Abstract
Background: Acne vulgaris is a common condition with a prevalence of over 90% among adolescents and post- acne scarring is a well known sequelae. Different types of scars (ice pick, boxcar, and rolling scars) warrant a customized approach of treatment for each type. We propose a novel treatment of atrophic acne scars using combination of subcision and microneedling. 
 Methods: Ten consecutive patients of skin types III - IV with moderate and severe facial acne scarring received three sequential subcision and microneedling treatments after informed consent over a period of three months with an interval of 4 weeks between each session. Goodman and Baron’s qualitative and quantitative acne scar grading systems along with side by side comparison of pre operative and post operative photographs were used for assessment at the end of three sessions of the combination procedure. 
 Results: Estimation of improvement with Goodman and Baron’s Global qualitative acne scarring system , we found good results in patients with Grades 3 and 4 acne scars. Out of 7 patients with grade 4 scars, 29% showed improvement by 2 grades and 71% showed improvement by 1 grade and all the 3 patients with grade 3 scars showed improvement by 1 grade. Quantitative assessment showed 30% patients had minimal improvement, 50% had moderate improvement and 20% had good improvement in scars. Adverse effects were transient pain, erythema and oedema.
 Conclusion: Subcision and microneedling are simple and inexpensive office procedures which in combination are well tolerated and are efficacious in treatment of moderate and severe acne scars.
 
Highlights
Acne vulgaris is a common condition with a prevalence of over 90% among adolescents,[1] and often causes an unfortunate and permanent complication of scarring that results from an altered wound healing response to cutaneous inflammation
A retrospective photographic analysis of 10 consecutive patients with Global Acne Scarring Classification grades 2 to 4 treated with a combination of subcision and microneedling after informed consent for moderate to severe facial atrophic acne scarring was done at the Department of Dermatology and Venereology in a tertiary care teaching hospital between January 2019 and March 2019
According to Goodman and Baron acne scar grading scale, 7 patients presented with grade 4 scars and 3 patients presented with grade 3 scars on both sides of the face
Summary
Acne vulgaris is a common condition with a prevalence of over 90% among adolescents,[1] and often causes an unfortunate and permanent complication of scarring that results from an altered wound healing response to cutaneous inflammation. For choosing the appropriate intervention, assessment of the severity of scarring is necessary. The severity assessment is done by classification of the scars. They have been broadly classified into three different types: atrophic, hypertrophic, or keloidal. We propose a novel treatment of atrophic acne scars using combination of subcision and microneedling
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