A side-firing 1440 nm fiber laser achieves thermal subcision by physically entering the sub-dermal layer to restructure tissue from within. This specialized fiber delivers directed thermal energy to sever the fibrous connective tissues that hold scars down, while simultaneously heating the dermis to trigger repair.
The core mechanism combines the mechanical separation of deep scar tissue with thermal stimulation, resulting in both the immediate release of scar tension and long-term collagen remodeling.
The Mechanics of Action
Targeted Sub-Dermal Delivery
Unlike topical lasers that treat from the outside in, this method involves inserting a specialized side-firing fiber directly under the skin.
Placing the energy source in the sub-dermal layer allows the practitioner to bypass the surface and interact directly with the structure of the scar.
Severing Fibrous Tethers
The primary goal is to address the fibrous connective tissues that tether the skin downwards, creating the depressed appearance of the scar.
The laser's thermal energy acts as a cutting tool, physically severing these bands. This mimics the mechanical release of traditional surgical subcision but utilizes laser precision.
Controlled Thermal Remodeling
While the fiber severs the tethers, the laser energy generates controlled thermal damage within the dermis.
This heat stress stimulates the body's natural healing response, prompting the production of new collagen. This process fills the void left by the scar and improves skin texture over time.
Understanding the Trade-offs
Invasiveness vs. Efficacy
Thermal subcision is an invasive procedure requiring the physical insertion of a fiber into the skin.
This differs significantly from non-invasive treatments like Pico lasers or IPL, which target the area from the surface. While more intensive, the sub-dermal approach is necessary for effectively treating deep, depressed acne scars that surface treatments cannot fully resolve.
Specificity of Indication
This treatment is highly specialized for structural scarring.
It is distinct from therapies designed for active acne, such as IPL, which focuses on eliminating bacteria and reducing inflammation rather than physically detaching scar tissue.
Making the Right Choice for Your Goal
The most effective treatment depends entirely on the depth of the pathology and the current state of the skin.
- If your primary focus is treating deep, depressed scars: Prioritize thermal subcision to physically sever the connective tethers and stimulate deep collagen remodeling.
- If your primary focus is active acne or inflammation: Consider IPL therapy to target bacteria and reduce inflammation before addressing scarring.
- If your primary focus is surface-level precision: Look into Pico laser treatments for quick, targeted targeting of the affected area.
By combining mechanical separation with thermal energy, thermal subcision offers a comprehensive solution for restructuring the skin's foundation.
Summary Table:
| Feature | Thermal Subcision (1440 nm Fiber) | Traditional Surface Lasers (Pico/CO2) |
|---|---|---|
| Mechanism | Sub-dermal physical & thermal separation | Topical thermal or photoacoustic energy |
| Target Area | Fibrous tethers in the deep dermis | Surface texture and epidermis |
| Invasiveness | Minimally invasive (fiber insertion) | Non-invasive to minimally invasive |
| Best For | Deep, depressed (rolling/boxcar) scars | Surface pigmentation and mild scarring |
| Key Benefit | Immediate release of scar tension | Rapid recovery and surface refinement |
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References
- American Society for Laser Medicine and Surgery Abstracts. DOI: 10.1002/lsm.22229
This article is also based on technical information from Belislaser Knowledge Base .
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