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. © 2026 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, LLC. All rights reserved.