Subcision vs Filler Support: Which Works Better for Tethered Acne Scars?

Acne scars don’t all behave the same way — some are shallow, some are sharp, and others are tethered down by fibrous bands beneath the skin. 

If you’ve been exploring treatments, you’ve likely come across the debate of subcision vs filler support for acne scars. Both are procedures that have been used in clinical practice for acne scar management, but they target different underlying causes.

In this guide, we’ll explain how each treatment works, the types of scars it targets, and why doctors sometimes recommend combining them.

Subcision vs. Filler Support – Key Differences

Subcision and filler support are two of the most widely used treatments for depressed acne scars. While both improve skin texture, they target different underlying issues.

Subcision vs. Filler: Comparison at a Glance

Brief Overview of Each Treatment

• Subcision: A minimally invasive surgical procedure where a fine needle or blunt cannula is used to release fibrous bands that tether scars to deeper tissue. Once these bands are cut, the skin surface can lift, and collagen production is stimulated for gradual, long-lasting improvement.
• Filler Support: A non-surgical injectable procedure where dermal fillers are placed beneath scars to replace lost volume. Some fillers provide an instant lift, while others also stimulate collagen for longer-term remodelling.

Ideal Candidates

• Subcision: Best suited for rolling scars and tethered atrophic scars caused by fibrous bands.
• Filler Support: Best for shallow atrophic scars, soft boxcar scars, or areas with volume loss.

Benefits

• Subcision:
  • Directly addresses tethering, the root cause of many depressed scars.
  • May provide longer-term improvement once fibrous bands are released.
  • Can trigger collagen production, which may gradually improve scar appearance.
• Filler Support:
  • Typically provides visible lifting once injected.
  • Delivers natural-looking improvement without surgery.
  • Some fillers, such as CaHA and PLLA, are designed to also stimulate collagen production, which may extend their effects.

Limitations

• Subcision:
  • Bruising and swelling are common for 5–10 days.
  • Not effective for deep ice-pick scars (better suited for TCA CROSS).
  • Multiple sessions may be required for widespread scarring.
• Filler Support:
  • Results are temporary:
    • Hyaluronic Acid (HA): 6–12 months
    • CaHA / PLLA: 12–24 months
  • Requires maintenance top-ups.
  • Risks include bruising, swelling, lump formation, or rare vascular occlusion (blockage of a blood vessel).

Downtime and Side Effects

• Subcision: Bruising, swelling, and tenderness for 5–10 days. Some patients may develop temporary pigmentation, especially in darker skin types.

• Filler Support: Minimal downtime; swelling or tenderness usually settles within 1–3 days.

Results and Longevity

• Subcision: Improvement may be gradual, and in some patients, longer-lasting once fibrous bands are released. Collagen stimulation continues to refine results. Touch-ups may be required for severe cases.

• Filler Support: Results are usually visible immediately after injection. HA fillers generally last 6–12 months, while CaHA and PLLA may last up to 24 months.

At Sozo Aesthetic Clinic, subcision and filler support are performed by MOH-licensed doctors, including Dr. Justin Boey, in line with MOH and HSA guidelines for acne scar management.

Why Subcision and Filler Are Often Combined

Many patients achieve the best results when subcision and filler support are used together. 

This is because acne scars usually involve more than one underlying issue — both tethering by fibrous bands and loss of volume beneath the skin.

Complementary Mechanisms

• Subcision releases the fibrous bands that pull the skin down.

• Filler lifts and supports the skin once it is freed.

Together they correct both anchoring and depression, leading to smoother, more even skin.

Same-Day vs. Staged Approach

• Same-day treatment: Subcision is performed first, followed immediately by filler to prevent re-anchoring.

• Staged treatment: In some cases, fillers are added 1–4 weeks later once swelling from subcision has resolved.

Benefits of Combination Therapy

• May address both tethering and volume loss in the same treatment plan.
• Filler injections can provide immediate volume support, while subcision may stimulate collagen over time.
• Doctors may recommend different treatment approaches depending on scar type and severity.

