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. 2024 Oct 25;17:2381–2389. doi: 10.2147/CCID.S470014

Korean Medicine Subcision Therapies in Scar Treatment: A Retrospective, Multicenter Study at Network Clinics

Jungsang Kim 1,2,*, Ju-Hyun Lee 3,*, Dongbin Jeong 4, Taekyung Lim 4, Sangwoo Jung 4, Kwongil Paeng 4, Sangyoup Lee 4, Hyunki Cho 4, Seungyoup Lee 4, Ikdu Kim 4, Byungsoo Kang 5,6, Jae Hyo Kim 7, Hongmin Chu 8,✉, Museok Hong 4,✉
PMCID: PMC11520713  PMID: 39474262

Abstract

Purpose

This study is a retrospective, multicenter research designed to report the efficacy of Korean medicine subcision therapies in scar treatment.

Patients and Methods

Charts and photographs of 29 patients who received subcision treatment between May 2016 and June 2020 in four scar treatment network clinics were analyzed. The Qualitative Global Acne Scarring Grade System (QGASC) and the Stony Brook Scar Evaluation Scale (SBSES) were used to objectively measure scar scores.

Results

Except for 4 patients whose GASGS and SBSES scores remained unchanged, most patients’ scars showed improvement from Visit 2 to about Visit 8. Furthermore, the degree of change for both scales was found to be statistically significant.

Conclusion

Subcision therapy using acupuncture has been found to be an effective treatment for scar, with statistically significant improvements in patients’ SBSES and QGASC scores.

Keywords: scar, Korean medicine, subcision, acupuncture

Introduction

Scars represent the physical changes in the skin barrier that occur during the wound healing process.1 Wound healing comprises three primary stages: Inflammation, Proliferation (Tissue Formation), and Maturation (Tissue Remodeling). Particularly, scars develop during the Maturation stage, in conjunction with the phenomenon of matrix remodeling.2,3 Various substances within the body, such as macrophages, lymphocytes, mast cells, and growth hormones, are known to be involved in scar formation. Scar formation is a physiological phenomenon that occurs during wound healing process. However, if the wound healing process does not work properly, pathological scars that cause cosmetic and functional problems may occur.4 Pathological scars can be classified into contractures, extended scars, atrophic scars, hypertrophic scars, and keloid scars.3,5

Existing prevention and treatment methods for pathological scars include the use of NSAIDs (Nonsteroidal Anti-inflammatory Drugs), gene therapy, Bleomycin, 5-FU (5-Fluorouracil), topical and intralesional steroids, laser therapy, silicone gel sheeting, pressure dressing, and radiation therapy.6 Surgical treatments that have been reported to be effective include mechanical dermabrasion, chemical peeling, excision with linear closure, excision with grafting, full-thickness skin grafting, z-plasty, w-plasty, and flap coverage.1,6

However, existing treatments for pathological scars, such as steroids, lasers, and peeling, can lead to side effects like erythema, ecchymosis, vesicles, crusts, hypo-pigmentation, skin atrophy, telangiectasia, pain, and dry skin due to epidermal damage or immune system disruption.7,8 Furthermore, there is a growing demand for less invasive but effective interventions for scars.9 Treatments for pathological scars are primarily used for cosmetic purposes but also play a significant role in improving patients’ quality of life by rejuvenating and remodeling scarred skin, highlighting the importance of scar management.10

In traditional East Asian medicine, acupuncture is frequently used for pathological scar treatment.11 Acupuncture subcision stimulation promotes wound healing and scar recovery, addressing scar pain and other related symptoms.12,13 In the field of Korean Medicine (KM), techniques such as subcision, KORA therapy, microneedle therapy system (MTS), transtherapy, and skin impediment therapy are used alone or in combination, or alongside pharmacopuncture.14 While subcision focuses on the detachment of adhesions beneath the scar, KORA therapy not only performs this detachment but also stimulates the area using cross/rotational acupuncture, creating an environment that promotes the formation of new skin tissue. Among these, subcision are being used concurrently for pathological scar treatment at certain clinics, often in combination for enhanced efficacy, with studies suggesting that the combined use of these treatments is more effective than using either treatment alone.15–19 These methods are being utilized from Asia and the Middle East to the United States. As a result, subcision are being presented as useful alternatives to conventional treatments.20

Despite the existence of numerous case reports suggesting the effectiveness of Subcision in pathological scar treatment, there is a notable scarcity of research detailing the specific methodologies and follow-up processes associated with these procedures.

