title: Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients 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 Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial Efficacy of the Fractional Photothermolysis System with Dynamic Operating Mode on Acne Scars and Enlarged Facial Pores Comparison of a Long‐Pulse Nd:YAG Laser and a Combined 585/1,064‐nm Laser for the Treatment of Acne Scars: A Randomized Split‐Face Clinical Study Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy. Treatment of acne scars using the plasma skin regeneration (PSR) system. Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism: comparative randomized controlled clinical trial Novel Technology in the Treatment of Acne Scars: The Matrix-tunable Radiofrequency Technology Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Comparison of Stacked Pulses versus Double‐Pass Treatments of Facial Acne with a 1,450‐nm Laser 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. Comparison of a Fractional Microplasma Radio Frequency Technology and Carbon Dioxide Fractional Laser for the Treatment of Atrophic Acne Scars: A Randomized Split‐Face Clinical Study Preliminary Comparison of Fractional Laser with Fractional Laser Plus Radiofrequency for the Treatment of Acne Scars and Photoaging Which Type of Atrophic Acne Scar (Ice‐pick, Boxcar, or Rolling) Responds to Nonablative Fractional Laser Therapy? Comparison of a 1,550 nm Erbium: glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: a simultaneous split-face trial. Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar. Safety and Efficacy of Erbium‐Doped Yttrium Aluminum Garnet Fractionated Laser for Treatment of Acne Scars in Type IV to VI Skin 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 Attenuation of acne scars using high power fractional ablative unipolar radiofrequency and ultrasound for transepidermal delivery of bioactive compounds through microchannels. Nonablative 1,064‐nm Nd: YAG Laser for Treating Atrophic Facial Acne Scars Histologic and Clinical Analysis Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. Treatment of Acne Scars of Skin Types II to V by Sublative Fractional Bipolar Radiofrequency and Bipolar Radiofrequency Combined with Diode Laser. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Clinical evaluation of the efficacy and safety of fractional bipolar radiofrequency for the treatment of moderate to severe acne scars Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation Autologous Platelet Rich Plasma: Topical Versus Intradermal After Fractional Ablative Carbon Dioxide Laser Treatment of Atrophic Acne Scars Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars
abstract: BACKGROUND Many methods have been proposed for the treatment of  acne scars  , with variable cosmetic results . Nonablative skin resurfacing is one method that has been proposed . Because of a need for more noticeable clinical improvements , the ablative fractional laser was recently introduced . OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers . METHODS A series of 20 patients ( skin phototypes IV – V ) with atrophic facial acne scars were r and omly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high ( group A ) and low ( group B ) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half . Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively . Clinical assessment scores were determined at each treatment session and follow‐up visit . RESULTS Although the use of the ablative fractional laser with high energy result ed in an improvement in patients ' acne scars , the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results , as assessed in photographs as well as by the overall appearance of the acne scars . With the combination method , fewer complications were observed . The authors have indicated no significant interest with commercial supporters 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 The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies . Recently , microneedling treatment has been showing promising results with lower costs , quick healing time , and low risk of postinflammatory hyperpigmentation ( PIH ) . OBJECTIVE To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars . METHODS Forty-six patients with atrophic facial acne scars were r and omized to microneedling and laser groups , receiving 3 sessions performed monthly . Two blinded dermatologists applied the vali date d “ Quantitative Global Grading System for Postacne Scarring ” scale , before , 2 months , and 6 months after the treatment . Side effects were recorded at each follow-up visit and patient 's satisfaction was evaluated . RESULTS Both groups showed a significant improvement , and there was no statistically significant difference between results of both therapies ( p = .264 ) . The erythema after each session was longer in the laser group and 13.6 % subjects experienced PIH . No PIH was