Search

Microneedling and soft-tissue filler injections have been used independently to improve acne scarring. The effectiveness of a combined approach using microneedling followed by polymethylmethacrylate (PMMA)-collagen gel has not been carefully studied.The goal of this study was to assess the effectiveness and safety of microneedling alone versus microneedling followed by injection of PMMA-collagen gel filler for correction of atrophic facial acne scars.We conducted a multicenter, open-label, randomized, prospective study on subjects with distensible atrophic acne scars in the face to determine whether microneedling with PMMA-collagen gel is a superior acne scar treatment over microneedling alone. Forty-four subjects received 3 microneedling treatments over a 12-week period followed by randomization to treatments with PMMA-collagen gel (treatment group) or no further treatment (control group).At 24 weeks, the treatment group achieved a statistically significant improvement in acne scores over microneedling alone. The improvement continued at 36 weeks. At 24 weeks, the treatment group showed a strong trend in improvement on the Physician Global Aesthetic Improvement Scale compared with microneedling alone.

Background Noninvasive technologies for treating acne scars use radiofrequency (RF)-emitting microneedles for both mechanical disruption of fibrotic strands and heat-mediated collagen remodeling. Objective Efficacy and safety evaluation of electronically controlled noninsulated RF microneedling system on acne scars in patients with dark skin. Methods Nineteen patients, 24 to 51 years old, skin types III to V, with acne scars were enrolled in the study. Each patient had 3 treatment sessions at monthly intervals using a multisource RF treatment platform with a microneedle RF applicator. Efficacy was evaluated by the Goodman and Barron's Global Qualitative Acne Scarring System. Results No bleeding points occurred during treatments. Post-treatment erythema was observed immediately after the treatment and lasted up to 10 hours after the treatment. Improvement of at least 1 acne scar grade was noted in 11 of 19 patients (57.9%) after 1 month and in 9 of 9 patients (100%) after 3 months. Conclusion The tested noninsulated electronically controlled RF microneedles were found to be safe and efficient in the treatment of atrophic acne scars in skin types III to V with minimal pain or downtime.

There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes (SPT) IV to VI.To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI.The authors conducted a randomized, investigator-blinded and rater-blinded, split-face comparative study of adults with SPT IV to VI and facial acne scars treated with 2 different density settings and the same fluence.Quantitative global scarring grading system (QGSGS) scores were significantly improved from baseline at 16 and 24 weeks (p = .0277). Improvements in QGSGS scores after higher and lower density treatments were statistically similar (p = .96). The live-blinded dermatologist, the blinded dermatologist photoraters, and the patients rated scars as being significantly more improved by visual analog scale at weeks 16 and 24 compared with baseline (p.001) for both treatment densities. Five of 7 and 3 of 7 patients in the higher and lower density group, respectively, experienced mild or moderate hyperpigmentation as an investigator observed site reaction.The nonablative 1550-nm fractional laser is safe and efficacious in treating acne scaring in Fitzpatrick skin types IV to VI. Self-limited postinflammatory hyperpigmentation was a common occurrence, especially with higher treatment densities.

Background Hill and valley scarring is 1 of 3 atrophic scar types that occur as a result of acne, becoming more apparent with facial skin aging. Treatment includes resurfacing techniques and the use of injectable fillers. Poly-L-lactic acid is an injectable collagen builder that has been used for the treatment of HIV-associated lipodystrophy and cosmetic enhancement. Objective To determine the degree of correction attainable with poly-L-lactic acid and safety findings for the treatment of hill and valley acne scarring. Materials and methods Poly-L-lactic acid was injected over 3 to 4 serial treatments at 4-week intervals in 22 subjects in this single-arm, unblinded, open-label Phase II study. Efficacy was determined by physician, blinded evaluator, and subject assessment of scar improvement using Likert scales, comparing photographs taken by 3 camera systems at treatment visits 2 to 4 and follow-up to baseline. Subjects also assessed treatment satisfaction. Results Percentage of patients with much to excellent improvement using the most sensitive camera system (VISIA-CR) ranged from 45.5% to 68.2%. Subject treatment satisfaction scores increased by 44%. One patient experienced a palpable nonvisible nodule. No subjects discontinued treatment. Conclusion Injectable poly-L-lactic acid facilitated improvement in hill and valley acne scarring and was well tolerated.

