Evaluating the Efficacy of Photodynamic Therapy with 20% Aminolevulinic Acid and Microdermabrasion as a Combination Treatment Regimen for Acne Scarring: A Split-face, Randomized, Double-blind Pilot Study. High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study Attenuation of acne scars using high power fractional ablative unipolar radiofrequency and ultrasound for transepidermal delivery of bioactive compounds through microchannels. Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy. Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism: comparative randomized controlled clinical trial Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Preliminary Comparison of Fractional Laser with Fractional Laser Plus Radiofrequency for the Treatment of Acne Scars and Photoaging Combination ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) on the treatment of severe acne. Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial Treatment of acne scars using the plasma skin regeneration (PSR) system. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. Which Type of Atrophic Acne Scar (Ice‐pick, Boxcar, or Rolling) Responds to Nonablative Fractional Laser Therapy? Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation.
Acne scarring is a consequence of abnormal resolution of wound healing after damage that occurs in the sebaceous follicle during acne inflammation . No trial to date has evaluated the efficacy of the combination of microdermabrasion and photodynamic therapy for acne scarring . This single-center , double-blinded pilot study enrolled subjects with moderate-to-severe acne scarring who were r and omly assigned in a blinded fashion to use aminolevulinic acid and vehicle in a split-face fashion after full-face treatment with microdermabrasion .  On average , 80 percent of the patients displayed more improvement in scarring on the aminolevulinic acid split face versus the vehicle split face after five treatments . Using two different noninvasive mechanisms of targeting acne scarring provided for a safe treatment regimen characterized by more efficacious results with respect to higher rates of scarring improvement Bipolar fractional radiofrequency ( FRF ) device was firstly FDA -approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation . The average energy at 60 mJ/pin was widely used to treat atrophic acne scars . However , the higher energy was delivered , the deeper ablation and coagulation were found . At present , the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin . The objective of the study was to explore and compare the efficacy of utilizing high energy ( 100 mJ/pin ) and moderate energy ( 60 mJ/pin ) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians . This is a split-face , double-blinded , r and omized control trial , pilot study by using parallel group design technique . Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled . All subjects received four monthly sessions of bipolar FRF treatment . Left and right facial sides of individual patients were r and omly assigned for different energy ( high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin ) . Acne scars improvement was blinded grade d by dermatologist using global acne scarring score ( GASS ) which was subjectively evaluated at baseline , 1- , 3- , and 6-month follow-up . Objective scar analysis was also done using UVA-light video camera to measure scar volume , skin smoothness , and wrinkle at baseline , 3- , and 6-month follow-up after the last treatment . Side effects including pain , erythema , swelling , and crusting were also recorded . Thirty subjects completed the study with full 4-treatment course . The mean GASS of high energy side and moderate energy side was significantly reduced at 1- , 3- , and 6-month follow-up visits . At 1 month follow-visit , high energy side demonstrated significant improvement compared with moderate energy side ( p = 0.03 ) . Postinflammatory hyperpigmentation ( PIH ) developed in 21/120 sessions in high energy side ( 17.5 % ) and 16/120 sessions in moderate energy side ( 13.3 % ) . Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy . Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians .  High energy setting demonstrated significant higher efficacy at 1 month follow-visit . However , the efficacy of both energy setting s was comparable at 3- and 6-month follow-up . In addition , side effects were significantly more intense on the side treated with high energy BACKGROUND AND OBJECTIVE To determine the efficacy and safety of a new method for treating  acne scarring  over a short-term period of 2 months and a long-term period of 6 months . MATERIAL S AND METHODS Six faces and 13 shoulders or backs for a total of 19 patients were treated , all of which displayed varying degrees of acne scarring , from moderate to severe . A newly developed high-power unipolar fractional ablative radiofrequency technology was used ( iPixel ™ RF , Alma Lasers , Caesarea , Israel ) , with acoustic pressure ultrasound guided dermal injection of the PixelTreat Scars preparation ( Alma Lasers ) , through RF Pixel fractionated microchannels . All patients underwent four treatment sessions at 3-week intervals . RESULTS Significant improvement was observed in scarring , both on the face ( P < 0.0001 ) , and on the back and shoulders ( P < 0.0001 ) . After 2 months , the percentage of fading on total scarring was 57 % on the face and 49 % on the back and shoulders ; after 6 months , the percentage increased to 62 % on the face , and 58 % on the back and shoulders , respectively . Patients reported to be Somewhat Satisfied ( 16 % ) , Satisfied ( 53 % ) , and Very Satisfied ( 31 % ) . No unexpected side effects to the ablation and no hypersensitive reactions to PixelTreat Scars were observed . CONCLUSION The bimodal procedure is safe and effective in reducing acne scarring . This represents a new therapeutic alternative of great interest , to be used either as a monotherapy , or in combination with other treatments Abstract Background : Pinpoint irradiation technique CO2 LASER and Chemical Reconstruction Of Skin Scars ( CROSS ) are effective treatments for atrophic acne scars as fractional photothermolysis . Objective : This study was design ed to prospect ively compare the use of a pinpoint irradiation technique versus TCA CROSS in treating ice pick acne scars . Methods : Thirty-two patients with ice pick acne scars were included in this open , label pilot study . Pinpoint irradiation technique by CO2 LASER and TCA CROSS were applied for the study and control group , respectively . Twenty-eight patients with ice pick acne scars were included in this open , label pilot study . They were r and omly assigned to two groups : the first group ( 14 patients ) received pinpoint irradiation by CO2 LASER as a study group , and the second group ( 14 patients ) received TCA CROSS as a control group . In both treatments , there were four sessions at 3-week interval , and 3 months of follow up . Results : There were statistically significant difference in acne scar severity index and qualitative scarring grading system in the improvement results between the study and control groups ( p < 0.05 ) . Conclusion : Pinpoint irradiation technique by CO2 LASER is safe and more effective than TCA CROSS technique . Clinical improvement was achieved in all 14 patients without dramatic adverse effects Fractional photothermolysis has been shown to improve various types of scarring , including atrophic  acne scars . The aim of the present authors was to assess the efficacy and safety of the nonablative fractional photothermolysis in the treatment of moderate and severe acne scars . Eighty-seven patients with moderate or severe acne scarring were treated with six sessions with a 1540-nm Erbium glass fiber laser at 3-week intervals . Six months after the final session , 7/87 ( 8 % ) patients showed a moderate improvement , whereas 80/87 ( 92 % ) patients had a marked improvement . In a subset of patients , the present authors also applied in vivo reflectance confocal microscopy to highlight the relevant microscopic changes . Hence , early and late posttreatment findings , most importantly the replacement of a coarser collagen with a new one , similar to the collagen seen in healthy skin , were observed . In accordance to previous studies , the present authors conclude that nonablative fractional photothermolysis is a safe and effective treatment for moderate or severe acne scarring Background : A number of treatments for reducing the appearance of acne scars are available , but general guidelines for optimizing acne scar treatment do not exist . The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide ( CO2 ) laser resurfacing combined with punch elevation with fractional CO2 laser resurfacing alone in the treatment of atrophic acne scars . Material s and Methods : Forty-two Iranian subjects ( age range 18–55 ) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received r and omized split-face treatments : One side received fractional CO2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO2 laser treatment , separated by an interval of 1 month . Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment . Side effects were also recorded after each treatment . Results : The mean ± SD age of patients was 23.4 ± 2.6 years . Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions . No significant difference in evaluation was observed 1 month after treatment ( P = 0.56 ) . Their evaluation found that fractional CO2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO2 laser treatment alone , assessed 4 months after treatment ( P = 0.02 ) . Among all side effects , coagulated crust formation and pruritus at day 3 after fractional CO2 laser treatment was significant on both treatment sides ( P < 0.05 ) . Conclusion : Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring Fractional microneedling radiofrequency ( FMR ) is one of the promising methods in acne treatment . Moreover , bipolar radiofrequency ( BR ) generates heat thereby which induces neocollagenosis . FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar . This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment . Furthermore , mechanism of the FMR treatment was investigated through skin tissues obtained from subjects . Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR . Two sessions of treatment was done 4 weeks apart in a total 12-week prospect i ve single-blind , r and omized clinical trial . Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety . Skin tissues were acquired for investigation of molecular changes . FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR . Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks , respectively . FMR treatment result ed in significant reduction of sebum excretion . Both treatments showed no severe adverse effects other than erythema . The FMR showed superior efficacy in acne and acne scar compared with BR . Increased expression of TGFβ and collagen I and decreased expression of NF-κB , IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR BACKGROUND Treatment of acne scars with ablative fractional CO2 laser appears to be an effective and well-tolerated treatment . However , so far the influence of treatment interval has not been evaluated . OBJECTIVE To evaluate whether treatment of acne scars with fractional CO2 laser resurfacing at 1-month interval achieves better results with no difference in the occurrence of adverse effects , than treatment given at 3-months interval . METHODS Patients ( n = 13 ) with symmetrical atrophic acne scars on right and left sides of the mid-face and lower-face were r and omized to two fractional CO2 laser treatments at 1-month versus 3-month intervals . Blinded on-site evaluations were performed 1 and 6 months after the last treatment on 10-point scales . Endpoints were scar atrophy , patient satisfaction , and adverse effects . RESULTS Pre-operatively , acne scars were moderately atrophic ( 5.86 ± 1.87 ) . After treatment acne scars appeared with less atrophy on both treated sides 1 month postoperatively ( 1-month interval 1.96 ± 1.23 , P < 0.0001 ; 3-months interval 1.82 ± 1.08 , P = 0.0006 ) and 6 months postoperatively ( 1-month interval 1.56 ± 1.24 , P = 0.0021 ; 3-months interval 1.33 ± 1.66 , P = 0.0002 ) . The treatment interval did not influence the improvement of scar atrophy at any time postoperatively ( P = 0.81 ) . Patients were moderately and equally satisfied with the treatment result on facial sides ( P = 0.93 ) . Postoperative adverse effects were minor and not influenced by the treatment interval . CONCLUSIONS Fractional CO2 laser resurfacing improves atrophic acne scars and a treatment interval of either 1-month or 3-months does not seem to influence the improvement of scar atrophy nor the occurrence of postoperative adverse effects BACKGROUND The therapeutic approach to the treatment of acne scars and photoaging varies according to the type of lesion . Traditional carbon dioxide ( CO2 ) laser is associated with long healing times , persistent erythema , and high risk of post‐inflammatory hyperpigmentation . Fractional laser technology , which involves the application of microscopic beams of pixilated light inducing focal zones of tissue injury surrounded by normal tissue , is currently used for the treatment of acne scars and photoaging . OBJECTIVE To compare the results obtained using CO2 fractional laser with those obtained using CO2 fractional laser plus radiofrequency for the treatment of atrophic acne scars and photoaging by means of clinical evaluation and confocal laser . MATERIAL S AND METHODS Ten patients with photoaging and acne scars underwent a single treatment using both technologies . Investigators and patients evaluated the clinical effect of the treatments using digital photographs , dermatoscopy , and in vivo reflectance confocal microscopy before and immediately , 1 week , and 3 months after treatment . RESULTS AND CONCLUSION Our results underlined the high efficacy of combining CO2 laser and radiofrequency , producing better results with fewer sessions , lower risks , and fewer side effects BACKGROUND Scarring is a very common complication of severe acne and is difficult to treat by conventional methods . 