observed in the microneedling group . CONCLUSION This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars . Microneedling is well tolerated , with fewer side effects and lower down time BACKGROUND Current treatments for acne scars and enlarged facial pores have shown limited efficacy . OBJECTIVE To evaluate the efficacy and safety of the fractional photothermolysis system ( FPS ) with dynamic operating mode on acne scars and enlarged pores . MATERIAL S AND METHODS Twelve patients with mild to moderate atrophic acne scars and enlarged pores were included in this study . Three sessions of FPS treatment were performed for acne scars and facial pores monthly . Two blinded dermatologists who compared before and after photos based on a quartile grading scale conducted objective clinical assessment s of acne scar– and facial pore – treated areas . We took a biopsy immediately after one treatment with the laser from one of the authors to assess the histologic effects of the laser on facial pores . RESULTS Follow-up results at 4 months after the last treatment revealed that , of the 12 patients , for acne scars , five demonstrated clinical improvements of 51 % to 75 % and three demonstrated improvements of 76 % to 100 % , and for facial pores , five demonstrated moderate clinical improvements of 26 % to 50 % and three demonstrated improvements of 76 % to 100 % . Side effects , including pain , post-treatment erythema , and edema , were resolved within 1 week . CONCLUSION We suggest that the FPS may provide a new treatment algorithm in some cases with acne scars and enlarged pores . Considering the lack of placebo-controlled , split-face design of our study , optimized , prospect i ve studies should be conducted to fully assess the efficacy of FPS with dynamic operating mode BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications , especially in patients with darker skin . OBJECTIVE To compare the efficacy and safety of a long‐pulse neodymium‐doped yttrium aluminium garnet ( Nd : YAG ) laser and a combined 585/1,064‐nm laser for the treatment of acne scars . MATERIAL S AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long‐pulse Nd : YAG laser or combined 585/1,064‐nm laser treatment sessions at fortnightly intervals . Treatments were administered r and omly in a split‐face manner . RESULTS Acne scars showed mild to moderate improvement , with significant Echelle d'évaluation clinique des cicatrices d'acné ( ECCA ) score reductions , after both treatments . Although intermodality differences were not significant , combined 585/1,064‐nm laser was more effective for deep boxcar scars . In patients with combined 585/1,064‐nm laser‐treated sides that improved more than long‐pulse Nd : YAG laser‐treated sides , ECCA scores were significantly lower for combined 585/1,064‐nm laser treatment . Histologic evaluations revealed significantly greater collagen deposition , although there was no significant difference between the two modalities . Patient satisfaction scores concurred with physicians ' evaluations . CONCLUSION Both lasers ameliorated acne scarring with minimal downtime . In light of this finding , optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response . The authors have indicated no significant interest with commercial supporters 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 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 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 : Despite the many advances , scarring , particularly acne or pimple scarring , does not have a satisfactory treatment . A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology , which utilizes radiofrequency emission in the treatment of acne scars . Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes . Setting s and Design : A prospect i ve study of 30 r and omly selected patients with acne scars was carried out . Material and Methods : Thirty healthy patients with different types of acne scars – ice pick , box and rolling type – were r and omly selected . The scars were either shallow or deep , varied in size from 2 to 20 mm and ranged in number from 10 to 50 . These patients were first treated with broad-spectrum antibiotics and local exfoliating agents ( topical tretinoin 0.025 % ) and then subjected to matrix-tunable radiofrequency technology . Each scar was treated at intervals of 1 month . A maximum of four such sittings were carried out . Patients were followed-up every 15 days . Results were noted at the end of 2 months and 6 months . Improvement was assessed by using the visual analog scale ( VAS ) at 2 months and 6 months , and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives . The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit . Results : The VAS improvement in scars ranged from 10 to 50 % at the end of 2 months to 20 to 70 % at the end of 6 months . Of the 30 patients of acne scars , the cosmetic result was excellent ( > 60 % improvement ) in four , good ( 35–60 % improvement ) in 18 and moderate to poor ( < 35 % improvement ) in eight . A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment . The patients reported a pinkish tone for 2–3 days . Importantly , with the help of some slight make up , all the 30 patients could return to work the following day . Conclusion : Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars , because of the effective results coupled with a low downtime 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 Although effective as a monotherapy for the treatment of inflammatory acne , the 1,450-nm diode laser is associated with considerable pain at higher fluences . MATERIAL S AND METHODS Eleven subjects were treated with a 1,450-nm diode laser in a split-face bilateral paired acne study . One-half of the face received a single-pass consisting of stacked double pulses . The other side received a double-pass treatment of single pulses . Setting s were 11 J/cm2 or lower as tolerated with appropriate dynamic cooling device ( range 25–35 ) . RESULTS The mean pain rating was 5.33 on a 0 to 10 scale on the stacked – pulse treatment side and 5.12 on the double-pass side . Blinded reduction in mean acne lesion counts were 57.6 % and 49.8 % reduction , respectively . An overall acne scar improvement was seen in 83 % of subjects with acne scarring . Transient hyperpigmentation occurred in two patients on the stacked pulse side and completely resolved without sequelae . CONCLUSIONS The pulsed 1,450-nm diode laser can be used at lower fluences that elicit less discomfort yet effectively improve inflammatory acne . Stacking pulses appears to render a slightly higher efficacy than the multipass technique . Single-pulse , multiple-pass treatments may have a lower risk of cryogen-induced transient hyperpigmentation compared to st and ard high fluence techniques 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 BACKGROUND No studies have compared fractional microplasma radio frequency ( RF ) technology with the carbon dioxide fractional laser system ( CO2 FS ) in the treatment of atrophic acne scars in the same patient . OBJECTIVE To compare the efficacy and safety of fractional microplasma RF with CO2 FS in the treatment of atrophic acne scars . METHODS AND MATERIAL S Thirty‐three Asian patients received three sessions of a r and omized split‐face treatment of fractional microplasma RF or CO2 FS . RESULTS Both modalities had a roughly equivalent effect . Échelle d'Évaluation Clinique Des Cicatrices d'Acné scores were significantly lower after fractional microplasma RF ( from 51.1 ± 14.2 to 22.3 ± 8.6 , 56.4 % improvement ) and CO2 FS ( from 48.8 ± 15.1 to 19.9 ± 7.9 , 59.2 % improvement ) treatments . There was no statistically significant difference between the two therapies . Twelve subjects ( 36.4 % ) experienced postinflammatory hyperpigmentation ( PIH ) after 30 of 99 treatment sessions ( 30.3 % ) on the CO2 FS side and no PIH was observed on the fractional microplasma RF sides . CONCLUSION Both modalities have good effects on treating atrophic scars . PIH was not seen with the fractional microplasma RF , which might make it a better choice for patients with darker skin 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 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 OBJECTIVE Acne scarring is a common complication of acne but no effective single treatment modality has been developed . To compare the efficacy of 1,550 nm Er : Glass fractional laser and chemical reconstruction of skin scar ( CROSS ) method in the treatment of acne scars . STUDY DESIGN / MATERIAL S AND METHODS A split-face trial was conducted in 20 patients ( 10 rolling , 10 icepick types ) with acne scars . One side was treated with the 1,550 nm Er : Glass fractional laser three times with a 6-week interval . And the other side was treated with CROSS method two times every 12 weeks . RESULTS Significant improvement was observed in both sides of the face . In rolling type , the objective and subjective improvement rates were significantly higher in the sides treated with laser than CROSS method . However , in icepick type , there were no statistically significant differences between the two treatment sides . In the laser sides , grade s of pain were significantly higher than that of treated with CROSS method . However , downtimes and lasting days of erythema were significantly longer in the sides treated with CROSS method . CONCLUSION A 1,550 nm Er : Glass fractional laser and CROSS method are both well-tolerated and effective treatment options in the acne scars . However , there was a relatively small difference between the two treatment modalities . Therefore , dermatologists should consider the acne scar type to select the treatment options . Lasers Surg . Med . 41:545 - 549 , 2009 . ( c ) 2009 Wiley-Liss , BACKGROUND The 1550 nm Er : Glass fractional laser is widely used for the treatment of atrophic acne scar .  