Fractional ablative CO2 laser treatment versus scar subcision and autologous fat transfer in the treatment of atrophic acne scars: New technique

Abstract - 1347 PDF - 1018
Laila Mohammad, Lamia H Elgarhy, Dina Saad, Walid Mostafa

Abstract


There are different modalities for management of atrophic acne scars which include lasers. Ablative fractional CO2 laser was developed to address the shortcomings of traditional ablative lasers, with superior results to non-ablative fractional lasers. Autologous fat transfer has been utilized for nearly a decade in tissue augmentation and reconstruction. Present studies were designed to compare ablative fractional CO2 laser treatment with scar subcision and autologous fat transfer in the treatment of atrophic acne scars. 20 patients with atrophic acne scars were recruited: 10 patients were treated by three sessions of ablative fractional CO2 laser therapy, and 10 patients treated by subcision and autologous fat transfer. All patients were followed up for three months, and were assessed by digital photograph before and after treatment through the application of Goodman and Baron quantitative and qualitative grading systems, in addition to reports by three physicians committees and reports of patients’ satisfaction. Analysis of both groups showed significant improvements in all types of atrophic acne scars. The mean percentage of total quantitative improvement was more significant in the case of autologous fat transfer with regard to ice-pick and total number of scars. Therefore, scar subcision with autologous fat transfer proved to be as effective as, or even more effective than, ablative fractional CO2 laser in the treatment of atrophic acne scars with regard to the total number of scars as well as ice-pick type.


Keywords


Acne scars; laser; fat transfer

Full Text:

PDF

References


Goodman GJ. Post acne scarring: A review. J Cosmet Laser Ther 2003; 5(2): 77–95. doi: 10.1080/14764170310001258.

Alam M, Dover JS. Treatment of acne scarring. Skin Therapy Lett 2006; 11(10): 7–9.

Landau M. Chemical peels. Clin Dermatol 2008; 26(2): 200–208. doi: 10.1016/j.clindermatol.2007.09.012.

Goodman GJ. Commentary: Subcision versus 100% tri-chloroacetic acid in the treatment of rolling acne scars. Dermatol Surg 2011; 37(5): 634–636. doi: 10.1111/j.1524- 4725.2011.01955.x.

Kadunc BV, de Almeida ART. Surgical treatment of facial acne scars based on morphologic classification: A Brazilian experience. Dermatol Surg 2003; 29(12): 1200–1209. doi: 10.1111/j.1524-4725.2003.29388.x.

Alkhawam L, Alam M. Dermabrasion and microdermabra-sion. Facial Plast Surg 2009; 25(5): 301–310. doi: 10.1055/ s-0029-1243078.

Alster T, Zaulyanov-Scanlon L. Laser scar revision: A review. Dermatol Surg 2007; 33(2): 131–140. doi: 10.1111/j. 1524-4725.2006.33030.x.

Goodman GJ. Management of post-acne scarring. What are the options for treatment? Am J Clin Dermatol 2000; 1(1): 3–17. doi: 10.2165/00128071-200001010-00001.

Hantash BM, Bedi VP, Kapadia B, Rahman Z, Jiang K, et al. In vivo histological evaluation of a novel ablative frac-tional resurfacing device. Lasers Surg Med 2007; 39(2): 96–107. doi: 10.1002/lsm.20468.

Hantash BM, Bedi VP, Chan KF, Zachary CB. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med 2007; 39(2): 87–95. doi: 10.1002/lsm.20405.

Graber EM, Tanzi EL, Alster TS. Side effects and compli-cations of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg 2008; 34(3): 301–307. doi: 10.1111/j.1524-4725.2007.34062.x.

Tsao SS, Dover JS, Arndt KA, Kaminer MS. Scar man-agement: Keloid, hypertrophic, atrophic, and acne scars. Semin Cutan Med Surg 2002; 21(1): 46–75. doi: 10.1016/ S1085-5629(02)80719-2.

Goodman GJ, Baron JA. The management of postacne scarring. Dermatol Surg 2007; 33(10): 1175–1188. doi: 10.1111/j.1524-4725.2007.33252.x.

Coleman SR. Structural fat grafting: More than a perma-nent filler. Plast Reconstr Surg 2006; 118(3 Suppl): 108S– 120S. doi: 10.1097/01.prs.0000234610.81672.e7.

Markey AC, Glogau RG. Autologous fat grafting: compar-ison of techniques. Dermatol Surg 2000; 26(12): 1135– 1139. doi: 10.1046/j.1524-4725.2000.00274.x.

Rigotti G, Marchi A, Galiè M, Baroni G, Benati D, et al. Clinical treatment of radiotherapy tissue damage by lipoas-pirate transplant: a healing process mediated by adipose- derived adult stem cells. Plast Reconstr Surg 2007; 119(5): 1409–1422. doi: 10.1097/01.prs.0000256047.47909.71.

Goodman GJ, Baron JA. Postacne scarring: A qualitative global scarring grading system. Dermatol Surg 2006; 32 (12): 1458–1466. doi: 10.1111/j.1524-4725.2006. 32354.x.

Goodman GJ, Baron JA. Postacne scarring – A quantitative global scarring grading system. J Cosmet Dermatol 2006; 5(1): 48–52. doi: 10.1111/j.1473-2165.2006.00222.x.

Majid I. Microneedling therapy in atrophic facial scars: An objective assessment. J Cutan Aesthet Surg 2009; 2(1): 26–30. doi: 10.4103/0974-2077.53096.

Shoshani O, Ullmann Y, Shupak A, Ramon Y, Gilhar A, et al. The role of frozen storage in preserving adipose tissue obtained by suction-assisted lipectomy for repeated fat in-jection procedures. Dermatol Surg 2001; 27(7): 645–647. doi: 10.1046/j.1524-4725.2001.00146.x.

Hunzeker CM, Weiss ET, Geronemus RG. Fractionated CO2 laser resurfacing: Our experience with more than 2000 treatments. Aesthet Surg J 2009; 29(4): 317–322. doi: 10.1016/j.asj.2009.05.004.

Brightman LA, Brauer JA, Anolik R, Weiss E, Karen J, et al. Ablative and fractional ablative lasers. Dermatol Clin 2009; 27(4): 479–489, vi-vii. doi: 10.1016/j.det.2009.08. 009.

Azzam OA, Atta AT, Sobhi RM, Mostafa PI. Fractional CO2 laser treatment vs. autologous fat transfer in the treat-ment of acne scars: A comparative study. J Drugs Dermatol 2013; 12(1): e7–e13.

The American Academy of Dermatology. Guidelines of care for soft tissue augmentation: Collagen implants. J Am Acad Dermatol 1996; 34(4): 698–702. doi: 10.1016/S0190- 9622(96)80091-0.

Donofrio LM. Panfacial volume restoration with fat. Der-matol Surg 2005; 31(Suppl 4): 1496–1505. doi: 10.2310/ 6350.2005.31234.

Guerrerosantos J. Long-term outcome of autologous fat transplantation in aesthetic facial recontouring: Sixteen years of experience with 1936 cases. Clin Plast Surg 2000; 27(4): 515–543.

Butterwick KJ. Lipoaugmentation for aging hands: A comparison of the longevity and aesthetic results of centri-fuged versus noncentrifuged fat. Dermatol Surg 2002; 28(11): 987–991. doi: 10.1046/j.1524-4725.2002.02096.x.

Sommer B, Sattler G. Current concepts of fat graft survival: Histology of aspirated adipose tissue and review of the lit-erature. Dermatol Surg 2000; 26(12): 1159–1166. doi: 10.1046/j.1524-4725.2000.00278.x.

Donofrio LM. Structural autologous lipoaugmentation: a pan-facial technique. Dermatol Surg 2000; 26(12): 1129– 1134. doi: 10.1046/j.1524-4725.2000.t01-1-00273.x.

de Benito J, Fernández I, Nanda V. Treatment of depressed scars with a dissecting cannula and an autologous fat graft. Aesthetic Plast Surg 1999; 23(5): 367–370. doi: 10.1007/ s002669900301.

Jeong JH. Adipose stem cells and skin repair. Curr Stem Cell Res Ther 2010; 5(2): 137–140. doi: 10.2174/1574-888¬10791268690.

Chapas AM, Brightman L, Sukal S, Hale E, Daniel D, et al. Successful treatment of acneiform scarring with CO2 abla-tive fractional resurfacing. Lasers Surg Med 2008; 40(6): 381–386. doi: 10.1002/lsm.20659.

Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R. Efficacy and safety of a carbon-dio¬xide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol 2010; 63(2): 274–283. doi: 10.1016/j.jaad.2009. 08.051.

Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, et al. The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 2009; 35(12): 1955–1961. doi: 10.1111/j.1524-4725.2009.01316. x.

Mojallal A, Lequeux C, Shipkov C, Breton P, Foyatier JL, et al. Improvement of skin quality after fat grafting: Clinical observation and an animal study. Plast Reconstr Surg. 2009; 124(3): 765–774. doi: 10.1097/PRS.0b013e3181b 17b8f.

Coleman WP 3rd. Fat transplantation. Facial Plast Surg Clin North Am 2008; 16(4): 451–458. doi: 10.1016/j.fsc. 2008.09.001.


Refbacks

  • There are currently no refbacks.