In this study, we aim to retrospectively collect and report the outcomes of pathological scar treatments utilizing Subcision, gathered from multiple Korean Medicine Clinics within Korea through a standardized protocol.

Patients and Methods

Study Design

We conducted our study on patient charts from four scar treatment network clinics (Rodam Korean Medicine clinic Gangnam branch, Hong-ik University branch, Cheonan branch, Suwon branch), focusing on patients treated between May 2016 and June 2020, who underwent treatment at least twice, with each session documented by photographs taken using the same method. If a patient’s visits spanned more than six months, they were not considered to have received continuous treatment and were excluded from the analysis. However, if a patient received a single treatment and then underwent two or more treatments within one month after a period of six months, their data were included in the analysis from that point onwards.

Subcision Protocol

The Subcision protocol, also known as KORA therapy, involves the incision of subdermal fibrous tissue caused by scars through multidirectional stimulation using a special needle. By crossing the scar underneath from various angles with the incision needle, it stimulates the damaged cells, creates space in areas where the epidermal layer and subcutaneous tissue have adhered too closely, and breaks up the incorrectly bonded collagen layers to allow for new tissue formation. The procedure is carried out at intervals of 2–3 weeks, with a typical course consisting of 6–10 sessions.

The procedure is conducted with the practitioner illuminating the treatment area with strong lighting from above and behind the head of practitioner to clearly observe the size and location of the scar. The practitioner uses an assistant hand to lift the near area around the scar and a dominant hand to incise the subcutaneous tissue of the scar site. (Figure 1). The specific procedural steps are illustrated in Figure 2

Figure 1.

Figure 1

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Overview of the Procedure Scene and a Close-up Photo (A) The posture of the practitioner and the position of the lighting (B) The hand movements of the practitioner and the direction of the needle.

Figure 2.

Figure 2

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Preparation and Procedure of the Treatment (A) Prepare alcohol disinfectant gauze and a needle for the procedure. (B) Disinfect the treatment area. (C) Proceed with the subcision of the treatment area. (D) If there is bleeding in the treatment area, wipe it off with a disinfected cotton swab.

Measurement

We utilized the Qualitative Global Acne Scarring Grade System (QGASC) and the Stony Brook Scar Evaluation Scale (SBSES) to objectively measure scar scores through photographs. While there are various scales for assessing scars, such as the Vancouver Scar Scale and the Manchester Scar Scale, these are often designed for evaluating a wide range of scars resulting from trauma, surgery, or pressure ulcers. Given the need for tools that focus on photographic evaluation, QGASC and SBSES were deemed appropriate for this study’s assessment purposes.21

QGASC is a scale that categorizes the condition of patients into four levels according to acne scar severity, making it one of the most widely used scales for evaluating scars caused by acne and similar conditions. Flat scars with erythematous, hyperpigmented, or hypopigmented changes are classified as grade 1. Mild scars with shallow indentations or low elevations are grade 2. Moderate scars with somewhat deeper indentations and higher elevations are grade 3. Severe scars with significant indentations and elevations are diagnosed as grade 4.22,23

SBSES employs a five-item, observer-reported methodology for the photographic assessment of linear scars. This includes measurements of width, height, pigmentation, presence of hatch or suture marks, and the general visual impression. Each category is allocated a score of either 0 or 1, with the aggregate score ranging from 0 (indicating the least favorable outcome) to 5 (representing the most favorable outcome).24,25

Evaluations using QGASC and SBSES were primarily conducted by researchers who are Korean Medicine doctors specializing in Otolaryngology, Dermatology, and Ophthalmology, all with a major in dermatology from a University Hospital of Korean Medicine. The assessments were finalized under the verification of one Korean Internal Medicine specialist.

Results

Among a total of 22,415 patients, the analysis was conducted on 29 patients whose photographs were taken under the same conditions for each treatment and whose visit intervals were less than six months. Additionally, cases where both sides of the patient’s face were not photographed, making it impossible to conduct evaluations with GASGS and SBSES, were excluded. The flowchart of the research is shown in Figure 3. All scars treated with KORA therapy were atrophic scars, and the procedure can be performed on indented areas regardless of pigmentation.

Figure 3.

Figure 3

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Flowchart of This Study.

The patients’ demographic information is presented in Table 1; while the changes in the average scores and standard deviations of GASGS and SBSES from the first to the last visit of the included patients are displayed in Table 2. For GASGS, a lower score indicates improvement in scar severity, while for SBSES, a higher score signifies improvement. Except for 2 patients whose GASGS scores remained unchanged and 2 patients whose SBSES scores remained unchanged, most patients showed improvement in their scars from Visit 2 to about Visit 8. Furthermore, the degree of change was statistically significant for both scales. The graph showing the score changes for all patients is displayed in Figure 4. Number of visits and treatment times are reported in Supplements 1 and 2. Furthermore, no side effect was reported. Figures 5 and 6 present actual cases of improvement.

Table 1.

Demographic Data

Total
Number (n, %) 29 (100%)
Gender 29 (100%)
 Men 13 (44.80%)
 Women 16 (55.20%)
Age
 10–19 0
 20–29 11
 30–39 10
 40–49 6
 50–59 2
 Over 60 0
Average 34.69土9.37
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Table 2.

Comparison of GASGS and SBSES from First to Final Visit

1st visit Final Visit P-value
GASGSMean (SD) 3.14 (0.68) 1.86 (0.90) <0.01**
SBSES Mean (SD) 1.90 (0.84) 3.14 (0.90) <0.01**
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Figure 4.

Figure 4

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Result of Scar treatment. (A) SBSES (B) QGASC.

Figure 5.

Figure 5

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Example of Scar treatment. (A) Before treatment Anterior view (B) Before treatment Anterio-lateral view (C) After 5-month six treatment, Anterior-lateral view. (D) After 5-month six treatment, Lateral view.

Figure 6.

Figure 6

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Another Example of Scar treatment. (A) Before treatment Anterior view (B) After 6-month six treatment, Anterior view. (C) Before treatment Anterior view (D) After 9-month 9th treatment, Anterior View.

Discussion

The wound healing process is a common physiological phenomenon that occurs in all living things. However, due to genetic, physical, and environmental factors, many scars do not heal properly and become pathological. Pathological scars can appear in various forms such as hypertrophic scars, atrophic scars, and keloid scars, and usually require appropriate treatment for complete healing and recovery.3,5,26

Pathological scar treatment is not only cosmetically important but also affects the pain and contracture of the adjacent skin due to scars, as well as potentially leading to depression in patients, and significantly impacting their quality of life. Despite this, current widely used pathological scar treatment methods such as dermabrasion, skin grafting, and steroid injections continue to face issues like redness, erythema, swelling, and hyperpigmentation. Among non-pharmacological scar treatment options, subcision stand out as representative methods. These approaches have been documented in traditional East Asian medicine and are utilized in modern practices as well.

Subcision are synergistic techniques enhancing pathological scar treatment through distinct but complementary mechanisms. Subcision, targeting the structural aspects of scars, especially those anchored by fibrotic strands, releases tension, allowing scars to elevate.27,28 Subcision operates by severing fibrous septal bands within the subcutaneous tissue, thereby releasing the reticular dermis from tethering and facilitating the deposition of new collagen fibers. This mechanism promotes an enhanced healing response, directly contributing to an improved skin texture and a smoother topography.29 Similarly, microneedling promotes skin regeneration by causing micro-injuries that trigger fibroblast stimulation, leading to neocollagenesis and neoelastinogenesis.30,31 This process thickens the dermis, smoothing out scars by filling in atrophic areas, and initiates angiogenesis to improve blood flow and nutrient delivery, crucial for healing.32

These techniques complement each other; microneedling addresses surface-level improvements and biochemical enhancements, while subcision rectifies deeper structural issues. Their combined use offers a holistic approach to scar management, tailored to individual scar characteristics, promising optimal patient outcomes.

Especially, these treatment methods are more affordable compared to other pathological scar treatments, more suitable for the skin characteristics of Asians, and have the advantage of being non-pharmacological.33,34 Dry needling is a traditional treatment used to improve scar mobility and decrease pain. Classically, the method is to encircle the lesion area with needles. The exact mechanism of dry needling is still unclear, however it is presumed to suppress local inflammation, reduce scar hyperproliferation, induce collagen formation, and stimulate reepithelialization of skin tissue.35

Lubczyńska et al35 reported that after dry needling treatment, scar symptoms such as pain, pigmentation, flexibility, itching, scar elasticity, thickness, regularity, and color were significantly improved. Fang et al36 reported that pain caused by a 3-month-old surgical scar was effectively relieved after the traditional acupuncture treatment. Lee et al37 also reported that the severity of pathological acne scars was significantly improved by using scar regeneration acupuncture and micro-needle therapy. Kim et al38 who also used micro-needle therapy and subcision combined with bee venom pharmacopuncture therapy, reported that the pathological acne scars of 27 patients were significantly improved.

Although there are various case reports in Korea of pathological scar treatment using acupuncture-based subcision, there is a lack of research evaluating the outcomes using the same treatment protocol across multiple institutions with photographic or other quantitative measures. In response, our research team retrospectively collected medical records from network clinics that utilize the same subcision protocol (KORA therapy) and evaluated the photo-based results under the scrutiny of specialists, analyzing the outcomes.

This study analyzed the charts of 29 patients with pathological scars who applied subcision treatment. As a result, it was confirmed that the patients’ GASGS scores decreased from 3.14 to 1.86 (P<0.01), and their SBSES scores increased from 1.90 to 3.14. (P<0.01). This result suggests that subcision may be an excellent alternative treatment for patients with pathological scars.

The potential significance of this study is in exploring the possibility through the collection and analysis of data from multicenter applications of a consistent protocol for pathological scar treatment using subcision techniques. Additionally, it demonstrates the potential for non-pharmacological and minimally invasive methods in pathological scar treatment. The significance of this study lies in its affirmation of the potential benefits of scar treatment.

However, this research has several methodological limitations. First, due to its retrospective design, a significant amount of data was excluded based on exclusion criteria, highlighting the need for future studies with more precise methodologies to thoroughly evaluate pathological scar treatment effectiveness. Also, the absence of a control group means the comparative effectiveness of subcision over other interventions for scar treatment remains unclear. Additionally, the QGASC, which is linked to quality of life, indicates that a score of 0 does not signify complete scar removal but rather an improvement. This suggests improvements in quality of life, not necessarily the total elimination of scars. Histopathological examination will also be needed. Also, as a retrospective study without controlled visit schedules and periods, determining the optimal frequency and timing of treatments for the best outcomes suggests the need for prospective research. Due to the limitations inherent in a case series study design, it is difficult to generalize the results. Nonetheless, this study has provided insights for the design of future prospective studies. We authors hope that the significance of this research will serve as foundational data for future multi-center prospective studies, and even randomized clinical trials.

Conclusions

The results of this study, highlighted by improvements in patients’ SBSES and QGASC scores after subcision therapy using acupuncture, indicate its potential effectiveness for scar treatment. Specifically, SBSES scores decreased from 3.14 ± 0.68 to 1.86 ± 0.90, while QGASC scores increased from 1.90 ± 0.84 to 3.14 ± 0.90 post-treatment. Acknowledging the limitations of the current dataset and the retrospective design, this research emphasizes the need for further investigation and will guide the design of future prospective studies. Further research is necessary to collect more comprehensive data, which will show effectiveness of acupuncture’s role in scar management.

Funding Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval

This retrospective, multicenter study was conducted in accordance with the Declaration of Helsinki, and approved by the Wonkwang University institutional review board (WKIRB-202108-BM-059) in August 2021.

Informed Consent (for Publication)

Before starting treatment, all patients were informed of the academic use of medical records and photographs. Informed consent has been obtained from the patient to publish this paper.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

References

  • 1.Reish RG, Eriksson E. Scar treatments: preclinical and clinical studies. J Am Coll Surg. 2008;206(4):719–730. doi: 10.1016/j.jamcollsurg.2007.11.022 [DOI] [PubMed] [Google Scholar]
  • 2.Singer AJ, Clark RAF. Cutaneous wound healing. N Engl J Med. 1999;341(10):738–746. doi: 10.1056/NEJM199909023411006 [DOI] [PubMed] [Google Scholar]
  • 3.Kinani ME, Duteille F. Scar epidemiology and consequences. In: Téot L, Mustoe TA, Middelkoop E, Gauglitz GG, editors. Textbook on Scar Management: State of the Art Management and Emerging Technologies. Berlin: Springer; 2020:45–49. [Google Scholar]
  • 4.Riedemann HI, Schmidt MF, Baron JM. Therapy of pathological scars. J Dtsch Dermatol Ges. 2023;21(7):761–776. doi: 10.1111/ddg.15088 [DOI] [PubMed] [Google Scholar]
  • 5.van der Veer WM, Bloemen MCT, Ulrich MMW, et al. Potential cellular and molecular causes of hypertrophic scar formation. Burns. 2009;35(1):15–29. doi: 10.1016/j.burns.2008.06.020 [DOI] [PubMed] [Google Scholar]
  • 6.Soliman YS, Horowitz R, Hashim PW, Nia JK, Farberg AS, Goldenberg G. Update on acne scar treatment. Cutis. 2018;102(1):21–25,47–48. [PubMed] [Google Scholar]
  • 7.Gauglitz GG. Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Invest Dermatol. 2013;6:103–114. doi: 10.2147/CCID.S35252 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Block L, Gosain A, King TW. Emerging therapies for scar prevention. Adv Wound Care. 2015;4(10):607–614. doi: 10.1089/wound.2015.0646 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Arul Raja G A Comparative study on efficacy of microneedling plus subcision with and without 50% TCA cross in atrophic acne scars [Masters Thesis]. Chengalpattu Medical College and Hospital. 2020. [Google Scholar]
  • 10.Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg. 2008;61(9):1049–1058. doi: 10.1016/j.bjps.2008.03.020 [DOI] [PubMed] [Google Scholar]
  • 11.Tuckey C, Kohut S, Edgar DW. Efficacy of acupuncture in treating scars following tissue trauma. Scars Burn Heal. 2019;5. doi: 10.1177/2059513119831911 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Lee JA, Jeong HJ, Park HJ, Jeon S, Hong SU. Acupuncture accelerates wound healing in burn-injured mice. Burns. 2011;37(1):117–125. doi: 10.1016/j.burns.2010.07.005 [DOI] [PubMed] [Google Scholar]
  • 13.Rozenfeld E, Sebakhutu ES, Krieger Y, Kalichman L. Dry needling for scar treatment. Acupunct Med. 2020;38(6):435–439. doi: 10.1177/0964528420912255 [DOI] [PubMed] [Google Scholar]
  • 14.Lee DJ, Kim CY, Kwon K, Seo HS. Case study on treating acne scar using Hani-maehwa laser. J Korean Med Ophthalmol Otolaryngol Dermatol. 2016;29(2):106–111. doi: 10.6114/jkood.2016.29.2.106 [DOI] [Google Scholar]
  • 15.Sitohang IBS, Sirait SAP, Suryanegara J. Microneedling in the treatment of atrophic scars: a systematic review of randomised controlled trials. Int Wound J. 2021;18(5):577–585. doi: 10.1111/iwj.13559 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Orentreich DS, Orentreich N. Subcutaneous incisionless (Subcision) surgery for the correction of depressed scars and wrinkles. Dermatologic Surg. 1995;21(6):543–549. doi: 10.1111/j.1524-4725.1995.tb00259.x [DOI] [PubMed] [Google Scholar]
  • 17.Im MJ, Kim BS, Kang JS. Study on the local wrinkle cure using acupuncture needle. J Physiol Pathol Korean Med. 2009;23(6):1261–1266. [Google Scholar]
  • 18.Bhargava S, Kumar U, Varma K. Subcision and microneedling as an inexpensive and safe combination to treat atrophic acne scars in dark skin: a prospective study of 45 patients at a Tertiary care center. J Clin Aesthet Dermatol. 2019;12(8):18–22. [PMC free article] [PubMed] [Google Scholar]
  • 19.Hassan R. Comparison of efficacy of micro needling for the treatment of acne scars in Asian skin with and without subcision. J Turk Acad Dermatol. 2015;9(2):1592a2. doi: 10.6003/jtad.1592a2 [DOI] [Google Scholar]
  • 20.Gozali MV, Zhou B. Effective treatments of atrophic acne scar. J Clin Aesthet Dermatol. 2015;8(3):33–40. [PMC free article] [PubMed] [Google Scholar]
  • 21.Fearmonti R, Bond J, Erdmann D, Levinson H. A review of scar scales and scar measuring devices. Eplasty. 2010;10:e43. [PMC free article] [PubMed] [Google Scholar]
  • 22.Goodman GJ, Baron JA. Postacne scarring: a qualitative global scarring grading system. Dermatol Surg. 2006;32(12):1458–1466. doi: 10.1111/j.1524-4725.2006.32354.x [DOI] [PubMed] [Google Scholar]
  • 23.Albalat W, Ghonemy S, Saleh A, Elradi M. Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study. Arch Dermatol Res. 2023;315(4):839–846. doi: 10.1007/s00403-022-02446-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ten Kate CA, Koese HJH, Hop MJ, et al. Psychometric performance of the Stony Brook Scar Evaluation Scale and SCAR-Q questionnaire in Dutch children after pediatric surgery. Int J Environ Res Public Health. 2024;21(1):57. doi: 10.3390/ijerph21010057 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Singer AJ, Arora B, Dagum A, Valentine S, Hollander J. Development and validation of a novel scar evaluation scale. Plast Reconstr Surg. 2007;120(7):1892–1897. doi: 10.1097/01.prs.0000287275.15511.10 [DOI] [PubMed] [Google Scholar]
  • 26.Mofikoya BO, Adeyemo WL, Ugburo AO. An overview of biological basis of pathologic scarring. Niger Postgrad Med J. 2012;19(1):40–45. doi: 10.4103/1117-1936.170327 [DOI] [PubMed] [Google Scholar]
  • 27.Vempati A, Zhou C, Tam C, et al. Subcision for atrophic acne scarring: a comprehensive review of surgical instruments and combinatorial treatments. Clin Cosmet Invest Dermatol. 2023;16:125–134. doi: 10.2147/CCID.S397888 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Pravangsuk J, Udompataikul M, Cheyasak N, Kamanamool N. Comparison of normal saline injection with pneumatic injector to subcision for the treatment of atrophic acne scars. J Clin Aesthet Dermatol. 2021;14(5):50–55. [PMC free article] [PubMed] [Google Scholar]
  • 29.Friedmann DP, Vick GL, Mishra V. Cellulite: a review with a focus on subcision. Clin Cosmet Invest Dermatol. 2017;10:17–23. doi: 10.2147/CCID.S95830 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Juhasz MLW, Cohen JL. Microneedling for the treatment of scars: an update for clinicians. Clin Cosmet Invest Dermatol. 2020;13:997–1003. doi: 10.2147/CCID.S267192 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Alster TS, Graham PM. Microneedling: a review and practical guide. Dermatol Surg. 2018;44(3):397–404. doi: 10.1097/DSS.0000000000001248 [DOI] [PubMed] [Google Scholar]
  • 32.Doddaballapur S. Microneedling with dermaroller. J Cutan Aesthet Surg. 2009;2(2):110–111. doi: 10.4103/0974-2077.58529 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol. 2014;13(3):180–187. doi: 10.1111/jocd.12095 [DOI] [PubMed] [Google Scholar]
  • 34.Fabbrocini G, De Vita V, Monfrecola A, et al. Percutaneous collagen induction: an effective and safe treatment for post-acne scarring in different skin phototypes. J DermatolTreat. 2014;25:147–152. doi: 10.3109/09546634.2012.742949 [DOI] [PubMed] [Google Scholar]
  • 35.Lubczyńska A, Garncarczyk A, Wcislo-Dziadecka D. Effectiveness of various methods of manual scar therapy. Skin Res Technol. 2023;29(3):e13272. doi: 10.1111/srt.13272 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Fang S. The successful treatment of pain associated with scar tissue using acupuncture. J Acupunct Meridian Stud. 2014;7(5):262–264. doi: 10.1016/j.jams.2014.05.001 [DOI] [PubMed] [Google Scholar]
  • 37.Lee K, Kim YR, Choi HS. Case study of treating acne scar using scar regeneration acupuncture therapy and micro-needle therapy. J Acupunct Res. 2012;29(4):81–91. [Google Scholar]
  • 38.Kim HY, Hong SH, Park IH, et al. Clinical study of twenty-seven case of treating acne scar using microneedle therapy and subcision combined with beevenom pharmacopuncture therapy. J Korean Med Ophthalmol Otolaryngol Dermatol. 2015;28(3):101–113. doi: 10.6114/jkood.2015.28.3.101 [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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