Results and Recovery Timeline

Every patient’s healing journey is unique, but most follow a recognisable pattern after treatment:

Immediate Results (Day 1–3)

• Subcision: Localised bruising and swelling.

• Filler: Immediate lift, though swelling may temporarily exaggerate results.

Early Recovery (1–2 Weeks)

• Bruising and swelling gradually fade within 7–10 days.
• Some patients may observe changes in scar appearance as healing progresses.
• Most patients can return to normal activities quickly, with makeup helping cover any residual marks.

Visible Improvement (1–3 Months)

• Collagen stimulation from subcision continues, remodelling scar tissue.
• Filler integrates into the skin, which may improve contour in the treated area.

Long-Term Results (6–24 Months)

• Subcision results remain stable once fibrous bands are released.
• Filler longevity depends on type:
  • HA fillers: 6–12 months
  • CaHA/PLLA: up to 24 months
• Maintenance sessions may be recommended for ongoing improvement.

Cost of Subcision and Fillers in Singapore

The cost of acne scar treatments depends on the procedure type, severity of scars, and the type of filler used. 

At Sozo Aesthetic Clinic, prices are transparent and reflect the expertise of MOH-licensed doctors.

Subcision Cost Breakdown

• Subcision sessions start from SGD $400 per session.
• Final cost depends on the number of scars, treatment areas, and whether other procedures (e.g., lasers or fillers) are performed in the same session.

Filler Cost Breakdown

• Hyaluronic Acid Fillers: SGD $600–$800 per syringe
• Collagen-based Fillers: SGD $700–$900 per syringe
• Semi-permanent Fillers (e.g., CaHA, PLLA): SGD $800–$1,000 per syringe
• When performed after subcision, filler support typically starts from SGD $800 per syringe.

Package Options and Value

• Combining subcision with filler in the same session may be more practical for patients who are undergoing both treatments.
• Some patients may also benefit from packages that integrate other acne scar treatments, such as microneedling or fractional lasers, for comprehensive results.

Aftercare and Recovery

Proper aftercare is essential to maximise results and reduce risks after subcision or filler treatment.

Immediate Aftercare (First 48 Hours)

• Apply cold compresses to reduce swelling and bruising.
• Take antibiotics or pain relief only if prescribed by your doctor.
• Avoid alcohol, saunas, and strenuous exercise for 24–48 hours.
• Keep the treated skin clean and avoid pressing or massaging unless instructed.

Preventing Pigmentation and Complications

• Use a broad-spectrum sunscreen (SPF 50+) daily to prevent post-inflammatory pigmentation.
• Avoid direct sun, hot showers, and steam rooms for at least a week.
• Contact your doctor immediately if you notice persistent pain, blanching, or unusual skin colour changes.

Follow-Up and Maintenance

• A review session is usually scheduled 1–2 weeks after treatment to monitor healing.
• Repeat subcision may be planned every 4–6 weeks, depending on scar severity.
• Filler touch-ups are typically required every 6–24 months, depending on the filler type used (HA vs. CaHA/PLLA).

Frequently Asked Questions

How many sessions are usually needed?

The number of sessions varies. Many patients undergo 2–3 subcision sessions and 1–2 filler treatments, depending on scar type and severity.

Can filler lumps be dissolved if needed?

Yes. Hyaluronic acid (HA) fillers can be dissolved with hyaluronidase. Non-HA fillers such as CaHA or PLLA cannot be dissolved but can be medically managed if issues arise.

Is subcision or filler treatment painful?

Both procedures are generally well tolerated. Local anaesthesia or numbing cream is applied before subcision to minimise discomfort, while fillers are injected with fine needles or cannulas. Patients usually describe the sensation as mild pressure or stinging rather than pain.

Conclusion: Finding the Right Acne Scar Treatment

Subcision and filler support offer effective solutions for rolling and tethered acne scars by releasing fibrous bands and restoring lost volume. Together, they may help improve the appearance of skin texture by addressing tethering and volume loss.

Learn more about our acne scar treatments at Sozo Aesthetic Clinic and book a consultation to find the approach best suited for your skin.