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Attia E. Atrophic Postacne Scar Treatment: Narrative Review. JMIR DERMATOLOGY 2024; 7:e49954. [PMID: 38381492 PMCID: PMC10918545 DOI: 10.2196/49954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/16/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.
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Affiliation(s)
- Enas Attia
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Dermatology, Ain Al Khaleej Hospital, Abu Dhabi, United Arab Emirates
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2
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Lobo Y, Lim DS. Surgical Subcision for Acne Scars: A Review of Instrumentation. Dermatol Surg 2023; 49:355-362. [PMID: 36943759 DOI: 10.1097/dss.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Subcision is a surgical technique for managing atrophic acne scars. Over time, new instruments have emerged to increase the efficiency, efficacy, and safety of the subcision procedure, including sharp, blunt, and energy-assisted devices. OBJECTIVE To review the instrumentation used for the subcision of acne scars and to provide clinicians with practical information regarding the selection of instrumentation, with a focus on advantages and disadvantages. METHODS A search of PubMed, MEDLINE, and Google Scholar was conducted for articles from January 2000 to June 2022 describing the use of subcision alone for the management of acne scarring. Demographic and clinical data were collected from the included articles. RESULTS A total of 417 patients from 17 articles were included; 155 patients underwent sharp subcision, 235 patients underwent blunt subcision, and 27 patients underwent energy-assisted subcision. The main indication for subcision was atrophic facial acne scars. Subcision using sharp, blunt, and energy-assisted instruments were all effective in treating atrophic acne scars. Adverse effects common to all subcision methods included erythema and edema. CONCLUSION Subcision is a safe and effective modality for the revision of selected acne scars and is a valuable skill set for dermatologists who perform scar revision to master.
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Affiliation(s)
- Yolanka Lobo
- Department of Dermatology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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3
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Vempati A, Zhou C, Tam C, Khong J, Rubanowitz A, Tam K, Hazany S, Vasilev R, Hazany S. Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments. Clin Cosmet Investig Dermatol 2023; 16:125-134. [PMID: 36698445 PMCID: PMC9868281 DOI: 10.2147/ccid.s397888] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
Subcutaneous incisionless surgery, also known as subcision, is a minimally invasive procedure that is commonly indicated for the treatment of atrophic acne scars. In recent years, many new techniques have been developed to maximize results from this procedure. This review article aims to identify an updated list of instruments and combinatorial treatments available for atrophic acne scar patients undergoing subcision. We constructed a comprehensive PubMed search term and performed triple-blinded screening on all resulting studies for mentions of subcision as indicated by acne scarring. Our results show that there are four main categories of subcision tools that are commonly employed to treat atrophic acne scars: needles, cannulas, wires, and blunt-blade instruments. Usage of these devices varies by scar depth, personal preference, and combinatorial treatment options. Overall, subcision is a particularly effective treatment for atrophic acne scars, and there is vast potential for further innovation with this technique.
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Affiliation(s)
- Abhinav Vempati
- Scar Healing Institute, Los Angeles, CA, USA,Correspondence: Abhinav Vempati, Scar Healing Institute, Los Angeles, CA, USA, Tel +1 424 225 2453, Fax +1 310 571 8435, Email
| | | | - Curtis Tam
- Scar Healing Institute, Los Angeles, CA, USA
| | - Jeffrey Khong
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kevin Tam
- Scar Healing Institute, Los Angeles, CA, USA
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4
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Roohaninasab M, Seifadini A, Atefi N, Sadeghzadeh-Bazargan A, Goodarzi A, Hanifnia AR, Nouri M, Zare S, Moradi S, Dehghani A, Nilforoushzadeh MA, Behrangi E. Evaluating the effectiveness of stromal-vascular fraction (SVF) cells along with subcision method in the treatment of acne scars: A double-blind randomized controlled clinical trial study. J Cosmet Dermatol 2022; 21:6928-6938. [PMID: 36086927 DOI: 10.1111/jocd.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Subcision method is one of the main techniques for treatment of acne scars or stromal-vascular fraction (SVF) and combined therapy can improve treatment strategy. OBJECTIVE To use subcision method along with SVF for treatment of acne scar and comprised with alone subcision method. MATERIALS AND METHODS In this double-blind clinical trial study, 10 patients with acne scars were entered into the study. Subcision technique was randomly performed on one side of the face and subcision technique plus SVF on opposite side of the face. All patients were examined before treatment and after 3 months by Visioface for volume, area, and depth of scars, as well as thickness and density of the epidermis and dermis of the scars in question. In addition, doctor's and patients' satisfaction, tolerability, and safety were determined after 3 months of treatment. Finally, statistical analysis was done by SPPS, version 25. RESULTS In terms of volume and area of scars, the mean percent change was 46.55 ± 13.92 and 44.60 ± 5.76, for the case group, and 13.31 ± 9.27 and 11.28 ± 9.64 for the control group, respectively. So, combined therapy led to significant recovery compared with alone subcision method (p value < 0.001). In both interventions, the increase of density and thickness was proven after treatment, also a significant difference in complete, epidermal, and dermal thickness and epidermal density variables was observed between combined therapy and alone subcision (p value < 0.05). Mean score of doctor's and patients' satisfaction in combined therapy (7.10 ± 0.74 and 7.10 ± 0.99, respectively), was also significantly higher than subcision alone (5.50 ± 0.53 and 5.30 ± 1.25, respectively). Finally, no complications were observed in the patients. CONCLUSION According to the acquired results, combined therapy can be considered as effective and safe treatment for acne scars with significant higher efficacy compared with subcision alone.