5-Aminolevulinic acid ( ALA ) photodynamic therapy ( PDT ) is a novel treatment for improving acne lesions . Fractional laser resurfacing is a promising treatment for scar treatment because of its unique ability to stimulate the wound healing response and its depth of penetration . OBJECTIVE To evaluate the efficacy of combination therapies of ALA-PDT and ablative fractional Er : YAG laser ( 2,940 nm ) for scarring lesions in severe acne patients . METHODS A prospect i ve , single-arm , pilot study . Forty subjects with severe acne were treated with 15 % ALA-PDT for four times at 10-day intervals . They then received ablative fractional Er : YAG laser treatment five times at 4-week intervals . Three independent investigators evaluated subject outcomes at 1 , 3 , 6 , and 12 months post-treatment ( primary outcome ) ; patients also provided self- assessment s of improvement ( secondary outcome ) . RESULTS Significant reductions in acne score ( P < 0.01 ) were obtained at follow-up visits after 1 , 3 , 6 , and 12 months . After 6 month , the lesions showed overall improvement in all of subjects ( good to excellent in acne inflammatory lesions ) , 80 % overall improvement in acne scars . After 12 months , most of subjects had improved hypertrophic/atrophic scars ( good to excellent in 85 % ) and no one had recurrent acne inflammatory lesions . Patient self-evaluation also revealed good to excellent improvements ( on average ) in acne lesions and scarring , with significant improvements in self-esteem after 6 months post-treatment . CONCLUSIONS PDT can control the inflammation and improve the severity of acne lesions . Fractional resurfacing is a promising new treatment modality for scars by stimulating wound healing and remodeling . The combination therapy is a promising option for severe acne to prevent and improve car formation The efficacy of nonablative fractional laser resurfacing of  acne scars has been described in case reports and uncontrolled trials . The present study is the first r and omized controlled trial in this field . The aim of this study was to examine the efficacy and adverse effects of 1,540-nm nonablative fractional laser treatment of acne scars . Ten patients with acne scars were included . Two intraindividual areas of similar size and appearance within contralateral anatomical regions were r and omized to ( 1 ) 3-monthly laser treatments with a StarLux 1,540-nm fractional h and piece , and ( 2 ) no treatment . Blinded on-site clinical evaluations were performed before treatment , and at 4 and 12 weeks after the final treatment . End-points were overall change in scar texture ( from score 0 , even texture , to 10 , worst possible scarring ) , adverse effects , change in skin colour ( from score 0 , absent , to 10 , worst possible ) , and patient satisfaction ( from score 0 , no satisfaction , to 10 , best imaginable satisfaction ) . Before treatment , scars were moderately atrophic and uneven in texture on both treated and untreated sides ( median score 6.5 , interquartile range 4.5–8 ; P=1 ) . After treatment , laser-treated scars appeared more even and smooth than untreated control areas ( 4.5 , 2–6.5 , versus 6.5 , 4.5–8 , P=0.0156 , at 4 weeks ; 4.5 , 2.5–6.5 , versus 6.5 , 4.5–8 , at 12 weeks ; P=0.0313 ) . Patients were satisfied with the treatment ( 5.5 , 1–7 , after 12 weeks ) and five of the ten patients evaluated their acne scars as moderately or significantly improved . No differences were found in skin redness or pigmentation between before and after treatment . Patients experienced moderate pain , erythema , oedema , bullae , and crusts . No adverse effects were seen in untreated control areas . The nonablative 1,540-nm fractional laser improves acne scars with a minimum of adverse effects Background : There have been no well-controlled studies evaluating the efficacy of combining 1540 nm nonablative fractional laser with percutaneous collagen induction ( PCI ) and trichloroacetic acid ( TCA ) 20 % in the treatment of atrophic acne scars . Objective : We hypothesized that combined alternating sessions of both modalities would show better results than each individual modality . Methods and material s : Thirty-nine patients with post acne atrophic scars were included in this study . Patients were r and omly equally divided into three groups ; group 1 was subjected to six sessions of PCI combined with TCA 20 % in the same session , group 2 was subjected to six sessions of 1540 nm fractional laser and group 3 was subjected to combined alternating sessions of the previously mentioned two modalities . Results : Scar severity scores improved by a mean of 59.79 % ( 95 % CI 47.38–72.21 ) ( p < 0.001 ) in group 1 , a mean of 61.83 % ( 95 % CI 54.09–69.56 ) ( p < 0.001 ) in group 2 and a mean of 78.27 % ( 95 % CI 74.39–82.15 ) ( p < 0.001 ) in group 3 . The difference in the degree of improvement was statistically significant when comparing the three