Saline injections for acne scars

[SarahVaughter]

> I've been looking into saline injection combined with needling to help

  > with scarring and acne pitting

  > I just wondered if you knew anything about this and how to go about

  > the procedure It seems

  > to work for these people. A combination of breaking down the collagen

  > and lifting the skin using

  > saline. Is this feasible Sarah? I'm not sure.

  This is definitely feasible and it works. Not for everybody though. As far  as I remember you had scars on your nose? Or wasn't it you? Sorry - I get so many emails that I do remember the stories but cannot connect them to names after a while. I don't think that it would work well on the nose. The nose is mainly made of cartilage and is not so easy to be "puffed up". You can always try though.

   

  A horizontal subcision of an acne scar with a syringe is performed to cut up the fibrous bands that are holding the scar down. Then bacteriostatic saline solution of NaCl + H2O ( for sale OTC in pharmacies) is injected with force into the acne scar. There is usually a little swelling after the injection for several minutes. A saline solution is not a filler - It will get absorbed within a day or days. The scar might be flat for some time but it will subside.

   

  A saline solution very temporarily puffs the scar up and further stretches the fibrous bands. Stretching the bands should make the scar slightly less indented.

   

  It also triggers collagen production - missing collagen is another contributor to the indentation of the scar.

   

  6-8 treatments are normally required to get results and the results are not immediate. It can take months. A saline solution is not perceived as foreign to the body so there is no risk of an allergic reaction.

   

  I recommend needling the scar with our single needle for a few weeks prior to the saline injections. Rolling and especially needling effectively functions as a vertical subcision. It cuts the fibrous septae and severs the scar's deep attachments.

It will also crush the hardened collagen fibers and increases the likelihood of success with the saline. Some people have good results and some don't.

   

  Some acne-afflicted just inject a saline solution (without subcision) into their scars and some obtain a slight improvement. It works better for wide scars.

   

  You can buy saline solution in the pharmacy. They also should have 30G diabetic needles.

   

  With a little bit of dexterity you can perform this procedure upon yourself. Don't forget to first remove any air from the syringe before you inject it into the skin.

   

  Some dermatologists perform this procedure. Probably advisable.

Other interesting methods:

https://http://forums.owndoc.com/dermarolling-microneedling/Subcision-suction-method-for-acne-scar

https://http://forums.owndoc.com/dermarolling-microneedling/Autologous-(own)-blood-injection-for-acne-scars-or-atrophic-scars

[Lainey]

Thank you, Sarah, for keeping us up to date on the various treatments for scarring.

I had saline subcision for rolling acne scars approximately 9 months ago. The improvement was fantastic! My dermatologist did a combination of traditional subcision, where the bands holding the scar down are cut, and saline injections to the area to keep the skin elevated for a short time. I would definitely recommend for rolling scars. It does not help at all with ice pick scars, and only provides  minimal improvement to boxcar scars. There is a new method that utilizes suction each day for 2 weeks after the subcision treatment, starting on day 3. It seems to help keep the scar tissue from reattaching. Unfortunately, the technique is new and there is not much information available.

I've started needling with the 1.5mm roller and single needle every 5-6 weeks, but the subcision treatment was certainly a good starting point for reducing my acne scarring.

[SarahVaughter]

Thank you very much for this feedback! I hope that this forum will become a place where people will share their experiences.

[hiyo84]

I have a question about which method would produce better result, 3 times saline subcision or 6 times just injecting saline?

[SarahVaughter]

Combining saline with subcision is a more "aggressive" approach and it should theoretically give better results but it is impossible to conclusively answer your question. Very few doctors perform this procedure and just as it is with other methods, it is individual - some people achieved very good results and some did not..

[FINLEY]

I want to try this, and I am a RN so have lots of experience with injections.  Should I do the single needling weekly for a few weeks before I do the injection?  And, should I dermaroll before or after I do the injection?

Thanks for your advise and expertise.

[SarahVaughter]

It is hard to give advice because so very few doctors use this cheap method so there is no relevant statistical data or recommendations on how to combine it with another method such as dermarolling. There is evidence that saline injections do work, especially for rolling acne scars but just like dermarolling, it works gradually - you have to do it repeatedly to see results.

   

I would recommend you to needle the scars (from different angles and to various depths) prior to saline injections to crush the hardened collagen, let it heal fully and then have the saline injections every two weeks (without needling).

   

  Alternatively, roll/needle immediately before saline injections to form a “pocket” under the scar, for the saline solution to reside in.

  The saline injections should be placed underneath the scar, where the scar is attached to the tissue.

   

  You could also improvise a suction method such as the one Lainey described in the post above or here:

   https://http://forums.owndoc.com/dermarolling-microneedling/Subcision-suction-method-for-acne-scars /a>

 

   

  Basically you will have to experiment a little to discover what works best. Do a test scar first.