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Affiliation(s)
- Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Seifadini
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghzadeh-Bazargan
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Hanifnia
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Zare
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Center, Sharif University of Technology, Tehran, Iran
| | - Sepideh Moradi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Dehghani
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Skin Repair Research Center, Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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Tsao SB, Wu CC, Lee CC. Purse-string suture combined with subcision and dermal graft for the treatment of wide depressed scars and boxcars. J Cosmet Dermatol 2022; 21:5969-5976. [PMID: 35984570 DOI: 10.1111/jocd.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dermal layer injuries can result in depressed or indented scars even when there is no subcutaneous injury. These scars can result from acne, chickenpox, trauma, or skin infection. Several procedures, including primary closure, subcision, microneedling, and dermal grafting, have been reported to be used to treat depressed scars, boxcars, or acne cosmetics. These procedures have not, however, been shown to be very effective when applied to the treatment of deep depressed scars, boxcars, or acne cosmetics. In this retrospective study, we assessed scar improvement in patients with deep depressed facial scars and boxcars treated with our novel combination of techniques. METHODS This study included all patients treated for deep depressed scars and boxcars at our clinic from 2018 to 2021. To be included, patients had to present in our clinic for the treatment of deep depressed scars or boxcars, have no prominent subcutaneous layer injury, and have full set of clear pre-and post-procedure photographs. All patients initially received technique combination including scar subcision, inner purse-string suturing, and dermal grafting for the first stage surgery treatment. In cases of residual uneven superficial scars, laser dermabrasion resurfacing was used as second-staged treatment. Preoperative and six-month postoperative scar appearance photographs were assessed for improvement by our three nonmedical staff members and divided into four improvement groups, as minimal, moderate, good, and excellent. RESULTS This study included a total of 24 patients (20 females and four males) with facial scarring. Two patients (8.3%) had moderate, 13 (54.2%) good and nine (37.5%) excellent improvement post-treatment. There were no instances of minimal improvement. Four patients received second stage laser dermabrasion resurfacing for residual uneven superficial scars. CONCLUSION We concluded deep depressed scars and boxcars can be easily, safely, and effectively treated using our novel combined scar subcision, inner purse-string suturing, and dermal grafting treatment with possible second-staged laser dermabrasion, and without major complications.
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Affiliation(s)
- Su-Ben Tsao
- Dr. Tsao's Clinic of Plastic Surgery, Kaohsiung, Taiwan
| | - Cheng-Chun Wu
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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6
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Drozhdina MB, Bobro VA, Sennikova YA, Kornilova EI. Post-acne symptom complex. Approaches to therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.
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7
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Nilforoushzadeh MA, Heidari‐Kharaji M, Alavi S, Nouri M, Zare S, Mahmoudbeyk M, Peyrovan A, Sadati AS, Behrangi E. Acne scar treatment using combination therapy; subcision and human autologous fibroblast injection. J Cosmet Dermatol 2022; 21:4677-4683. [DOI: 10.1111/jocd.14988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
- Jordan Dermatology and Hair Transplantation Center Tehran Iran
| | - Maryam Heidari‐Kharaji
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
- Jordan Dermatology and Hair Transplantation Center Tehran Iran
- Institut National de la Recherche Scientifique (INRS)‐Centre Armand‐Frappier Santé Biotechnologie (CAFSB) Laval Quebec Canada
| | - Shiva Alavi
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Sona Zare
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Mona Mahmoudbeyk
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Aisan Peyrovan
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Ashraf Sadat Sadati
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran IR Iran
| | - Elham Behrangi
- Department of Dermatology Rasool Akram Medical Complex Research Development Center (RCRDC) Iran University of Medical Sciences (IUMS) Thran Iran
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8
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Tam C, Khong J, Tam K, Vasilev R, Wu W, Hazany S. A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring. Clin Cosmet Investig Dermatol 2022; 15:455-469. [PMID: 35359828 PMCID: PMC8963193 DOI: 10.2147/ccid.s350040] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.