Neck wrinkles are common, troublesome aesthetic deformities for which a limited number of treatments exist. Although previous study has demonstrated the safety and efficacy of subdermal minimal surgery technology in treatment of acne scarring, this technology has never been applied to treatment of wrinkles.To evaluate the efficacy and safety of subdermal minimal surgery technology in the treatment of horizontal neck wrinkles.All 12 enrolled participants were Koreans (Fitzpatrick skin types II-IV) with horizontal neck wrinkles. Participants underwent up to four sessions of treatment with subdermal minimal surgery technology at 4-week intervals. Wrinkle assessments were conducted at baseline and 2 months after the final treatment session. Participants and physicians evaluated improvement using pre- and post-treatment photographs.All participants completed the study. Improvement of wrinkling by at least 50% was observed at 6 months (2 months after the final treatment session) in more than half of the participants, as determined according to physician and participant evaluation.Findings from this preliminary study demonstrate that use of subdermal minimal surgery technology results in an effective decrease of the appearance of neck wrinkles.

BACKGROUND Acne scarring is common but surprisingly difficult to treat. Newer techniques and modifications to older ones may make this refractory problem more manageable. The 100% trichloroacetic acid (TCA) chemical reconstruction of skin scars (CROSS) method is a safe and effective single modality for the treatment of atrophic acne scars, whereas subcision appears to be a safe technique that provides significant improvement for rolling acne scars. OBJECTIVE To compare the effect of the 100% TCA CROSS method with subcision in treating rolling acne scars. METHODS Twenty patients of skin types III and IV with bilateral rolling acne scars received one to three sessions of the 100% TCA CROSS technique for scars on the left side of the face and subcision for scars on the right side. RESULTS The mean decrease in size and depth of scars was significantly greater for the subcision side than the 100% TCA CROSS (p

BACKGROUND AND OBJECTIVES Acne scars affect the entire population, causing significant distress and concern. Previous treatments for acne scars have yielded varying degrees of success and associated side effects. Fractional photothermolysis has been shown to improve scars, including surgical scars, hypopigmented scars, and atrophic acne scars. The newest system has the option of increased fluences for greater depth of penetration and variable treatment coverage. Our aim was to determine the efficacy and safety of the second-generation erbium-doped 1,550-nm fractional photothermolysis laser (1,550nm Fraxel SR laser, Reliant Technologies Inc.) in the treatment of all types of acne scars and of all severities. STUDY DESIGN/MATERIALS AND METHODS Twenty-nine patients (20 females and 9 males, ages 15–65 years), Fitzpatrick Skin Types I to V, were treated with two to six treatments with the second-generation erbium-doped 1,550-nm fractional photothermolysis laser at 1-month intervals. Fluences ranged from 35 to 40mJ/microthermal zone. Treatment levels varied from 7 to 10 and ‘‘Advanced Level 1,’’ corresponding to treatment coverage of 20% to 35%. Patients were graded on a 4-point scale by three independent physicians using digital photography. RESULTS The majority of patients achieved a 50% to 75% improvement in facial and back acne scarring (18 of 29 patients). Five patients had an improvement of greater than 75% in acne scarring, 5 patients had a 25% to 50% improvement in acne scarring, and 1 patient had less than a 25% response to treatment. The patients’ degree of satisfaction paralleled the physicians’ assessment. Side effects were minimal and no posttreatment pigmentary changes were noted. CONCLUSION Fractional photothermolysis is a safe and efficacious treatment modality for the treatment of all types of acne scars of all severities. No adverse effects were noted, including in patients with Fitzpatrick Skin Types III to V. The authors have indicated no significant interest with commercial supporters.

BACKGROUND There is no global qualitative grading system for assessing the disease load and global severity of disease in a patient with postacne scarring. OBJECTIVE The purpose of this article is to provide a simple qualitative grading system that would allow better communication between practitioners of a patient's global disease severity and the most appropriate corresponding therapy for that degree of acne scarring. METHODS Four grades of postacne scarring are described, and appropriate therapeutic interventions are presented for each. Grade assignment is made by lesion morphologies and disease load as indicated by patient perception of severity (i.e., whether or not an individual can easily disguise his or her disease at social distances). RESULTS A simple qualitative global acne scarring grading system is presented. LIMITATIONS The determination of disease load in terms of patient perception of severity is intrinsically imperfect due to varying subjectivity among individuals. CONCLUSION A global acne scarring grading system is presented that is simple to use and may optimize therapeutic intervention. This system would also allow investigators, educators, and proceduralists to compare their cases more accurately and to have a more objective discussion of the efficacy of operative interventions or therapies.

BACKGROUND Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. OBJECTIVE In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. MATERIALS AND METHODS Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14J/cm 2 , 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. RESULTS Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%– 41.79%; p=.006); 89% of patients noted greater than 10% scar improvement. No treatmentrelated adverse events were seen. CONCLUSION Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. A laser upgrade needed for the study was provided to the authors at a reduced price.

BACKGROUND AND OBJECTIVE Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium–aluminum–garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3–12 months). RESULTS Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1–10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement.

Background. Facial acne scarring has been treated with multiple methods with varying degrees of improvement. Although the 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been widely used to improve photoaging, studies analyzing its effects on atrophic acne scarring are limited. Objective. To evaluate the efficacy of a dynamic cryogen-cooled 1,320 nm Nd:YAG laser for the treatment of atrophic facial acne scars in a larger cohort of patients with long-term follow-up. Methods. Twenty-nine patients (skin phototypes I–IV) with facial acne scarring received a mean of 5.5 (range 2–17) treatments with a 1,320 nm Nd:YAG laser. Objective physician assessment scores of improvement were determined by side-by-side comparison of preoperative and postoperative photographs at a range of 1 to 27 months (mean 10.4 months) postoperatively. Subjective patient self-assessment scores of improvement were also obtained. Results. Acne scarring was significantly improved by both physician and patient assessment scores. Mean improvement was 2.8 (p < .05) on a 0- to 4-point scale by physician assessment and 5.4 (p < .05) on a 0- to 10-point scale by patient assessment. No significant complications were observed. Conclusions. Nonablative laser skin resurfacing with a 1,320 nm Nd:YAG laser can effectively improve the appearance of facial acne scars with minimal adverse sequelae.

Background. This article addresses the use of liquid injectable silicone as both an immediate and long-lasting treatment for broad-based, depressed acne scars. The only filler substance that maintains precision and permanence in improving and/or correcting these types of acne scar defects is medical-grade liquid silicone. Objective. We describe five patients with a history of acne scarring who showed improvements from injections of liquid silicone at the initial treatment session and lasting over a 10-, 15-, and 30-year follow-up period. Methods. Monthly liquid silicone injections using a technique known as the microdroplet, multiple-injection approach. Results. This article documents the safety, effectiveness, and precision of silicone in addition to highlighting the fact that its permanence is what distinguishes it from other filler materials. Conclusion. As a precise and permanent filling substance used for soft tissue augmentation, liquid injectable silicone can improve and/or eliminate depressed, broad-based acne scars through a technique known as the microdroplet, multiple-injection approach.

background. Selective nonablative wrinkle reduction with low-fluence pulsed dye laser has been shown to provide cosmetic benefits by stimulating the production of dermal collagen. The clinical efficacy for improving the appearance of acne scarring using selective nonablative laser treatments has yet to be established. objective. To evaluate the improvement in the appearance and topography of acne scarring following application of a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis. methods. Ten patients (mean age 34.8 years) with Fitzpatrick skin types I–IV and shallow to moderately deep, saucerized facial acne scars were enrolled in a prospective trial to receive a single laser treatment of both cheeks. Patients were evaluated at 30, 60, 90, and 120 days to assess the degree of clinical improvement. The evaluation process included assessment of pre- and posttreatment photography by two independent observers, patient assessment surveys, and surface profilometry using silicone imprints in order to quantify the degree of clinical improvement. results. All 10 patients reported visible cosmetic improvement in the treated areas while surface profilometry showed that, on average, the depth of the acne scars was reduced by 47.8%. No adverse effects of this treatment were reported. conclusion. The treatment of acne scars utilizing a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis may be a safe and effective noninvasive alternative for a natural result.

background. Laser skin resurfacing has added to the numerous treatment options available for acne scarring. Adjunct modalities such as punch excision should be considered to enhance treatment outcomes. Traditionally, punch excision and grafting have been performed, followed 1–2 months later by dermabrasion. objective. To determine the effectiveness of laser skin resurfacing and the concurrent use of punch excision performed at the same treatment session in the treatment of acne scarring. methods. Twenty-one patients with skin types I-III with mild to severe facial acne scarring were treated with a combination of laser skin resurfacing and punch excision of acne scars in the same treatment session. Baseline, postoperative, and follow-up photographs were taken and evaluated by an independent dermatologist and a laser nurse blinded to patient treatment. In addition, subjective patient assessments of improvement were obtained. results. There was a range of clinical improvement by the independent assessor of 25–50% in skin type I, 50–75% in skin type II, and 50–75% in skin type III There was a patient subjective improvement of 25–50% for skin type I, 50–75% for skin type II and 75–100% for skin type III. Postoperative hyperpigmentation was noted in five patients and postoperative hypopigmentation was not seen in any patients. There was no wound dehiscence, evidence of infection, or hypertrophic scarring of treated areas noted on follow-up. conclusion. Laser skin resurfacing with the concurrent use of punch excision improves facial acne scarring. This newly described method negates the need to delay additional resurfacing for a future visit.

The treatment of acne scarring is complex and often involves multiple modalities. Some of the different options for managing scarring are chemical peels, laser resurfacing, photorejuvenation, mini punch grafts, and dermabrasion. Subcision, a nonoperative technique for managing depressed scars by percutaneously releasing scar bands within the dermis and subcutaneous tissue, was introduced in 1995. A needle is used to release the fibrous septa within the scar, resulting in the formation of new connective tissue underneath the scar.