What type of needle is commonly used for subcision procedures?

Needle Selection for Subcision Procedures

For subcision procedures treating acne scars and depressed cutaneous defects, use an 18-gauge Nokor needle or 18-21 gauge blunt cannula, with blunt cannulas demonstrating superior patient satisfaction and fewer complications. 1, 2, 3

Primary Needle Options

Nokor Needle (Traditional Approach)

• 18-gauge tri-beveled hypodermic needle is the traditional instrument for subcision, inserted through a single puncture point to perform subcuticular cuts beneath depressed scars 4
• The tri-beveled design allows sharp edges to maneuver under the defect and release fibrous bands connecting the dermis to deeper structures 4
• This "incisionless" technique lifts depressions through both the releasing action and subsequent connective tissue formation during wound healing 4

Blunt Cannula (Preferred Alternative)

• 18-21 gauge blunt cannulas represent an effective alternative with demonstrated advantages over traditional Nokor needles 1, 2, 3
• Cannula-based subcision requires only a single perforation on each treatment side rather than multiple punctures, reducing patient pain and procedural risk 1
• Blunt cannula subcision achieves comparable or superior efficacy with significantly higher patient satisfaction rates (100% good-to-very-good satisfaction) compared to Nokor needle technique 1, 3

Evidence-Based Comparison

Efficacy Outcomes

• Both modalities produce similar improvement in scar depth, topography, and overall appearance at 3-month follow-up 2, 3
• Cannula subcision demonstrated greater than 50% improvement after just 2 sessions with 100% improvement in photographic assessment parameters 1
• Average lesion count reduction from 24.8 ± 12.1 to 12.8 ± 2.1 (p<0.05) with cannula technique 1

Complication Profile

• Blunt cannula demonstrates significantly lower complication rates than Nokor needle (p<0.05) 2, 3
• Nokor needle complications include ecchymosis and nodule formation 3
• Cannula technique primarily causes transient edema with minimal bruising 3
• Single-entry technique with cannulas reduces inflammation, recovery time, and infection risk compared to multiple punctures 1

Patient Satisfaction

• All patients (100%) reported good-to-very-good satisfaction with cannula subcision versus variable satisfaction with Nokor needles 1
• Patients demonstrated statistically significant preference for blunt cannula over Nokor needle at all time points (p=0.000) 3
• Physician satisfaction was also significantly higher with cannula technique during 3-month monitoring 3

Technical Considerations

Needle Gauge Selection

• 18-gauge is the most commonly reported size for both Nokor needles and cannulas 1, 4
• 21-gauge cannulas can be used for more delicate areas or smaller scars 1
• Larger bore needles (18G) provide better mechanical advantage for releasing fibrous bands while maintaining adequate maneuverability 1

Procedural Advantages of Cannulas

• Requires fewer treatment sessions compared to traditional needle subcision 1
• Single puncture entry point per treatment area minimizes tissue trauma 1
• Blunt tip design prevents inadvertent penetration beyond the target plane 5
• Maintains horizontal orientation more easily during the procedure 5

Clinical Algorithm for Needle Selection

Choose blunt cannula (18-21 gauge) as first-line for:

• Patients concerned about pain or recovery time 1
• Rolling acne scars with moderate-to-severe depth 1, 3
• Treatment areas requiring extensive undermining 1
• Patients with history of post-procedure inflammation 1

Consider Nokor needle (18-gauge) when:

• Treating very localized, small depressed scars requiring precise release 4
• Blunt cannula equipment is unavailable 4
• Treating wrinkles or superficial depressions where minimal undermining is needed 4

Common Pitfalls to Avoid

• Do not use needles smaller than 18-gauge—insufficient mechanical strength to effectively release fibrous bands 1, 4
• Avoid multiple puncture sites when using Nokor needles—this increases pain, inflammation, and complication risk without improving outcomes 1
• Never advance the needle beyond the boundaries of the scar—risk of creating new defects or vascular injury 5
• Do not perform subcision without proper anesthesia—adequate local anesthesia is essential for patient comfort and procedural success 1, 2