Although HA or threads offer a temporary improvement of the acne scars, they are suitable options with immediate results in patients who refuse other invasive techniques.”


Ebrahim HM, Nassar A, ElKashishy K, Artima AYM, Morsi HM. A combined approach of subcision with either cross-linked hyaluronic acid or threads in the treatment of atrophic acne scars. J Cosmet Dermatol. Published online December 20, 2021. doi:10.1111/jocd.14675

This article originally appeared on Dermatology Advisor