Subcision Versus Subcision With Suction for the Treatment of Atrophic Acne Scars: A Randomized, Split-Face Clinical Trial

BACKGROUND Subcision is an established minimally invasive technique for the treatment of atrophic acne scars. Adjunctive suction has been proposed to prevent early redepression, but evidence remains limited. OBJECTIVE To compare the efficacy of subcision alone versus subcision combined with suction using objective and subjective outcome measures. MATERIALS AND METHODS This randomized, split-face, patient-blinded clinical trial included 27 patients with bilateral atrophic acne scars. Both facial sides underwent cannula subcision. One randomized side additionally received 10 suction sessions over 2 weeks, while the contralateral side received sham pressure. Outcomes were assessed at baseline, 1 month, and 4 months using the Goodman and Baron Qualitative Grading Scale, Modified Quantitative Global Scarring Grading, scar counts, and the Acne Scar Improvement Grading Scale. RESULTS Both treatments resulted in significant improvement over time in qualitative and quantitative scar measures ( p < .05). No significant differences were detected between sides for objective outcomes. Physician- and patient-rated Acne Scar Improvement Grading Scale scores were significantly higher on the suction-treated side ( p = .002 and p = .026, respectively). CONCLUSION Both subcision alone and suction-assisted subcision significantly improved atrophic acne scars. Subjective assessments favored suction-assisted subcision, suggesting clinically perceptible benefits not fully captured by objective scar-counting methods.