   I wrote about another cheap and interesting method:

   

  https://http://forums.owndoc.com/dermarolling-microneedling/Autologous-(own)-blood-injection-for-acne-scars-or-atrophic-scars

[Rickey]

It is true that there are many useful medical and surgical measures accessible these days. The problem with these is again the price these procedures are highly charged so a proper research is needed to find out the most effective treatment available. But this treatment is definitely a successful and a proven treatment so people can go ahead without any further queries regarding the treatment.

[Lainey]

I have obtained some bacteriostatic sodium chloride for injection, as well as some 31G diabetic needles. I want to try self-injecting several acne scars. How deep should the injection be? Should it go into the epidermis only, or into the dermis?

I have had saline subcision performed by a dermatologist, and that was very effective, and I'd like to try the less aggressive saline injections at home.

[SarahVaughter]

I have found an article where Dr. Sire who has been advocating and  performing this method explains how to do it. I post here the relevant  sentences:

 

  Dr. Sire:

 

"During the procedure, backlighting is important for creating shadows  that highlight scars' appearance. With such lighting, "You can see  changes in the surface of the skin to pinpoint where exactly the scars  are," Dr. Sire says.

 

"Usually I inject into the scar itself,  creating a bleb or bolus of saline, which then expands the scar.  Typically, there's only one injection into each scar," using a 30-gauge  needle     

Saline injection volume varies from 0.5 cc to 1 cc per injection site,  Dr. Sire says. Each treatment takes about 15 minutes, and most patients  see 20 to 80 percent improvement after five or six sessions.     

When injecting saline for post acne scarring, the needle tip is advanced  45 degrees into the dermis and the saline injected with the objective  of creating a wheal.     

Dr. Sire proposes that the treatment's mechanism of action stems from  the fact that stretching and physical stimuli provoke fibroblasts to  produce collagen and various growth factors.13     

In the eyes of peer-reviewed medical-journal editors, Dr. Sire says, the  saline procedure's simplicity is perhaps a disadvantage. "I've  submitted it before, and it's been ignored." Perhaps these editors  believe that "something this simple can't be that great," he says, "but  it actually is."     

 

  Sources:

 
https://http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/dermatologytimes_201106/index.php?startid=S25#/128


https://http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/dermatologytimes_201106/index.php?startid=S25#/130


   

 

Instead of retinoic acid, I highly recommend pre-treament of the scar  with single needling to re-establish metabolic activity and promote  revascularisation in the scar. Needling is excellent for this. It will  also soften the hard scar tissue and trigger collagen.

  The saline should be injected about once every 2 weeks.

   

  Do not buy one big bottle of saline but many small ones that you discard once opened. Keep it in the fridge.

  If you buy a big bottle of saline, do not dip a used needle or  anything into it - it will contaminate it. For your procedure, pour some  saline into another container that you had cleaned with boiling water  (do not use any sponges to clean it, sponges are bacteria breeders), and  discard it when you finish injecting.

  You must remove all air from the syringe before you inject.

[Lainey]

Thank you, Sarah. Does that mean that the saline should be injected into the dermis, about 2mm into the scar (like the single needle length), or should it be injected a bit deeper deeper?

[Luchitas]

I am also wondering about the same question above, how deep to insert the needle?  Also, did someone write that this does not work for icepick or box scars?  These two types of scars are my main issue since my tx with Accutane in 1991.

Thanks,

Lisa

[SarahVaughter]

The depth of the skin itself (without the underlying fat) is certainly no more than 2 mm. Yes, inject it into the dermis. You should inject it to the bottom or slightly below the bottom of the scar to stretch and detach the scar from its anchoring.

   The article doesn't say it is not working for ice pick scars but it says:

   

  "Saline injections provide a safe, simple and cost effective solution for post-acne scarring, particularly atrophic, shallow boxcar scars."

[Lainey]

Thanks, Sarah, for all your help. I did find this article about subcision. It has some good pictures showing how to hold the needle that might help others interested in the saline injection method, which is similar to subcision without the needle movement. I would not want to use a very fine (30-31G) needle for subcision, as it might break off in the skin!

https://http://www.scribd.com/shady_aly_3/d/57736427-Acne-Scarring

[SarahVaughter]

Subcision is a different technique than saline injections. Those two are sometimes combined in one session but the insertion of the needle is done differently.

   

  In subcisson, a strong needle is inserted horizontally under the scar and moved left to right under the scar to cut off the fibrous attachments that hold the scar down. The space that is formed under the scar by subcision is then filled by saline solution. The saline solution is injected approximately under a 45-degree angle. This is the angle:

 

  https://http://www.mathopenref.com/images/constructions/constangle45/proof.png

  Q is the skin,

  R is the needle.

   

  Saline solution injections do not have to be combined with subcision. I do not recommend doing a subcision at home. It is quite difficult procedure and it can leave scars or nodules.

   

  Instead of the subcision, needle the scar with the single needle from various angles and various depths (max. 2 mm).

   

  In any case, saline injections are not inserted horizontally under the scar but directly into the scar, under an angle of approximately 45 degrees.

   

  Anyway, you should only resort to saline injections if you do not get satisfactory improvement by needling, stamping or dermarolling.