Despite the advancement of Laser and surgical resurfacing procedures, atrophic acne scars is still the Achillesâ heel of dermatologic surgery. According to the theory of Orentreich (1994), fibrous strands that are the consequence of inflammatory acne vulgaris result in tethering the skin surfaceto the hypodermis. Therefore, releasing these fibrous strands and subsequent formation of new connective tissue in the course of wound healing can lead to level up the skin which is the
basis of âsubcutaneous incisionless surgeryâ or âsubcisionâ procedure. Tri-beveled hypodermic needle (Nokor) is the most common device to undermine atrophic acne scars. Since the introduction of subcision, several methods have been proposed in order to enhance clinical efficacy besides reduction of complications and discomforts. Although various instruments such
as a tribevelled needle, triangular Nokor needle, or conventional needles (hypodermic 18 to 27G needle), cataract blade and wire with different techniques for better device controlling have been suggested, their effectiveness is a subject of controversy. Moreover, Low length of the Nokor needle, difficulty to control horizontal movements, need to multiple needle entrance sites,
the high risk of needle sticking for surgeon, the possibility of neurovascular injuries and complications such as permanent discoloration, iatrogenic scars of the needle entry, bleeding and excessive fibroplasia leading to subdermal nodule formation in addition to moderate patient satisfaction has led to lose overall popularity of this type of subcision based on cutting the fibrotic bands and producing hematoma as an autologous filler.
(Behrooz Barikbin, Maryam Yousefi, Zahra Akbari, Somayyeh Hejazinia: An evolution in cosmetic dermatology & rejuvenation)
Last date updated on June, 2014