Wire subcision for complete release of depressions, subdermal attachments, and scars.

BACKGROUND: Deep lines, facial folds, retracted scars, and contour depressions on all areas of the body have typically been resistant to efforts at release.

OBJECTIVE: A method using a wire dissector to achieve complete release or subcision of these subdermal attachments with access only through the needle insertion sites is described.

METHODS: The wire dissector was inserted into the subcutaneous tissue just below the dermal-subcutaneous tissue junction and brought out of the skin on one side of the defect. The needle was then passed back and forth through the same puncture holes until the depression was circled entirely in the subcutaneous plane by the wire. Traction was applied by the assistant, and the wire was sawed gently back and forth until the depression was completely released.

RESULTS: The areas most commonly treated with the wire were the deep nasolabial folds; among the other areas treated were marionette lines, cheek and chin lines, and retracted scars of the face and body. Of 38 patients treated, 27 underwent simultaneous fat injection, 1 received an AlloDerm (LifeCell Corp., Branchburg, NJ) graft, 1 received a Radiesse (Bioform Medical, Inc., San Mateo, CA) injection; and 1 received injection with Sculptra (Dermik Laboratories, Berwyn, PA). Eight patients had nothing placed under the subcision area. Follow-up of 1 to 19 months showed persistent correction in all patients. Postoperative complications included one hematoma, one localized abscess, and overcorrection in three cases where fat was used.

CONCLUSIONS: The wire dissector holds promise as a tool for complete subcision of deep lines, folds, depressions, and scars of the face and body without incisions and with few complications.