Subcision Re-tethering misinformation
Okay there's constant misinformation on this app so wanted to share this.
Retethering is a real thing after subscision. But, there is no research to show that microneedling retethers the scars.
Again, there is zero evidence that microneedling itself causes previously released tethered scars to re-tether.
There is no clinical trial, review, or case report showing that:
- microneedling performed after successful subcision causes scars to become tethered again,
- microneedling increases scar reattachment rates, or
- microneedling induces the type of deep fibrous bands responsible for tethered rolling scars.
Re-tethering is a recognized limitation of subcision itself, but it has not been linked to subsequent microneedling in the medical literature.
Actual information:
- Subcision is the treatment that mechanically releases tethered scars. It cuts the fibrous bands that pull the scar downward. The improvement comes from both releasing those bands and subsequent collagen remodeling during healing.
- Re-tethering (reattachment) is a recognized phenomenon after subcision, but the literature attributes it to the normal wound-healing process after the fibrous bands are cut—not to later microneedling. This is one reason some physicians combine subcision with fillers or other techniques to keep the space open during healing.
Theoretically, people worry because microneedling stimulates wound healing and collagen deposition. However:
- the collagen produced after microneedling is intended to remodel the dermis, not create new deep fibrous adhesions between the dermis and subcutaneous tissue;
- the needles are very fine and create vertical microchannels rather than the broad tissue disruption that forms tethering bands.
There is currently no human evidence that this collagen response recreates deep tethering.
What is more likely if scars seem worse after microneedling?
Dermatologists describe several possibilities that don't involve new tethering:
- temporary swelling wears off, revealing the baseline scar,
- collagen remodeling is incomplete,
- the original subcision did not fully release all fibrous bands,
- natural healing after subcision led to some recurrence of tethering over weeks to months.
More specifically:
- The 2023 review of subcision for atrophic acne scars discusses recurrence of tethering after subcision and methods to reduce recurrence (fillers, suction, etc.), but it does not identify microneedling as a cause of re-tethering.
- Multiple randomized trials have actually combine subcision with microneedling as part of treatment protocols, with the goal of improving outcomes rather than avoiding microneedling. If there were evidence that microneedling promoted reattachment, this combination would be difficult to justify.
- The mechanistic literature describes microneedling as producing controlled dermal injury that induces collagen remodeling and breaks up superficial scar strands. It does not describe formation of new deep fibrous adhesions between the dermis and subcutis—the pathology responsible for tethered rolling scars.
The important distinction is:
- What is known: scars can re-tether after subcision because wound healing can recreate fibrous attachments. This is a recognized limitation of subcision itself.
- What is not supported by evidence: that a subsequent microneedling session induces or accelerates that re-tethering. I could not find published evidence supporting that claim.
The clearest medical framing is after tissue is injured or surgically released, healing can create new adhesions — fibrous scar connections between tissues that should move separately. ASRM describes postoperative adhesions as a “natural consequence of surgical tissue trauma and healing,” and explains that fibrin can organize into permanent adhesions.
For skin/depressed/tethered scars, plastic surgery literature uses that same concept: techniques place dermal tissue under the released scar as a “re-adhesion barrier” after release of tethering/depression, and report whether there is relapse of depression or tethering.
So medical literature supports retethering/re-adhesion as a scar-healing concern after release... just not after microneedling. It is usually discussed as adhesion formation, re-adhesion, relapse of tethering, or recurrent adhesions, not always the exact word re-tethering.