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Affiliation(s)
- Curtis Tam
- Salar Hazany M.D. Inc, Beverly Hills, CA, USA
| | | | - Kevin Tam
- Salar Hazany M.D. Inc, Beverly Hills, CA, USA
| | | | - Wesley Wu
- Department of Dermatology, Veterans Affairs Medical Center, Seattle, WA, USA
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9
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Mohammed GF, Al‐Dhubaibi MS. Triple steps acne scar revision technique a new combination therapeutic modality for atrophic acne scars. J Cosmet Dermatol 2022; 21:4659-4668. [DOI: 10.1111/jocd.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ghada F. Mohammed
- Department of Dermatology and Venereology Faculty of Medicine Suez Canal University Ismailia Egypt
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10
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Ebrahim HM, Nassar A, ElKashishy K, Artima AYM, Morsi HM. A combined approach of subcision with either cross-linked hyaluronic acid or threads in the treatment of atrophic acne scars. J Cosmet Dermatol 2021; 21:3334-3342. [PMID: 34927342 DOI: 10.1111/jocd.14675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acne scars are one of the most common cosmetic concerns causing psychosocial distress. OBJECTIVE To evaluate the efficacy of subcision versus its combination with either cross-linked hyaluronic acid (HA) or poly-l-lactic acid (PLLA) threads in the treatment of atrophic post-acne scars. METHODS Forty patients of both genders with atrophic acne scars were subjected to subcision 1 month apart for 3 sessions. After the last session of subcision, the patients were reclassified randomly into 2 equal groups each received either HA or threads in one side of the face leaving the other side that underwent subcision before as a control. Clinical assessment was carried out by the physicians and patients. Photographs and skin biopsies were obtained. Follow-up was 6 months. RESULTS A significant clinical improvement was achieved in 67.3% of patients after subcision alone compared to 94.1%, 82.4% of subcision combined with HA or threads, respectively. Patients' satisfaction was higher in the combined groups compared to subcision alone (p < 0.0001). Side effects were tolerable and transient. CONCLUSION Subcision combined with HA or threads could offer a higher significant clinical improvement of acne scars than subcision alone.
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Affiliation(s)
- Howyda M Ebrahim
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Nassar
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Kamal ElKashishy
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Hala Mohamed Morsi
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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11
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Liu Y, Li Z, Hu J, Wang M, Qu C, Wu H, Su X, Wang L. Treatment of nasal depressed scars using micro-plasma radiofrequency technology combined with subcision. J Cosmet Dermatol 2021; 21:2458-2462. [PMID: 34496123 DOI: 10.1111/jocd.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The nose is located in the middle of the face; therefore, nasal scarring will bring a significant psychological impact on patients. Although there are many treatment methods for depressed scars, these methods have varying degrees of efficacy and all carry certain adverse effects. A better treatment method is urgent to be found. In this study, the effect of micro-plasma radiofrequency technology combined with subcision to treat nasal depressed scars is evaluated. METHODS 18 Chinese patients with nasal depressed scars participated in this study. All patients received one session of micro-plasma radiofrequency treatment first. 2 months later, subcision combined with micro-plasma radiofrequency technology was performed on them at 6-month intervals, and a total of 2 sessions of combined treatment were performed. Goodman and Baron Scale was used to evaluate nasal scars before treatment and 6 months after the final session. RESULTS All 18 patients in this study had Grade 4 nasal scars before treatment. 6 months after the end of treatment, 13 patients (72.2%) showed excellent or near total improvement, and 5 patients (27.8%) showed marked improvement. No adverse side effects were observed during treatment. Patient self-evaluation indicated that all patients were satisfied with the cosmetic outcomes. CONCLUSIONS In this study, we explored a new treatment method for nasal depressed scars. We used micro-plasma radiofrequency technology combined with subcision to treat nasal depressed scars and obtained relatively satisfactory results with no adverse effects.
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Affiliation(s)
- Yue Liu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zehui Li
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Wang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunan Qu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanhuan Wu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lianzhao Wang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Kaur M, Sharma VK, Sethuraman G, Arava S, Gupta S. A split-face randomized controlled study comparing the efficacy and safety of intralesional radiofrequency-assisted subcision vs conventional subcision in postacne scars. J Cosmet Dermatol 2020; 19:1086-1092. [PMID: 32233007 DOI: 10.1111/jocd.13384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postacne scars have significant psychosocial distress among patients. Subcision is a well-known treatment modality specially for rolling type of acne scars, but is a crude mechanical process, which carries a risk of hematoma formation. AIMS To compare the efficacy and safety of radiofrequency-assisted subcision (rSubcision) with conventional subcision in postacne scars. METHODS In this randomized, split-face study, adult patients with postacne scars were randomized to receive either conventional subcision or rSubcision in 2 sessions, 4 weeks apart and followed up for 2 months. Outcome was measured using Goodman and Baron score (GBS), investigator global assessment (IGA) by two blinded dermatologists, and patient global assessment (PGA). RESULTS Seventeen out of 21 patients completed the treatment. Statistical analysis of the results was performed using SPSS 15.0 statistical software (SPSS). Patients in both the groups had significant improvement from baseline according to quantitative scoring (P = .0001), number of scars (P = .0001), IGA, and PGA. The improvement was comparable in both the groups according to GBS and IGA but better on rSubcision side in terms of PGA. Two patients developed small entry point burn during rSubcision which healed in one month and one developed persistent hematoma with conventional subcision. CONCLUSIONS Both modalities were comparable in terms of assessment scores and investigator assessment, but patients found improvement better on rSubcision side.
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Affiliation(s)
- Maninder Kaur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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13
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Dadkhahfar S, Robati RM, Gheisari M, Moravvej H. Subcision: Indications, adverse reactions, and pearls. J Cosmet Dermatol 2020; 19:1029-1038. [PMID: 31990113 DOI: 10.1111/jocd.13308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subcision, also known as subcutaneous incisionless surgery, is a surgical intervention used to treat a variety of skin conditions including atrophic acne scars, depressed scars, cellulite, and wrinkles. AIMS We plan to prepare a review article about the indications of subcision, its adverse reactions, and pearls. PATIENTS/METHODS We searched the literature for the information about subcision and its applications from papers published up to March 2019. The search was performed through the databases of the National Library of Medicine. RESULTS After a thorough review of the published papers about subcision, we finally chose to review 40 articles that had proper sample size and design to prepare this review article. Twenty-one papers were related to the application of subcision in the treatment of acne scar and other scars. Four articles were about the application of subcision to treat cellulite, and eight articles were related to other applications of subcision such as the treatment of striae or nasolabial fold. The remaining seven articles include published review papers about subcision or acne scar classification. CONCLUSION Subcision seems to be effective on various skin conditions including acne scar, other depressed scars, and cellulite. It is easy to apply and inexpensive with short downtime and no significant complications. Subcision needs proper technique and adequate experience.
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Affiliation(s)
- Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ibrahim ZA, Elgarhy LH. Evaluation of PSP technique including dot peeling, subcision and intradermal injection of PRP in the treatment of atrophic post-acne scars. Dermatol Ther 2019; 32:e13067. [PMID: 31414709 DOI: 10.1111/dth.13067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic post-acne scars are common complications of acne. Many modalities are proposed, but each does not yield satisfactory clinical outcomes. To evaluate the therapeutic effect of PSP technique including dot peeling, subcision and intradermal injection of autologous platelet-rich plasma (PRP) for the treatment of atrophic post-acne scars. PATIENTS AND METHODS Twenty patients with different types of atrophic acne scars on the face were included. All patients received PSP technique in the form of dot peeling, then after 2 weeks, subcision and intradermal PRP injection were done simultaneously. PSP technique was performed for each patient every month for 3 months. RESULTS After 3 months of the last session, 30% of 20 patients had excellent improvement, 20% of patients had good improvement, 20% of patients had moderate improvement, and 30% of patients had mild improvement. There was statistically significant difference after treatment (p ≤ .001). Side effects were mild and tolerable and included erythema, ecchymosis, and hyperpigmentation. All types of scars showed significant improvement with no significant difference between them. CONCLUSION PSP technique was found to be a safe and cost-effective treatment option for atrophic acne scars.
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Affiliation(s)
- Zeinab A Ibrahim
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Lamia H Elgarhy
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
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15
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Nilforoushzadeh MA, Lotfi E, Heidari-Kharaji M, Nickhah N, Alavi S, Mahmoudbeyk M. Comparing cannula-based subcision with the common needle method: A clinical trial. Skin Res Technol 2019; 26:39-44. [PMID: 31373077 DOI: 10.1111/srt.12761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Abstract
OF TRIAL DESIGN Treatment of depressed acne scars requires multiple modalities. Although needle subcision is a valuable method, it exhibits mild to moderate efficacy in treatment of deep acne scars owing to the high recurrence rate and other side effects. A total of 100 patients with rolling acne scars were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision in two parallel groups, and the effect of cannula subcision instead of needle subcision was evaluated in the treatment of rolling acne scars. METHODS A total of 100 patients were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision. The outcomes of these procedures were assessed by three blinded dermatologists and by patients' satisfaction. RESULTS Subcision using the cannula showed good and very good improvement in about 83% of patients (n = 50, P < .05) based on dermatologists investigation and almost no side effects were observed in compared with needle subcision. The response rate was significantly different while using cannula subcision. CONCLUSION Cannula subcision appears to be a safe and practical technique that can enhance the efficacy of subcision without considerable complications.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Lotfi
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Maryam Heidari-Kharaji
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Nahid Nickhah
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Alavi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Mahmoudbeyk
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
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16
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Hassan AS, El‐Hawary MS, Abdel Raheem HM, Abdallah SH, El‐Komy MM. Treatment of atrophic acne scars using autologous platelet‐rich plasma vs combined subcision and autologous platelet‐rich plasma: A split‐face comparative study. J Cosmet Dermatol 2019; 19:456-461. [DOI: 10.1111/jocd.13048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Akmal Saad Hassan
- Department of Dermatology, Faculty of Medicine Cairo University Cairo Egypt
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Asilian A, Faghihi G, Asemi Esfahani A, Mokhtari F, Nilforoushzadeh M, Mozafarpoor S. Comparison of two methods of subcision Nokor and blunt blade in acne scars treatment. J Cosmet Dermatol 2019; 18:1788-1793. [PMID: 31102320 DOI: 10.1111/jocd.12981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/09/2019] [Accepted: 03/22/2019] [Indexed: 11/27/2022]
Abstract
CONTEXT Subcision is a simple surgical method that can be effective in treatment of acne scars. AIMS This study was conducted to evaluate and compare the two methods of Nokor needle and blunt blade (BB) subcision in treatment of acne scars. SETTINGS AND DESIGN This clinical trial study was conducted on 28 patients with acne scars. PATIENTS AND METHODS One side of the face was treated with BB subcision method, and the other side was treated with Nokor needle method. Followed up period was 6 months after treatment. STATISTICAL ANALYSIS USED Data were analyzed by Statistical Package for the Social Sciences (version 20) software using independent sample t test, Mann-Whitney test, Friedman test, and Fisher's exact test. RESULTS In follow-up period, the improvement of acne scars was comparable in both groups (P > 0.05). Complications were lower in BB method than another method (P < 0.05). The patient satisfaction was higher in BB method (P < 0.05). CONCLUSIONS Both of modalities offered similar improvement, but the complication rate was lower and the patient satisfaction was also higher in the BB method than another method.
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Affiliation(s)
- Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gita Faghihi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Asemi Esfahani
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mokhtari
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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Fagien S, Bertucci V, von Grote E, Mashburn JH. Rheologic and Physicochemical Properties Used to Differentiate Injectable Hyaluronic Acid Filler Products. Plast Reconstr Surg 2019; 143:707e-720e. [PMID: 30921116 PMCID: PMC7597953 DOI: 10.1097/prs.0000000000005429] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injectable hyaluronic acid fillers are routinely used for correction of soft-tissue volume loss and facial rejuvenation. Product differentiation has primarily been based on the rheologic parameter known as elastic modulus (G'), although other physicochemical properties are being explored to characterize potential product performance. As clinical data regarding product performance are lacking, the practical experience of injectors provides a valuable bridge in the knowledge gap between product rheologic data and product use. METHODS Rheologic and physicochemical measurements (swelling factor and cohesion) were collected for 18 products. To observe the impact of G' and hyaluronic acid concentration on swelling factor and cohesion, proportional relationships were evaluated. Contributing authors were queried regarding their G'-based selection of products when considering skin quality, degree of correction, injection depth, and anatomical location. RESULTS Relationships were observable between G' and swelling factor and G' and cohesion only when limited to products manufactured by the same crosslinking technology and the same concentration. No relationship between isolated hyaluronic acid concentration and swelling factor or cohesion was apparent. Although rheological parameters and the assumptions of ex vivo data translating to in vivo performance are oftentimes not completely aligned, in the clinical experience of the authors, in general, higher G' products are better suited for thicker skin and deeper injection planes, whereas lower G' products are better for more superficial planes, although exceptions to these trends are also made based on technical experience. CONCLUSIONS While rheologic and physicochemical characteristics can vary widely between products and the methods and measurements of these parameters are often difficult to correlate, G' represents a useful and consistent parameter for product differentiation. Understanding how to select products based on G' is valuable knowledge for customizing injection plans and contributes to an optimal aesthetic outcome.
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Affiliation(s)
- Steven Fagien
- From private practice; the Division of Dermatology, University of
Toronto and private practice; and Galderma Laboratories, L.P
| | - Vince Bertucci
- From private practice; the Division of Dermatology, University of
Toronto and private practice; and Galderma Laboratories, L.P
| | - Erika von Grote
- From private practice; the Division of Dermatology, University of
Toronto and private practice; and Galderma Laboratories, L.P
| | - Jay H. Mashburn
- From private practice; the Division of Dermatology, University of
Toronto and private practice; and Galderma Laboratories, L.P
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19
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Arsiwala SZ, Desai SR. Fractional Carbon Dioxide Laser: Optimizing Treatment Outcomes for Pigmented Atrophic Acne Scars in Skin of Color. J Cutan Aesthet Surg 2019; 12:85-94. [PMID: 31413476 PMCID: PMC6676816 DOI: 10.4103/jcas.jcas_171_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.
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Affiliation(s)
- Shehnaz Z Arsiwala
- Renewderm-Skin Hair Lasers Aesthetics Centre, Mumbai, Maharashtra, India
| | - Swasti R Desai
- Consultant dermatologist, Janta hospital, Surat, Gujarat, India
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20
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McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.
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Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
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21
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Nilforoushzadeh MA, Faghihi G, Jaffary F, Haftbaradaran E, Hoseini SM, Mazaheri N. Fractional Carbon Dioxide Laser and its Combination with Subcision in Improving Atrophic Acne Scars. Adv Biomed Res 2017; 6:20. [PMID: 28349023 PMCID: PMC5353774 DOI: 10.4103/2277-9175.201332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Acne is a very common skin disease in which scars are seen in 95% of the patients. Although numerous treatments have been recommended, researchers are still searching for a single modality to treat the complication due to its variety in shape and depth. We compared the effects of fractional carbon dioxide (CO2) laser alone and in combination with subcision in the treatment of atrophic acne scars. Materials and Methods: This clinical trial study was performed in Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran) during 2011–2012. Eligible patients with atrophic acne scars were treated with fractional CO2 laser alone (five sessions with 3-week interval) on the right side of the face and fractional CO2 laser plus subcision (one session using both with four sessions of fractional CO2 laser, with 3-week interval) on the left side. The subjects were visited 1, 2, and 6 months after the treatment. Patient satisfaction rate was analyzed using SPSS 20 software. Results: The average of recovery rate was 54.7% using the combination method and 43.0% using laser alone (P < 0.001). The mean patient satisfaction was significantly higher with the combination method than laser alone (6.6 ± 1.2 vs. 5.2 ± 1.8; P < 0.001). Bruising was only seen with the combination method and lasted for 1 week in 57.0% and for 2 weeks in 43.0%. Erythema was seen in both methods. Postinflammatory pigmentation and hyperpigmentation were associated with combination method. No persistent side effects were seen after 6 months. Conclusion: Using a combination of subcision and laser had suitable results regarding scar recovery and satisfaction rate.
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Affiliation(s)
| | - Gita Faghihi
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Jaffary
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Haftbaradaran
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hoseini
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Mazaheri
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Abdel Hay R, Shalaby K, Zaher H, Hafez V, Chi C, Dimitri S, Nabhan AF, Layton AM. Interventions for acne scars. Cochrane Database Syst Rev 2016; 4:CD011946. [PMID: 27038134 PMCID: PMC7069546 DOI: 10.1002/14651858.cd011946.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. OBJECTIVES To assess the effects of interventions for treating acne scars. SEARCH METHODS We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. SELECTION CRITERIA We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. MAIN RESULTS We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged 17 studies to be at high risk of performance bias, because the participants and dermatologists were not blinded to the treatments administered or received; however, we judged all 24 trials to be at a low risk of detection bias for outcome assessment. We evaluated 14 comparisons of seven interventions and four combinations of interventions. Nine studies provided no usable data on our outcomes and did not contribute further to this review's results.For our outcome 'Participant-reported scar improvement' in one study fractional laser was more effective in producing scar improvement than non-fractional non-ablative laser at week 24 (risk ratio (RR) 4.00, 95% confidence interval (CI) 1.25 to 12.84; n = 64; very low-quality evidence); fractional laser showed comparable scar improvement to fractional radiofrequency in one study at week eight (RR 0.78, 95% CI 0.36 to 1.68; n = 40; very low-quality evidence) and was comparable to combined chemical peeling with skin needling in a different study at week 48 (RR 1.00, 95% CI 0.60 to 1.67; n = 26; very low-quality evidence). In a further study chemical peeling showed comparable scar improvement to combined chemical peeling with skin needling at week 32 (RR 1.24, 95% CI 0.87 to 1.75; n = 20; very low-quality evidence). Chemical peeling in one study showed comparable scar improvement to skin needling at week four (RR 1.13, 95% CI 0.69 to 1.83; n = 27; very low-quality evidence). In another study, injectable fillers provided better scar improvement compared to placebo at week 24 (RR 1.84, 95% CI 1.31 to 2.59; n = 147 moderate-quality evidence).For our outcome 'Serious adverse effects' in one study chemical peeling was not tolerable in 7/43 (16%) participants (RR 5.45, 95% CI 0.33 to 90.14; n = 58; very low-quality evidence).For our secondary outcome 'Participant-reported short-term adverse events', all participants reported pain in the following studies: in one study comparing fractional laser to non-fractional non-ablative laser (RR 1.00, 95% CI 0.94 to 1.06; n = 64; very low-quality evidence); in another study comparing fractional laser to combined peeling plus needling (RR 1.00, 95% CI 0.86 to 1.16; n = 25; very low-quality evidence); in a study comparing chemical peeling plus needling to chemical peeling (RR 1.00, 95% CI 0.83 to 1.20; n = 20; very low-quality evidence); in a study comparing chemical peeling to skin needling (RR 1.00, 95% CI 0.87 to 1.15; n = 27; very low-quality evidence); and also in a study comparing injectable filler and placebo (RR 1.03, 95% CI 0.10 to 11.10; n = 147; low-quality evidence).For our outcome 'Investigator-assessed short-term adverse events', fractional laser (6/32) was associated with a reduced risk of hyperpigmentation than non-fractional non-ablative laser (10/32) in one study (RR 0.60, 95% CI 0.25 to 1.45; n = 64; very low-quality evidence); chemical peeling was associated with increased risk of hyperpigmentation (6/12) compared to skin needling (0/15) in one study (RR 16.00, 95% CI 0.99 to 258.36; n = 27; low-quality evidence). There was no difference in the reported adverse events with injectable filler (17/97) compared to placebo (13/50) (RR 0.67, 95% CI 0.36 to 1.27; n = 147; low-quality evidence). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables.There is moderate-quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long-term effects, the longest follow-up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works. The results of this review do not provide support for the first-line use of any intervention in the treatment of acne scars.Although our aim was to identify important gaps for further primary research, it might be that placebo and or sham trials are needed to establish whether any of the active treatments produce meaningful patient benefits over the long term.
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Affiliation(s)
- Rania Abdel Hay
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | | | - Hesham Zaher
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | - Vanessa Hafez
- Cairo UniversityDepartment of Dermatology, Faculty of MedicineKasr El Aini Hospital Medical School15 Nasser Street from Fatma Roshdi St.Haram, GuizaCairoEgypt
| | - Ching‐Chi Chi
- Chang Gung Memorial HospitalDepartment of Dermatology and Centre for Evidence‐Based Medicine6, Sec West, Chia‐Pu RoadPuzihChiayiTaiwan61363
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
| | - Sandra Dimitri
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
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23
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Nilforoushzadeh M, Lotfi E, Nickkholgh E, Salehi B, Shokrani M. Can Subcision with the Cannula be an Acceptable Alternative Method in Treatment of Acne Scars? Med Arch 2015; 69:384-6. [PMID: 26843730 PMCID: PMC4720458 DOI: 10.5455/medarh.2015.69.384-386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/15/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Most people who experience the acne suffer from damage under the surface of their skin which causes saucer-like depressions or pits on their skin. Sometimes the skin loses its underlying support and develops fibrous bands of tissue between the skin and subcutaneous layer, which pull on the epidermis and cause a wavy texture called as rolling scar. Treatment of acne scars is a therapeutic challenge that may require multiple modalities. Subcision is a procedure that has been reported as a beneficial method in the treatment of rolling acne scars. Although Subcision is a valuable method, its efficacy is mild to moderate because of the high recurrence rate and patients dissatisfaction due to some side effects include post procedure inflammation. MATERIALS AND METHODS This pilot study is a clinical trial. The 8 patients suffered from mild to severe rolling acne scars on their face with symmetrical distribution of lesions, underwent Subcision with the Cannula No 18 and 21 and followed-up for 3 months. Outcomes of Subcision procedures were assessed by 3 board certified dermatologists (blind) after 2 session of treatment. The patients' satisfaction was considered to compare with dermatologist's opinions. The degree of improvement and satisfaction of the treatment estimated with these points: poor: 0, fine: 1-3, good: 4-6, and very good: 7-9. The data were finally analyzed with SPSS-18 software. RESULTS Subcision with the Cannula showed good and very good improvement in about 88% of patient with a satisfaction good and very good improvement in all of patients (100%). Assessment of photographic data showed 100% improvement in scar depth, topography and overall appearance of acne scars. The average numbers of lesions before the treatment were 24.8 ± 12.1 and after treatment it was reduced to 12.8 ± 2.1 (p<0.05). CONCLUSION Subcision with the Cannula appears to be a safe method with high efficacy in the treatment and high satisfaction in patients as we observed an interesting cure rate (more than 50% after 2 sessions). It demonstrates to be a safe procedure because it performed by single perforation in each side instead of multiple perforations that helps to reduce the patients' pain and risk of scars. In other hand Cannula-based Subcision needs considerable fewer sessions of surgery and also less recovery time.
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Affiliation(s)
- Mohammadali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran. Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Lotfi
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bahareh Salehi
- Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Marjan Shokrani
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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24
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Kaur J, Kalsy J. Subcision plus 50% trichloroacetic acid chemical reconstruction of skin scars in the management of atrophic acne scars: A cost-effective therapy. Indian Dermatol Online J 2014; 5:95-7. [PMID: 24616873 PMCID: PMC3937506 DOI: 10.4103/2229-5178.126053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jasleen Kaur
- Departments of Dermatology Venereology, Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Punjab, India
| | - Jyotika Kalsy
- Departments of Dermatology Venereology,Government Medical College, Amritsar, Punjab, India
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25
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Arsiwala SZ. Subcision with CROSS TCA peels for moderate to severe acne scars. Indian Dermatol Online J 2014; 5:97-8. [PMID: 24616874 PMCID: PMC3937507 DOI: 10.4103/2229-5178.126055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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Rahpeyma A, Khajehahmadi S. Needle subcision: a conservative treatment for facial dimpling after elimination of odontogenic infection source: a technical note. Oral Maxillofac Surg 2013; 18:415-8. [PMID: 23922011 DOI: 10.1007/s10006-013-0429-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
AIM Extraoral skin fistula after resolution of odontogenic infection often resolves spontaneously, but in some cases, facial dimpling occur which needs revision surgery. This article evaluates the result of needle subcision for treatment of this condition, with or without dermal filler injection. METHODS Five patients with facial dimpling that was remained after elimination of odontogenic infection origin were evaluated. Subcision alone was used in four patients, and needle subcision followed by dermal filler was done in a patient. RESULTS Facial dimpling in the chin (a case), mandibular lower border (two cases) as well as cheek skin (two cases) were treated by this method. All patients were satisfied with the cosmetic results. Six month after surgery, treatment outcomes were stable. CONCLUSION Needle subcision is a simple and conservative method for correction of facial dimpling after elimination of odontogenic infection source.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad, Iran,
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Munavalli GS, Smith S, Maslowski JM, Weiss RA. Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial. Dermatol Surg 2013; 39:1226-36. [PMID: 23566237 PMCID: PMC3881516 DOI: 10.1111/dsu.12204] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background A previous clinical trial evaluating autologous fibroblasts (human dermal) injections for the treatment of facial contour deformities found significantly greater improvements in wrinkle and acne scar appearance than with placebo treatment. Objective To compare the efficacy and safety of autologous fibroblast treatment of moderate to severe, depressed, distensible facial acne scars with that of vehicle control. Methods This was a randomized multicenter, double-blind, placebo-controlled trial in subjects with bilateral moderate to severe acne scarring; subjects served as their own controls. Skin biopsies were obtained from randomized subjects for fibroblast production. Subjects (n = 99) underwent three intradermal injection sessions with 2 mL of autologous fibroblast suspension (10–20 million cells/mL) on one cheek and vehicle control (cell culture medium) on the other at 14-day intervals. Efficacy was based on the blinded subject’s, evaluator’s, and independent photographic viewer’s (IPR) assessment of acne scarring 1 to 4 months after the last treatment. Results Autologous fibroblast treatment was associated with significantly greater treatment success than vehicle control for the subject (43% vs 18%), evaluator (59% vs 42%), and IPR assessments. Autologous fibroblast injections were well tolerated, without permanent adverse effects. Conclusions Autologous fibroblast injections safely and effectively improved the appearance of depressed distensible acne scars.
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Affiliation(s)
- Girish S Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina 28207, USA.
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Subcision: a further modification, an ever continuing process. Dermatol Res Pract 2012; 2012:685347. [PMID: 23304122 PMCID: PMC3530797 DOI: 10.1155/2012/685347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/16/2012] [Accepted: 11/30/2012] [Indexed: 11/17/2022] Open
Abstract
Subcision is a surgical technique used mostly to manage depressed scars. Over time, many modifications to this surgical technique have been made by various surgeons in order to make it simpler and more effective. We report here a new technique that aims to combine the privilege of the prevention of penetrating the skin beyond the scar and maintaining a horizontal orientation, while taking the advantage of the ergonomics of having the dominant hand parallel to the skin surface and the cylindrical grip of a 3 cc syringe. The purpose of our technique is to make subcision more practical and easier for the surgeon.
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Al-Dhalimi MA, Arnoos AA. Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study. J Cosmet Dermatol 2012; 11:144-50. [PMID: 22672279 DOI: 10.1111/j.1473-2165.2012.00616.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne scarring is a common dermatologic problem causing a great cosmetic disfigurement. Subcision is one of the effective modalities for treatment of rolling acne scars. OBJECTIVE To evaluate the efficacy and safety of subcision for rolling acne scars in Iraqi patients. PATIENTS AND METHODS Forty patients (21 males and 19 females) with moderate to severe grades of facial rolling acne scars were enrolled in this study. Subcision was done for all patients. Patients were followed up at 2, 6, 12 weeks, and 6 months after the last session. The response to treatment was evaluated by objective and subjective methods. RESULTS Thirty-four patients completed the study and follow up period. Eight of them were complaining of severe and 26 of moderate grade of acne scars. At the end of the study, 18 (52.94%) patients had mild grade, 15 (44.11%) patients had moderate grade, and one (2.92%) patient had severe grade. This change was statistically highly significant (P-value = 0.0000001). The average scar score before treatment was 13.264 ± 1.675; and it improved to 9.47 ± 2.71 after 6 months (P-value = 0.0000001). Regarding the photographic assessment, the difference in the visual analogue scale before and after the treatment was statistically highly significant (P-value = 0.0000001). All patients were satisfied regarding the improvement after treatment with varying degrees. All reported side-effects were mild and transient. CONCLUSION Subcision is a safe, easy to perform, well-tolerated, and valuable surgical technique for treatment of rolling acne scars.
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Affiliation(s)
- Muhsin A Al-Dhalimi
- Department of Dermatology, College of Medicine, University of Kufa, Kufa, Iraq.
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Sanchez FH. Treatment of Acne Scars. Dermatol Surg 2012. [DOI: 10.1002/9781118412633.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy.
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Affiliation(s)
- Bs Chandrashekar
- Dr. Venkat Charmalaya, Centre for Advanced Dermatology, Bangalore, Karnataka, India
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita AR, Lozada VT, Berson D, Finlay A, Goh CL, Herane MI, Kaminsky A, Kubba R, Layton A, Miyachi Y, Perez M, Martin JP, Ramos-E-Silva M, See JA, Shear N, Wolf J. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60:S1-50. [PMID: 19376456 DOI: 10.1016/j.jaad.2009.01.019] [Citation(s) in RCA: 374] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 01/06/2009] [Accepted: 01/10/2009] [Indexed: 12/13/2022]
Abstract
The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
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Affiliation(s)
- Diane Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, USA.
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Injectable poly-L: -lactic acid: a novel sculpting agent for the treatment of dermal fat atrophy after severe acne. Aesthetic Plast Surg 2009; 33:113-6. [PMID: 18923863 PMCID: PMC2696608 DOI: 10.1007/s00266-008-9242-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 08/19/2008] [Indexed: 11/12/2022]
Abstract
Acne vulgaris affects up to 80% of people 11 to 30 years of age, and scarring can occur for up to 95% of these patients. Scarring may be pitted or hypertrophic in nature, although in most cases it is atrophic. Atrophic acne scarring follows dermal collagen and fat loss after moderate to severe acne infection. Injectable poly-L-acid (PLLA) is a biocompatible, biodegradable, synthetic polymer device that is hypothesized to enhance dermal volume via the endogenous production of fibroblasts and, subsequently, collagen. The gradual improvements in cutaneous volume observed after treatment with injectable PLLA have been noted to last up to 2 years. The case studies presented describe the use of injectable PLLA to correct dermal fat loss in macular atrophic acne scarring of the cheeks. Two female patients underwent three treatment sessions with injectable PLLA over a 12-week period. At each treatment session, the reconstituted product was injected into the deep dermis under the depressed portion of the scar. Both patients were extremely pleased with their results at, respectively, 1- and 4-year follow-up evaluations. Patients experienced minimal swelling and redness after injection and no product-related adverse events such as papule and/or nodule formation. The author believes these data suggest that injectable PLLA is a good treatment option for the correction of macular atropic scarring with thin dermis (off-label use), particularly compared with other injectable fillers currently used for this indication that have shorter durations of effect.
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Chivot M, Pawin H, Beylot C, Chosidow O, Dreno B, Faure M, Poli F, Revuz J. Cicatrices d’acné : épidémiologie, physiopathologie, clinique, traitement. Ann Dermatol Venereol 2006; 133:813-24. [PMID: 17072207 DOI: 10.1016/s0151-9638(06)71053-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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