Subcision works by releasing the fibrous bands that pull acne scars downward — but for many patients, that release alone is not enough. Adding dermal fillers after subcision addresses what subcision leaves behind: the space where scar tissue was tethered, and the volume lost to years of atrophic scarring. At Sozo Aesthetic Clinic, Dr Justin Boey, Medical Director, plans subcision and filler as a combined approach for patients with rolling and boxcar scars that have not responded to laser treatment alone.
At Sozo Aesthetic Clinic, subcision and filler procedures are performed by MOH-licensed doctors in line with MOH and HSA guidelines for acne scar management.
This page explains how the two procedures work together, who is most likely to benefit, what the treatment involves step by step, and what results you can reasonably expect in Singapore.
What Is Subcision and Why Does It Work?
Subcision is a minimally invasive technique used to treat tethered acne scars. A specialised needle or blunt cannula is inserted just beneath the skin surface to sever the fibrous bands that anchor scar depressions to deeper tissue. Once those bands are cut, the scar surface is free to lift.
The procedure is particularly suited to rolling and boxcar scars — the kind that create wave-like or broad depressions, most commonly across the cheeks. Ice pick scars, which are narrow and deep, do not respond to subcision; they are better addressed with TCA Cross.
Subcision also creates a pocket beneath the skin. That pocket is where healing begins — and where filler can be introduced to provide structural support once the tether has been released.
Why Add Dermal Filler After Subcision?
Releasing a scar tether is one step. Keeping it released is another. The body’s natural healing response after subcision involves repair — and without support, scar tissue can re-adhere and recreate the original indentation. Dermal filler addresses this directly.
Prevents re-adhesion
After subcision, the released tissue needs time and space to remodel without being pulled back down. Filler occupies the pocket created by the procedure, physically preventing the scar base from re-adhering to underlying tissue. This is structural support at the treatment site, not a cosmetic patch.
Provides immediate volume
Acne scarring is not only about texture. It also involves volume loss — areas where the dermis has thinned or collapsed over time. Filler restores that volume immediately, elevating depressed areas and improving skin contour in a way that subcision alone cannot achieve.
Supports long-term correction
Certain fillers, particularly bio-stimulatory types such as calcium hydroxylapatite (CaHA) and poly-L-lactic acid (PLLA), encourage the body to produce new collagen over time. The improvement continues even after the filler itself is absorbed — making the combination an approach with both immediate and sustained benefit.
The Step-by-Step Procedure at Sozo
Subcision and filler are performed as a staged or same-session procedure depending on the patient’s healing response, scar depth, and the type of filler being used. Dr Justin Boey assesses each patient individually before deciding on the sequencing.
Pre-treatment
The skin is cleansed and a topical numbing agent is applied to the treatment area. Dr Justin Boey reviews the scar map — identifying which scars are tethered and what depth of correction is needed — before determining filler volume and injection points.
Patients are advised to avoid blood-thinning supplements, alcohol, and certain medications in the days leading up to treatment to reduce bruising risk.
Subcision step
A specialised needle or blunt cannula is inserted beneath the skin at the scar site. The fibrous bands anchoring the scar to deeper tissue are severed with controlled movements, allowing the scar surface to lift. The technique — needle versus cannula — depends on scar type and the practitioner’s assessment.
Filler injection
Filler is introduced into the released space either immediately after subcision or at a follow-up appointment. When performed on the same day, subcision is completed first and filler is injected immediately to prevent re-anchoring before healing begins. When staged, filler is added 1–4 weeks later once swelling subsides and remaining depressions can be accurately assessed.
Filler type is chosen based on scar depth, skin characteristics, and the degree of correction needed:
- Hyaluronic Acid (HA): immediate, reversible volume. Dissolvable with hyaluronidase if needed.
- Collagen-based fillers: structural lift with gradual integration.
- CaHA and PLLA (bio-stimulatory): stimulate collagen over 12–24 months. Not reversible; medically managed if issues arise.
Filler pricing at Sozo Aesthetic Clinic:
| Filler Type | Price From |
|---|---|
| Hyaluronic Acid (HA) | $600–$800 per syringe |
| Collagen-based fillers | $700–$900 per syringe |
| Semi-permanent fillers (CaHA, PLLA) | $800–$1,000 per syringe |
| Post-subcision filler support (from) | $800 per syringe |
The total cost depends on the extent of scarring and the type and volume of filler used. Your doctor will provide a personalised estimate during consultation.
Post-care
After the procedure, bruising and swelling are normal. Subcision typically causes bruising and swelling for 5–10 days; filler adds 1–3 days of minor swelling or tenderness at injection sites.
- Apply cold compresses during the first 24–48 hours to manage swelling.
- Avoid applying pressure to the treated areas, strenuous activity, alcohol, and saunas for at least 48 hours.
- Use a broad-spectrum sunscreen (SPF 50+) daily to prevent post-inflammatory pigmentation.
- Avoid direct sun, hot showers, and steam rooms for at least one week after treatment.
- Contact the clinic promptly if you experience severe pain, unusual discolouration, or swelling that does not improve.
Subcision Alone vs Subcision with Filler
Both approaches target tethered acne scars. The difference lies in what happens after the fibrous band is cut—and whether volume loss is also being addressed.
| Subcision Alone | Subcision + Dermal Filler | |
|---|---|---|
| Target problem | Fibrous tethering beneath the skin | Fibrous tethering + volume loss / scar depression |
| Best suited to | Rolling scars, tethered atrophic scars | Rolling scars, soft boxcar scars, areas with volume loss |
| Method | Needle or cannula severs fibrous bands | Subcision release + filler injected beneath the scar |
| Downtime | 5–10 days (bruising, swelling, tenderness) | 5–10 days (subcision) + 1–3 additional days (filler) |
| Common side effects | Bruising, swelling, temporary PIH in darker skin | Subcision-related bruising plus rare lump formation and rare vascular risk |
| Collagen stimulation | Natural healing response only | Enhanced with bio-stimulatory fillers (CaHA, PLLA) |
| Duration of results | Long-lasting once bands are released; collagen remodelling continues | HA fillers: 6–12 months; CaHA/PLLA: 12–24 months |
| Price from | From $400 per session | From $400 (subcision) + from $800/syringe (filler) |
The right approach depends on scar depth, skin type, and prior treatment history. Dr Justin Boey discusses these factors during your consultation to determine whether subcision alone is appropriate or whether filler support is warranted.
Why the combination often produces better results
Acne scars usually involve more than one underlying problem — tethering by fibrous bands and loss of volume beneath the skin. Subcision alone addresses anchoring. Filler alone addresses depression but not the fibrous cause. Together, they correct both, which is why many patients see better outcomes from combination treatment than from either procedure used in isolation.
- Complementary mechanisms: subcision releases the bands that pull the skin down; filler lifts and supports the skin once freed.
- Immediate and long-term benefit: filler provides volume support on the day; bio-stimulatory fillers continue remodelling for up to 24 months.
- Reduced re-adhesion risk: filler occupies the released space and reduces the chance of scar tissue reattaching before healing completes.
Who Is a Good Candidate?
Not every scar responds equally to subcision and filler. The combination tends to produce the strongest results in patients with a specific scar profile and skin condition.
Rolling scars
Rolling scars — shallow, wave-like depressions caused by fibrous tethering beneath the skin — are the most responsive scar type for this combination. Subcision releases the tether; filler fills the resulting space and supports recovery. Patients with multiple rolling scars across the cheeks tend to see the most visible improvement.
Skin laxity
Patients with mild skin laxity or general volume loss in the mid-face may benefit from the structural support that filler provides. In these cases, filler does not just fill individual scar depressions — it also restores the broader volume framework that makes surface texture easier to correct. Soft boxcar scars with some volume deficit also respond well to filler support.
Prior treatment history
Patients who have completed a course of laser resurfacing but retain residual tethered scars are often good candidates. Laser improves surface texture and post-inflammatory hyperpigmentation; subcision and filler address what laser cannot — the mechanical tethering beneath the surface.
Doctor’s Note:
“I start every acne scar consultation with a detailed scar map. I am looking at depth, scar type, how many scars are tethered versus atrophic, and whether there is concurrent volume loss in the surrounding skin. Rolling and soft boxcar scars with a fibrous component are where subcision and filler together make the most clinical sense. If a patient has already had a course of laser treatment and their scars have not fully resolved, that often points to underlying tethering that laser cannot address, and that is exactly what subcision targets.”
— Dr Justin Boey, Medical Director, Sozo Aesthetic Clinic
Recovery and Results
Most patients experience bruising and swelling in the treated areas for 5–10 days after subcision, with filler adding 1–3 days of minor swelling at the injection sites. Social downtime — the period during which bruising is visible — is the primary consideration for most patients planning around work or events.
Recovery timeline
Days 1–3
- Localised bruising and swelling from subcision.
- Filler provides an immediate lift, though swelling may temporarily exaggerate the result.
- Cold compresses and rest recommended.
1–2 weeks
- Bruising and swelling gradually fade within 7–10 days.
- Some patients observe early changes in scar appearance as healing progresses.
- Most return to normal activities quickly; makeup can cover residual marks.
1–3 months
- Collagen stimulation from subcision continues, gradually remodelling scar tissue.