A novel fractional radiofrequency microneedle device has recently emerged as an alternative for treating acne scars . OBJECTIVES To evaluate the clinical efficacy and safety of a Er : Glass fractional laser and fractional radiofrequency microneedle device in the treatment of facial atrophic acne scars and to assess the difference between the treatment modalities depending on facial compartment . METHODS A total of 40 patients were equally r and omized into two groups . Each group of 20 patients received three treatments at 4-week interval using Er : Glass fractional laser or fractional radiofrequency microneedle device . RESULTS Scar severity scores ( ECCA grading scale ) improved by a mean of 25.0 % and 18.6 % in groups A and B , respectively ( both P < 0.01 ) . The difference in the degree of improvement was not statistically significant between the groups after three sessions of treatment . There were no significant side effects . CONCLUSION Atrophic acne scars improved in both groups without significant side effects . Additionally , the fractional laser was a more effective treatment option for acne scars , but the fractional radiofrequency microneedle device offered good adherence and short downtime BACKGROUND Ablative resurfacing lasers are effective for treatment of  acne scars , but they have a high risk of complications . Fractional lasers have less severe side effects but more moderate efficacy than ablative devices . Studies were performed in individuals with Fitzpatrick skin type I to VI . OBJECTIVE To determine the efficacy and safety of an erbium 1,550‐nm fractional laser in the treatment of facial acne scars in Fitzpatrick skin types IV to VI . METHODS We conducted a prospect i ve , single‐blind , r and omized trial in patients with acne scars ( n=15 ) , skin type IV to VI , with a 1,550‐nm erbium fractionated laser .  Patients were divided into two groups ; one was treated with 10 mJ and the other with 40 mJ. Five monthly laser sessions were performed . A patient question naire was distributed . RESULTS There was a significant improvement in the acne scarring and overall appearance ( p<.001 ) . No significant difference was found between 10 and 40 mJ. Patients were highly satisfied with their results . Significant postinflammatory hyperpigmentation was seen ; pain was significantly higher in darker skin . CONCLUSIONS Fractional photothermolysis is effective for the treatment of acne scars , but practition‐ers should be aware of the higher incidence of pain and postinflammatory hyperpigmentation in individuals with skin types IV to VI . The study was funded by Reliant Technologies , Inc. , which participated in the study design . Galderma ( Ft . Worth , TX ) provided Tri‐luma cream and GlaxoSmithKline ( Research Triangle Park , NC ) provided valacyclovir ( Valtrex ) 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 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 BACKGROUND Non-ablative methods have been attempted in treating atrophic facial scars , but the histologic findings do not always coincide with the clinical results and patient satisfaction . OBJECTIVE To study the effects and safety of the Nd : YAG laser for treating atrophic facial scars . MATERIAL AND METHODS Twelve subjects ( skin phototypes II-V ) with mild to moderate atrophic facial acne scars received five monthly treatments with 1,064 nm Nd : YAG laser and were photographed before , in the middle of , and 6 months after the last treatment . Histologic evaluations were performed on skin biopsies obtained before treatment and 1 month after the last session . Collagen quantification per area , before and after the treatment , was performed by morphometry , with computerized image analysis . Patient satisfaction and clinical condition were assessed using st and ard grading scales . RESULTS Mild to moderate clinical improvement was observed in most patients . Photographic assessment of scars found visible cosmetic improvement in eleven patients . All patients were satisfied . There were statistically significant collagen increases in the dermis following the treatment . Side effects were limited to mild transient erythema and increased skin sensitivity after the procedure . CONCLUSIONS The 1,064 nm Nd : YAG laser is a safe and effective nonablative method for improving atrophic scars , even in darker skin 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 OBJECTIVE This study evaluated the safety and efficacy of sublative fractional bipolar radiofrequency and bipolar radio frequency combined with diode laser for the treatment of both  superficial and deep acne scars in patients with skin types II to V. DESIGN Prospect i ve , single-center study . Subjects received up to five treatments with sublative fractional bipolar radiofrequency and bipolar radiofrequency combined with diode laser . Treatments