The Treatment of Acne Scarring Using a Wire Scalpel

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Introduction: Treatment of acne scarring is a staged and time-consuming procedure. Needle subcision is used to raise rolling scars that are attached below the level of the dermis. This article describes a modification of that technique to treat a “field” of acne scars with a commercially available wire scalpel. This technique treats rolling scars and has some benefit to clusters of deep boxcar scars. A patient example is demonstrated. Materials and Methods: After local infiltration with 1% lidocaine with 1:100 000 epinephrine in a volume sufficient to blanch the operative sites, the areas are divided into narrow triangular or oval sections approximately 5 mm at the widest point. A straight needle swedged on a wire scalpel is used to guide the wire from the apex through the 3 sides of the triangle and back out the apex. The desired level is just subdermal. The needle should exit and re-enter through the same hole at the 3 corners. The wire is then grasped firmly and pulled beneath the dermis with a sawlike motion, allowing the wire to severe the dermal attachments. This process is repeated in slightly overlapping sections to avoid depressions from untreated areas until every identified scar is treated. Patient Presentation: In the case presented, some acne scarring remained visible; however, the authors noted an overall improvement, and the patient stated he was pleased with the results. Bleeding is usually minimal, and pressure dressings are normally not necessary. Discussion: The technique of wire subcision is an extension of a proven technique of needle subcision in the treatment of acne scarring. Although it is not useful in the treatment of all types of acne scarring, it is very effective when treating rolling scars that have dermal attachments. Each pass of the wire treats a wider area than the needle technique and is therefore better designed to completely undermine an area with fewer dermal attachments left untreated. Lacerations can be avoided by carefully exiting and entering through the same needle holes. Conclusions: The wire subcision technique treats rolling scars and may benefit clusters of deep boxcar scars. It may also be used to treat wider areas than needle subcision. The technique is simple and the complication rates are low. The authors believe this is a useful addition to the pantheon of acne scarring treatment techniques.