The main difference between subcision and microneedling is how they address acne scars.
Subcision releases fibrous bands that pull depressed skin downward.
Microneedling creates controlled micro-injuries to encourage collagen remodelling.
Subcision is particularly relevant to tethered rolling scars, while microneedling may help improve suitable atrophic scars and broader textural irregularities.
If you are comparing these treatments, you may already have a specific concern: a dent that catches the light, uneven cheeks that makeup cannot disguise, or scars that remain after previous procedures.
The question is whether the treatment addresses the underlying cause of those particular depressions.
At BIANCA CLINIC in Tokyo, our doctors assess individual acne scars before recommending a procedure.
This article explains the differences, what to look for in before-and-after photographs, and what to discuss before planning treatment in Japan.
Subcision vs Microneedling: What Are the Main Differences?
Both procedures involve needles, but the instruments are used differently.
Understanding that distinction helps explain why one treatment may improve some scars while others remain visible.
How Does Subcision Release Tethered Acne Scars?
Some depressed acne scars are attached to deeper tissue by fibrous bands.
These attachments can hold the skin down, creating an uneven contour.
During subcision, a doctor introduces a specialised instrument beneath the skin to release selected attachments.
The aim is to reduce the downward pull and allow the depressed area to rise as healing progresses.
Subcision is most closely associated with rolling scars.
It does not remove every type of scar, and releasing an attachment does not guarantee that the skin will become completely flat.
How Does Microneedling Improve Uneven Skin Texture?
Microneedling uses fine needles to make controlled punctures in the skin.
The resulting healing response stimulates collagen production and remodelling, which can gradually soften the appearance of suitable scars.
BIANCA offers Dermapen microneedling.
In this article, “microneedling” primarily refers to conventional microneedling.
Radiofrequency microneedling also delivers energy into tissue and has a different treatment and risk profile.
Microneedling does not perform the same deliberate mechanical release as subcision.
However, it can improve atrophic acne scars, so it should not be regarded as a treatment for pores alone.
| Сравнение | Субцизия | Conventional Microneedling |
| Main action | Releases selected fibrous attachments beneath scars | Creates controlled punctures to stimulate remodelling |
| Main consideration | Whether a depression is tethered | Whether the scar pattern is likely to respond to collagen induction |
| Treatment approach | Directed beneath selected depressions | Applied across the treatment area |
| Common recovery concerns | Bruising, swelling and tenderness | Redness, sensitivity and swelling |
| Important limitation | Does not address every scar shape or surface concern | Does not provide the same targeted release of fibrous bands |
The useful comparison is therefore not simply “stronger versus gentler.” It is whether the mechanism fits the scar.
▶Learn More About Dermapen Microneedling at BIANCA CLINIC
Subcision or Microneedling: Which Is Better for Your Acne Scars?
A photograph may show that a scar is deep, but depth alone does not explain its structure.
Scar shape, tethering and the surrounding skin all influence treatment selection.
Is Subcision Better for Rolling Scars and Tethered Depressions?
Rolling scars tend to have broad depressions and sloping edges.
Where fibrous attachments contribute to the depression, subcision may address a structural problem that requires targeted release.
This is why a consultation should move beyond identifying “deep acne scars.”
The more useful question is: Is this particular depression being held down, and would releasing it help?
What If You Have Boxcar Scars, Ice-Pick Scars, or Mixed Scars?
Boxcar scars have more defined edges, while ice-pick scars are narrow and deep.
A person may have several patterns within the same cheek.
Selected boxcar scars may benefit from subcision when tethering is present, but their edges or depth may require a different approach.
Narrow ice-pick scars also need separate consideration.
At BIANCA CLINIC, we offer several acne scar treatments, including Dermapen, TCA CROSS, and TriFill Pro.
This allows us to consider different approaches rather than assume that every depression requires subcision.
At BIANCA CLINIC, we look beyond how deep an acne scar appears.
We consider its shape, whether the skin is tethered to underlying tissue, and whether different scar types are present in the same area.
This helps us determine whether targeted release with subcision, collagen remodelling with microneedling, or another approach may be more appropriate for your skin.
Why Might Deep Dents Remain After Microneedling?
Residual dents do not automatically mean that microneedling was performed incorrectly.
The remaining scars may have features that need a different approach, or the response may have been incomplete.
Before repeating the same procedure, it is worth reviewing what changed and what did not.
Did the surrounding texture improve while a few depressions remained?
Were photographs taken after enough healing time? Were several scar types treated together?
At your consultation, bring the names and dates of previous procedures.
That history helps make the next decision more specific.
▶Explore Subcision for Deep and Tethered Acne Scars
How Should You Read Acne Scar Before-and-After Photos?
Before-and-after photographs are most helpful when they come with enough information to understand the treatment.
Look beyond the overall impression of smoother skin. Compare the same area, note the timing of the photographs, and check whether the patient received one procedure or a combination.
Lighting, camera angle and facial expression can change how strongly depressions appear.
An early photograph may also reflect swelling rather than the settled result.
Images should therefore be considered alongside the treatment record and follow-up interval.
When viewing subcision and microneedling before-and-after photographs, check whether both procedures were actually performed. A combined result cannot establish how much improvement came from either treatment alone.
The purpose of before-and-after photographs is to support a discussion about realistic goals.
They cannot predict an identical result for another patient.
Can Subcision and Microneedling Be Combined for Better Results?
They can form part of the same treatment plan, but combining procedures is not automatically necessary.
When Might a Plan Address Both Tethering and Texture?
A patient may have tethered depressions together with more widespread textural irregularity.
In that situation, releasing selected attachments and later addressing residual texture may serve different purposes.
A prospective study* of 45 patients reported improvement following combined subcision and microneedling.
However, it did not establish that everyone needs both treatments or prove that the combination is superior to either procedure alone for every scar pattern.
The practical question is what a second procedure is expected to add.
If that purpose is unclear, the plan needs further discussion.
Which Treatment Comes First, and Can They Be Performed on the Same Day?
The treatment sequence depends on the clinical findings and how the skin recovers.
At BIANCA, subcision is not performed on the same day as needle-based treatments, heat-based treatments, or thread lifts.
If microneedling is recommended as part of a staged plan, the doctor will advise on timing.
Overseas visitors should discuss this before arranging a short stay in Japan.
What Are the Risks, Downtime, and Costs of Each Treatment?
A treatment decision should include the possibility of limited improvement, recovery time and complications—not only the anticipated benefit.
Can Subcision Make Scars Worse?
Yes. Although the intention is to improve depressed scars, complications or an unsatisfactory cosmetic result are possible.
Bruising, swelling and tenderness can temporarily change the appearance of the treated area.
Other reported complications include haematoma, infection, persistent nodules, pigmentation changes and additional scarring.
The instrument used, the extent of treatment, and the anatomy of the treated area can influence these risks.
Temporary swelling should not be mistaken for the final result.
Equally, worsening pain, spreading redness or an unexpected change should not be dismissed as routine recovery. Contact the treating clinic for assessment.
Can Microneedling Make Scars Worse?
Yes. Microneedling can cause complications, including infection, pigmentation changes and scarring. Appropriate patient selection, technique and aftercare matter.
Tell the doctor about active acne, skin infections, a history of abnormal scarring, medications and reactions to earlier procedures.
Avoid choosing a more aggressive treatment simply because the scars look deep;
greater intensity does not guarantee a better result.
How Do Pain and Recovery Compare?
Subcision often involves bruising and deeper tenderness, while conventional microneedling commonly causes redness, sensitivity and a sunburn-like feeling.
The extent and duration vary.
After subcision at BIANCA CLINIC, temporary swelling and bruising usually improve within a few days, with downtime typically settling within about one week.
Makeup can generally be applied from the day after treatment.
However, recovery varies from patient to patient.
At BIANCA, subcision is performed with local anaesthesia;
optional nitrous oxide anaesthesia is also available.
Discuss concerns about discomfort before treatment.
After subcision at BIANCA CLINIC, many patients notice visible improvement approximately one month after treatment.
When hyaluronic acid injections are combined with subcision, some patients may notice changes immediately after the procedure.
However, results vary depending on scar characteristics and the treatments performed.
For travel planning, distinguish between feeling well enough for ordinary activities and being comfortable appearing in photographs or attending an event.
Allow flexibility rather than relying on the fastest recovery reported online.
How Many Sessions Might You Need, and What Affects the Total Cost?
There is no reliable session count that applies to every patient.
Scar pattern, treatment area, previous response and the degree of improvement sought all affect the plan.
Microneedling commonly involves a series of appointments, and subcision may also require further treatment.
Collagen remodelling takes time, so immediate appearance is not an adequate basis for deciding whether treatment has succeeded.
Ask what the estimate includes:treatment area, anaesthesia, any proposed additional procedures and follow-up.
For international patients, a possible return visit also matters when assessing the overall commitment.
At BIANCA CLINIC, subcision costs ¥288,800 for the full face and ¥114,400 for each additional area, including tax.
These prices include additional anaesthesia and touch-up treatment within two weeks.
Prices are subject to change, so please contact us to confirm the latest fees before booking.
▶View Subcision Treatment Details and Pricing at BIANCA
FAQs About Subcision vs Microneedling at BIANCA
Here, we answer common questions about choosing between subcision and microneedling and planning your visit to BIANCA CLINIC in Tokyo.
Can I Discuss My Acne Scars Online Before Travelling to Japan?
Yes. At BIANCA CLINIC, we offer online initial consultations and multilingual support for international patients. Before travelling to Japan, you can discuss your acne scar concerns, previous treatments, and preferred travel dates with our team.
Our international concierge can also assist with planning your visit.
However, photographs and online consultations cannot fully replace an in-person examination, and your treatment plan may change after your doctor assesses your skin directly.
What Should I Prepare for My Consultation?
Bring a record of previous acne scar treatments, including the procedure names, dates, results, and any complications. Please also share your current skincare, medications, medical history, and travel dates.
It helps to identify what bothers you most—for example, a particular cheek depression or shadows visible in side lighting. This gives us a clearer starting point for discussing your goals and suitable options.
Is Subcision Worth It If I Have Already Tried Microneedling?
Subcision may be worth considering if the remaining depressions involve fibrous attachments that can be released.
Having had microneedling does not, by itself, mean that you need subcision.
The decision depends on the structure of your scars, the expected improvement, risks, cost, and your priorities.
At your consultation, ask which remaining concerns subcision could address and which may need a different approach.
Can Either Treatment Completely Remove Acne Scars?
Neither subcision nor microneedling can guarantee complete removal of acne scars.
The aim is to make suitable scars less noticeable and improve skin contour or texture.
Ask your doctor what improvement may be realistic for your scars, which features may remain, and whether further treatment could be needed.
Can I Complete Treatment During One Trip to Japan?
You may be able to undergo an initial procedure during a single visit, but a complete treatment plan may require several appointments and later assessment.
At BIANCA, subcision is not performed on the same day as needle-based treatments, heat-based treatments, or thread lifts.
If your plan includes microneedling, discuss the timing, recovery period, and follow-up requirements before booking your trip.
If you are still comparing subcision vs microneedling, you do not need to choose a procedure before your consultation.
Start by finding out what your scars need.