were directed to at least two facial ( forehead , perioral , cheeks ) and /or neck areas with acne scars at four-week intervals . Treatment parameters on each subject were based on skin type and on skin responses to test spots on the target area just before treatment . SETTING Physician office . PARTICIPANTS Subjects ( n=20 , aged 40.7±10.5 years [ mean ± SD ] , skin types II-V ) with acne scars and without acne lesions enrolled in this prospect i ve study . MEASUREMENTS RESULTS were evaluated just before each treatment and at four and 12 weeks after the final treatment using the Goodman Scar Scale , a quantitative method of evaluating scars that attempts to reduce grading subjectivity , as well as by patient satisfaction . RESULTS Acne scars improved significantly one month after three treatments and improvement persisted for at least 12 weeks after the fifth treatment . Improvement was not affected by skin type . Adverse effects were limited to transient erythema and edema . CONCLUSION The combination of diode laser and bipolar radiofrequency energy device in addition to fractionated sublative radiofrequency is a safe and statistically significantly effective combined modality for the treatment of both superficial and deep acne scars in patients with skin types II to V with minimal downtime and no significant side effects 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 Several treatment modalities are used for the treatment of acne scars with variable results . Recent studies showed that fractional radiofrequency may be an effective treatment modality for acne scars . The objective of this study was to assess the efficacy , safety , tolerability and patient satisfaction of fractional bipolar radiofrequency ( RF ) , the eTwo ™ system ( Syneron C and ela Ltd. , Yokneam , Israel ) for treating acne scars . Twelve patients with moderate to severe acne scars received 3–5 treatments with the Sublative fractionated bipolar RF applicator of the eTwo device at 1‐month intervals . Patients were evaluated clinical ly and photographically at each visit and 3 months after the final treatment . Very good improvement ( at least one scale ) was seen after completing the five treatments . The patient satisfaction survey ( Global Aesthetic Improvement Scale scores ) revealed that half ( 6 out of 12 ) of the patients reported to be satisfied with treatment results , while the other half reported to be very satisfied . Beyond the expected erythema and minimal scab formation in the treated areas , which was mild and transient , none of the participants reported any adverse events . The data presented here support the high efficacy and safety of fractionated bipolar RF for the aesthetic improvement of moderate to severe acne  scars 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 BACKGROUND There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes ( SPT ) IV to VI . OBJECTIVE To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI . METHODS AND MATERIAL S The authors conducted a r and omized , 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 setting s and the same fluence . RESULTS 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 . CONCLUSION 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 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 A proposal has recently been made regarding the potential adjuvant use of platelet‐rich plasma ( PRP ) with fractional carbon dioxide laser ( FCL ) for the correction of acne scars . OBJECTIVE To compare the efficacy and safety of two administration modes of autologous PRP ( intradermal injection ( ID ) and topical application ) after FCL with that of FCL alone in the treatment of atrophic acne scars . PATIENTS AND METHODS Thirty patients were r and omly divided into two groups . Both underwent split‐face therapy . Group 1 was administered FCL followed by ID PRP on one side and FCL followed by ID saline on the other . In group 2 , one cheek was treated with FCL followed by ID PRP , and the other received FCL followed by topical PRP . Each patient received 3 monthly sessions . The final assessment took place at 6 months . RESULTS Combined PRP‐ and FCL‐treated areas had a significantly better response ( p = .03 ) , fewer side effects , and shorter downtime ( p = .02 ) than FCL‐treated areas , but there were no significant differences in ID‐ and topical PRP – treated areas in degree of response and downtime ( p = .10 ) ; topically treated areas had significantly lower pain scores . CONCLUSION The current study introduces the combination of topical PRP and FCL as an effective , safe modality in the treatment of atrophic acne scars with shorter downtime than FCL alone and better tolerability than FCL combined with ID PRP 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
target: 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 .
background: 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 .