groups using ANOVA test ( p = 0.004 ) . Conclusion : The current work recommends combining 1540 nm nonablative fractional laser in alternation with PCI and TCA 20 % in the treatment of atrophic acne scars BACKGROUND AND OBJECTIVES Acne scarring is a common and difficult to treat condition . The plasma skin regeneration ( PSR ) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis . PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions . In this study , we investigated the safety and efficacy of single-treatment , high-energy , double-pass PSR for the treatment of acne scarring . STUDY DESIGN / MATERIAL S AND METHODS Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study . All patients underwent a single PSR treatment with two high-energy passes ( 3.5 - 4.0 J ) . Treatments were performed in an outpatient clinic setting . Nine patients completed 6 months of follow-up . Improvement was determined by patient question naires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment . RESULTS On average , patients reported 34 % improvement in their acne scarring at 3 months and 33 % improvement at 6 months . Blinded physician ratings of patient photos demonstrated 19 % improvement at 3 months and 34 % at 6 months . Re-epithelialization was complete by 4 - 6 days after treatment , and no serious adverse events were encountered . CONCLUSION PSR appears to provide a safe and effective single treatment , minimal downtime alternative for the treatment of acne scarring . Additional studies are warranted to further demonstrate the safety and efficacy of this device IMPORTANCE Fractional laser technology is routinely used in the treatment of acne scarring , with thermal injury result ing in collagen synthesis and remodeling . Use of a picosecond pulse duration with a diffractive lens array may be a new technologic advancement in the treatment of acne scarring . OBJECTIVE To investigate the safety and efficacy of a 755-nm alex and rite picosecond pulse duration laser with diffractive lens array for the treatment of facial acne scarring . DESIGN , SETTING , AND PARTICIPANTS This single-center , prospect i ve study performed in a private practice with a dedicated research department included patients with clinical ly diagnosed scarring secondary to inflammatory or cystic acne . INTERVENTIONS Patients received 6 treatments with a 755-nm picosecond laser with a spot size of 6 mm , fluence of 0.71 J/cm2 , repetition rate of 5 Hz , and pulse width of 750 picoseconds in combination with a diffractive lens array , allowing for greater surface area and pattern density per pulse . MAIN OUTCOMES AND MEASURES The pain and satisfaction scores for overall appearance and texture were recorded . Masked assessment of clinical photographs and analysis of 3-dimensional volumetric data were performed . Biopsy specimens were obtained for independent histologic evaluation by 2 investigators at baseline and at 3 months after last treatment . RESULTS Fifteen women and 5 men ( mean age , 44 years ; age range , 27 - 61 years ) with Fitzpatrick skin types I through V and facial acne scarring were enrolled . The mean pain score was 2.83 of 10 . Patients were satisfied to extremely satisfied with improvement in appearance and texture at their final treatment and follow-up visits . The masked assessment scores of 17 patients were 1.5 of 3 and 1.4 of 3 at 1 and 3 months , respectively ( a score of 0 indicates 0%-25 % improvement and a score of 3 indicates > 75 % improvement ) . A 3-dimensional analysis revealed a mean 24.3 % improvement in scar volume , maintained at 1 ( 24.0 % ) and 3 ( 27.2 % ) months after treatment . Histologic analysis revealed elongation and increased density of elastic fibers , with an increase in dermal collagen and mucin . CONCLUSIONS AND RELEVANCE Treatment of facial acne scars with a diffractive lens array and 755-nm picosecond laser produced improvement in appearance and texture at 3 months after the last treatment , with objective findings similar to those published for a series of fractional ablative laser treatments . Histologic findings suggest that improvement in scarring from this treatment goes beyond remodeling of collagen BACKGROUND Few studies have examined the role of fractional lasers in individual acne scars ( ice‐pick , box car , rolling ) using objective assessment tools in darkly pigmented skin . OBJECTIVE To evaluate the effect of 1,540‐nm fractional lasers on individual acne scars . METHODS and MATERIAL S A prospect i ve interventional study was conducted in 35 patients using a 1,540‐nm fractional laser .  