- Filler integrates into the surrounding skin, improving contour in the treated area.
6–24 months
- Subcision results remain stable once fibrous bands are released.
- HA fillers typically last 6–12 months; CaHA/PLLA fillers up to 24 months.
- Maintenance sessions may be recommended for ongoing improvement.
Most patients undergo 2–3 subcision sessions and 1–2 filler treatments depending on scar type and severity. Repeat subcision is typically scheduled every 4–6 weeks. Dr Justin Boey reviews progress at each appointment and adjusts the plan accordingly.
Frequently Asked Questions
How do I know if I need filler after subcision, or just subcision alone?
Scar depth, type, and the degree of volume loss determine whether filler is warranted. Shallow rolling scars with minimal volume deficit may respond well to subcision alone. Deeper scars with visible volume loss typically benefit from filler support. Dr Justin Boey assesses this during your consultation before recommending a plan.
Can subcision and filler be done in the same session?
In some cases, yes — particularly when a blunt cannula is used and bruising is minimal. Performing filler immediately after subcision helps prevent re-anchoring before healing begins. Other patients benefit from a staged approach, with filler added 1–4 weeks later once swelling subsides and remaining depressions can be accurately assessed.
How many sessions will I need?
Most patients undergo 2–3 subcision sessions and 1–2 filler treatments depending on the severity and distribution of their scars. Repeat subcision is typically scheduled every 4–6 weeks. Dr Justin Boey outlines the expected number of sessions and treatment spacing during your initial consultation.
Can filler lumps be dissolved if needed?
Hyaluronic acid (HA) fillers can be dissolved with hyaluronidase if a lump forms or the result needs to be revised. Bio-stimulatory fillers such as CaHA and PLLA cannot be dissolved, but any complications can be medically managed. Your doctor will discuss filler type and its reversibility before treatment.
What does subcision with filler cost in Singapore?
Subcision from $400 per session. Filler pricing depends on type: HA fillers from $600–$800/syringe; CaHA and PLLA from $800–$1,000/syringe. Post-subcision filler support typically starts from $800/syringe. Total cost depends on the extent of scarring and the volume required. Your doctor will provide a personalised estimate during consultation.
Is this treatment suitable for all skin tones?
Yes, but treatment planning adjusts accordingly. Darker skin tones carry a higher risk of post-inflammatory hyperpigmentation following subcision, so filler type, technique, and any complementary laser work are selected carefully to minimise that risk. Daily SPF 50+ sunscreen use after treatment is particularly important for patients with higher PIH risk.
How long do results last?
HA fillers typically last 6–12 months. Bio-stimulatory fillers such as CaHA and PLLA stimulate collagen over 12–24 months, delivering longer-term structural improvement. Results from subcision improve progressively as scar tissue remodels, and the timeline varies by individual.
Book a Consultation at Sozo Clinic
If you are considering subcision and filler for acne scars, the starting point is an assessment with Dr Justin Boey, Medical Director of Sozo Aesthetic Clinic. He will review your scar type, treatment history, and skin condition before recommending a plan tailored to your needs.
Subcision from $400 per session. Filler from $800 per syringe.
Book a consultation: sozoclinic.sg/contact-us
WhatsApp Dr Boey’s team: 9610 5102
All acne scar treatment options: acne scar treatments at Sozo Clinic
References
Clinical Studies
- Alam M, Omura N, Kaminer MS. Subcision for acne scarring: technique and outcomes in 40 patients. Dermatol Surg. 2005;31(3):310–317. doi: 10.1111/j.1524-4725.2005.31080. PMID: 15841633. https://pubmed.ncbi.nlm.nih.gov/15841633/
- Lobo Y, Lim DS. Surgical subcision for acne scars: a review of instrumentation. Dermatol Surg. 2023 Apr;49(4):355–362. doi: 10.1097/DSS.0000000000003706. PMID: 36943759. https://pubmed.ncbi.nlm.nih.gov/36943759/
- Siperstein R, Nestor E, Meran S. Prospective clinical trial demonstrating the efficacy of hyaluronic acid filler for the improvement of atrophic facial scars up to 2 years. Dermatol Surg. 2024;50(12):1143–1148. doi: 10.1097/DSS.0000000000004315. PMID: 38968085. https://pubmed.ncbi.nlm.nih.gov/38968085/
- Christen MO. Collagen stimulators in body applications: a review focused on poly-L-lactic acid (PLLA). Clin Cosmet Investig Dermatol. 2022;15:997–1019. doi: 10.2147/CCID.S359813. PMID: 35761856. https://pmc.ncbi.nlm.nih.gov/articles/PMC9233565/