Six sessions were performed with four passes per session and a dose varying from 70 to 100 mJ to maximize the DWR . A self‐devised objective assessment tool with dose setting s to optimize the depth‐to‐width ratio ( DWR ) and a visual analog scale ( VAS ) were used to count individual atrophic scars . Final results were assessed 6 months after final laser treatment . RESULTS Acne scar reduction efficiency was used to vali date the improvement of individual scars , a meaningful difference was considered as 51 % or greater improvement . The boxcar scars ( 52.9 % ) responded better than the rolling ( 43.1 % ) and ice‐pick scars ( 25.9 % ) , with statistically significant improvement ( p < .05 ) seen in boxcar scars after four sessions . Overall VAS scores revealed significant improvement ( p < .001 ) . CONCLUSION Using an objective evaluation tool , an erbium‐doped glass laser was found to improve atrophic acne scars , markedly so for boxcar and rolling scars . The VAS score overestimated improvement because of its subjective nature BACKGROUND AND OBJECTIVES Ablative fractional resurfacing ( AFR ) is a new modality for photorejuvenation and acne scars which combines carbon dioxide ( CO₂ ) laser ablation with fractional photothermolysis . The objective is to evaluate the efficacy and side effects of a new fractional CO₂ ablative device ( Fraxel Re : pair ) for skin rejuvenation and acne scars in Asians . MATERIAL S AND METHODS Nine patients underwent one full-face treatment . The energy levels ranged from 30 - 70 mJ with coverage between 30 % and 45 % . Improvement in skin texture , laxity , wrinkles , enlarged pores , overall pigmentation irregularity , and adverse effects were assessed up to 6 months post-treatment . St and ardized photographs using the Canfield Visia CR system ® were assessed by two independent observers . Subjective improvement was assessed by patient question naires . RESULTS Nine Chinese patients ( skin types III and IV , mean age 44.8 ) were included . Statistically significant improvements were seen for skin texture , skin laxity , wrinkles , enlarged pores , and acne scars . The post-inflammatory hyperpigmentation rate was 55.5 % and 11.1 % at 1 and 6 months post-treatment , respectively . Eighty-six percent of patients were overall satisfied to very satisfied with the treatment . CONCLUSION Ablative fractional CO₂ laser resurfacing was overall safe and effective for skin rejuvenation and acne scars in Asians . However , in view of the high post-inflammatory rate and the statistically significant but only mild to moderate improvement after a single treatment as observed in this study , there is a need to review the current role of fractional ablative CO₂ laser treatment as compared to fractional non-ablative for skin rejuvenation and acne scar treatment in Asians BACKGROUND Non-ablative 1550-nm erbium-doped fractional photothermolysis systems ( FPS ) and 10 600-nm carbon dioxide fractional laser systems ( CO(2 ) FS ) have been effectively used to treat scars . OBJECTIVE We compared the efficacy and safety of single-session treatments of FPS and CO(2 ) FS for acne scars through a r and omized , split-face , evaluator-blinded study . METHODS Eight patients with acne scars were enrolled in this study . Half of each subject 's face was treated with FPS and the other half was treated with CO(2 ) FS . We used a quartile grading scale for evaluations . RESULTS At 3 months after the treatment , the mean grade of improvement based on clinical assessment was 2.0 + /- 0.5 for FPS and 2.5 + /- 0.8 for CO(2 ) FS . On each side treated by FPS and CO(2 ) FS , the mean duration of post-therapy crusting and scaling was 2.3 and 7.4 days respectively and that of post-therapy erythema was 7.5 and 11.5 days respectively . The mean VAS pain score was 3.9 + /- 2.0 with the FPS and 7.0 + /- 2.0 with the CO(2 ) FS . CONCLUSION We demonstrated the efficacy and safety of single-session acne scar treatment using FPS and CO(2 ) FS in East Asian patients . We believe that our study could be used as an essential reference when choosing laser modalities for scar treatment
Discussion : Ablative lasers seem to achieve the highest degree of efficacy , albeit this is associated with significant pain and downtime , and the risk for long-term pigmentary changes .
Non-ablative fractional photothermolysis ( FP ) has a much safer profile but can not achieve as good cosmetic results .
The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile .
Conclusion : Multiple devices have been used with varying levels of efficacy and very different safety profiles .
There is an overall lack of high- quality evidence about the effects of different interventions .
Introduction : Acne scarring is a very common problem , which can be extensive , and may lead to significant psychosocial morbidity .
Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success .
This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring .
Objectives and methods : A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring .