Facial Acne Scars Research Articles

Combination of Fractional Microneedling Radiofrequency and Ablative Fractional Laser versus Ablative Fractional Laser Alone for Acne and Acne Scars.

Fractional microneedle radiofrequency (FMR) systems are used to treat inflammatory acne and scarring. Nonetheless, few controlled studies have combined this treatment with the traditional ablative fractional laser (AFL). We aimed to assess the safety and efficacy of the combination of FMR and AFL versus AFL alone in treating acne and acne scars. In this 20-week, randomized, split-face study, 23 Korean patients with facial acne and acne scars underwent FMR and AFL treatments. One half of each patient's face was randomly assigned to receive FMR+AFL, whereas the other half received AFL alone. Treatments were administered in three consecutive sessions at 4-week intervals. This study investigated the severity of inflammatory acne, acne scars, individual lesion counts, depressed scar volumes, as well as patient and physician satisfaction. In addition, five patients underwent skin biopsy, and sebum output was measured. The FMR+AFL treatment demonstrated superior efficacy compared to AFL alone in terms of inflammatory acne and acne scar grading, lesion counts, and subjective satisfaction. The side effects were minimal and well-tolerated in both groups. Immunohistochemical findings from skin biopsy samples revealed that the application of FMR+AFL could induce an inhibitory effect on sebum secretion at the molecular level. FMR combined with AFL is a well-tolerated and effective treatment modality for inflammatory acne and acne scarring.

Comparative Evaluation of Therapeutic Efficacy and Safety of Microneedling Alone Versus Microneedling with Hyaluronic Acid in Post-Acne Scarring.

Facial acne scars are perceived negatively by society; in an era where everyone wants to look their best, acne and its sequelae are a great source of stress driving down self-worth and elevating the risk of depression and anxiety. It affects over 95% of acne patients, particularly in nodulocystic, conglobate, and fulminans varieties. Various treatment modalities are available, but no single modality is 100% curative. Microneedling produces controlled skin injury, releasing various growth factors and setting up a healing cascade, and laying down collagen as a result. Hyaluronic acid plays an important role in wound healing by creating physiological conditions in the extracellular matrix for the proliferation, migration, and organization of dermal cells. To compare the therapeutic efficacy and safety of microneedling alone and microneedling with hyaluronic acid in acne scars. Sixty patients of age 18-40 years with clinically diagnosed acne scars were recruited and randomly divided into two groups of 30 each. Three sittings were done at an interval of 3 weeks of microneedling alone to Group A and microneedling with hyaluronic acid to Group B and followed up with two visits 4 weeks apart. Scoring was done with Goodman Quantitative Global Scarring Grade System. Side effects, patient satisfaction score, and pre and postprocedure Dermatological Life Quality Index (DLQI) were also recorded. The female:male ratio was 3:2, mean age was 26.90 ± 4.90 years in Group A and 24.43 ± 5.39 years in Group B. Overall, 60% patients had a duration of 2-5 years, and unmarried patients outnumbered married ones in both groups. The combination morphology of the scars was the most common finding. In Group A mean Goodman Quantitative Global Scarring Grade System score reduced from baseline 24.13 ± 7.96 to 16.3 ± 7.2, and in Group B, from 27.73 ± 7.86 to 18.20 ± 7.12 at 17 weeks, this decrease was gradual and statistically significant. The patient satisfaction score for Group B (6.20 ± 1.45) was only slightly higher than that of Group A (5.73 ± 1.31). DLQI for Group A decreased from 7.77 to 4.10 and in Group B from 7.63 to 5.00. Both procedures were safe, with over 80% patients experiencing no side effects. The majority of patients showed "moderate" improvement in both groups; however, more patients in microneedling with hyaluronic acid group showed "good" and "very good" results at the end of the treatment completion. These are easy, office-based procedures not requiring training or any high-end machine, especially useful in resource-limited setups; the use of hyaluronic acid can enhance the efficacy of microneedling alone.

Fractional Laser Resurfacing for Acne Scars: Our Experience at Tertiary Care Hospital of North India.

Acne is very common among adolescents, which may sometimes persist into adulthood, and acne scars continue to have a profoundly negative impact on quality of life. Of all the various modalities available, fractional lasers have shown effective results. The aim of this study was to assess the efficacy and safety of fractional carbon dioxide (CO2) laser resurfacing in atrophic facial acne scars. The study included 104 subjects aged ≥18 years with atrophic acne scars on face of more than 6 months of duration recruited over a period of 1 year. All the patients were treated with fractional CO2 laser (600 W power and wavelength 10,600 nm). Four sessions of fractional CO2 laser resurfacing were done at 6-week intervals in each patient. We compared the improvement rate of scars after every session at 6-week interval, 2 weeks after the last session, and finally 6 months after the last laser session. The difference between the mean baseline score (3.43) and mean final score (1.83) using Goodman and Baron's qualitative scar scale was found to be statistically significant (P = 0.001). Mean improvement increased from first treatment session to the end of the treatment course from 0.56 to 1.62 indicating the role of the number of sessions in the overall improvement of acne scars. With regard to overall satisfaction, maximum number of patients were either very satisfied (55.8%) or satisfied (25%) as compared to those who were only slightly satisfied (11.5%) or completely unsatisfied (7.7%). Fractional ablative laser gives excellent results in the management of acne scars and has emerged as an appealing non-invasive option for this indication. Being a safe and effective option for atrophic acne scar treatment, it can be recommended wherever available.

Fractional CO2 Laser resurfacing treatment of acne scar comparing high and low energy levels

Background : Fractional CO2 laser resurfacing in the treatment of acne scars, attempts to reduce the adverse effect of laser resurfacing by creating microscopic injury zones to the dermis with skipped interval areas. Aim of the study : The purpose of this study is to compare the safety and efficacy of high pulse energy (70 mJ) and low pulse energy (45 mJ) of fractional CO2 laser resurfacing in the treatment of facial acne scars. Patients and Methods : Twenty patients with moderate to severe atrophic acne scars were treated with three sessions of fractional CO2 laser resurfacing at four-week intervals with high and low energy levels applied to each side of the face separately. The severity of acne scars at baseline and after treatment was assessed using Goodman and Baron’s qualitative scar grading system. Patient satisfaction score was obtained using a quartile grading scale. Results : The severity of acne scars on both sides was comparable to each other before the treatment (p = 0.643). At the final assessment, both sides with high and low energy levels demonstrated an excellent response (p = 0.000). However, the difference between the mean final scores of both sides was not significant (p = 0.731). The most frequently reported side effects were crustation and erythema. Crustation lasted longer on the right side (mean = 6.75 days) whereas for the left side (mean = 5.45 days). Erythema was transient and only in four cases persisted beyond a week (right side mean = 10.5 days while left side mean = 8.75 days) Conclusions : Both high energy (70 mJ/pulse) and low energy (45 mJ/pulse) CO2 fractional laser resurfacing of acne scar results in satisfactory outcomes with no statistically significant differences. While the duration of side effects (crustation and erythema) was increased slightly with higher fluence.

A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment

Different treatment options for post-acne scars exist, but with varying clinical efficacy, side effects, and prolonged downtime. This study aims to compare the efficacy and safety of combined subcision with either fractional CO2 laser or cross-linked hyaluronic acid filler (HA) versus subcision alone in the treatment of facial atrophic post-acne scars. Forty patients with atrophic post-acne scars were subjected to subcision on both sides of the face, then were randomly divided into three groups. Group I (20 patients): subcision combined with cross-linked HA filler injection at one side of the face; group II (20 patients): subcision followed by fractional CO2 at the other side of the face; and group III (20 patients): with subcision only as a control group. Treatment sessions were every month until clinical improvement or for maximum three sessions. The treatment’s efficacy was assessed by Goodman and Baron’s qualitative and quantitative grading systems. The two blinded investigator scores showed significant improvement in both the filler side versus subcision (p value = 0.015), and the fractional laser side versus subcision (p value < 0.001), with no statistically significant difference between both sides (p value = 0.171). Qualitative grading by Goodman and Baron scores showed that the percentage of patients with excellent improvement was higher in group 1 and group 2 than in group 3 with p value = 0.031; also the mean percentage of reduction in quantitative grading was higher in group 1 and group 2 than in group 3 with p value < 0.00. Either combined subcision with fractional CO2 laser or with cross-linked HA filler achieved superior improvement in facial atrophic post acne scars treatment with no serious side effects in this study. However, subcision only by blunt canula also had modest improvement.

ASSESSMENT OF THE EFFECT OF POST-ACNE SCARS ON THE QUALITY OF LIFE IN PATIENTS TREATED WITH FRACTIONAL CO2 LASER

Introduction: Although research has been conducted on the psychosocial impact of post-acne scarring in young people, and there have been few reports on the consequences of post-acne scarring on the quality of life. In fact, there are barely any reports of the change in quality of life (QOL) post acne scar management. Aims and objectives: This study was intended to assess the impact of acne scarring on the quality of life in patients before initiating acne scar management with C02 laser and the improvement in quality of life after the completion of therapy. Materials and methods: Patients over the age of 18 years with atrophic acne scars were included to be a part of the study. The dermatology life quality of life index (DLQI) and The facial Acne Scar Quality of Life (FASQoL) was assessed at baseline. The cases were subjected to CO2 laser sessions. The improvement in quality of life was assessed using the change in scores of DLQI and FASQoL.Results: This study included 100 cases with acne scars. The mean DLQI score of our at baseline was 8.19±1.33 while the mean FASQoL score was 12.49±1.02. Females had a signicantly higher impact on quality of life at baseline. After completion of CO2 laser therapy treatment, there was a signicant fall in the DLQI score. The DLQI score reduced to 4.18±1.87 (p value-0.0001), while he mean FASQoL also reduced to 5.31±0.24. The improvement was highly signicant (p value=0.0001). Conclusion: Post-acne scars have a considerable detrimental impact on patients' QOL, emphasizing the importance of increasing public awareness through education programs and early treatment. Fractional laser treatment is quick and easy for these individuals and provides a signicant improvement in the patient's quality of life.

To evaluate the efficacy and safety of laser interventions for facial acne scars: a systematic review and Bayesian network meta-analysis.

There are numerous laser treatments for acne scars in clinical practice. However, there are no clinical studies comparing all laser methods to provide an evidence-based bias for clinicians to choose the best strategy. Therefore, this systematic review and network meta-analysis was conducted to explore the efficacy of different types of laser treatment on acne scars. This study can provide the most effective treatment for acne scars in clinical practice. The databases of PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to July 2022. The Cochrane risk of bias assessment tool was used to assess the bias of the included original studies. Bayesian network meta-analysis was used to investigate the efficacy of laser treatment strategies in scar improvement, cure rate, and satisfaction. As shown by the results, the top 3 treatment options for scar improvement were fractional carbon dioxide laser (FCL) + platelet-rich-plasma (PRP) [surface under the cumulative ranking curve (SUCRA): 0.699], 1064Nd (1,064-nm neodymium-doped yttrium aluminum garnet picosecond laser) + 15%VC (Vitamin C; SUCRA: 0.675), and 1064Nd (SUCRA: 0.627). The standard mean difference (SMD) of FCL + PRP was -1.76 (95% CI: -3.49, -0.03), compared with that of FCL. The top 3 treatment options for improving cure rate were Er (Er:YAG laser treatment) + PRP (SUCRA: 0.873), FCL (SUCRA: 0.773), and FCL + 30% salicylic acid (30%SC) (SUCRA: 0.772). The RR of Er + PRP cure rate was 13.86 (95% CI: 1.79, 107.22), compared with non-laser radiofrequency therapy. The findings suggested that combined therapies should be used to treat acne scars. Er + PRP showed the highest cure rate of acne scar, followed by FCL + 30%SC or FCL monotherapy. FCL combined with PRP could improve acne scarring to the greatest extent, and 1064Nd combined with 15%VC can also exert a good effect. As for satisfaction, FCL monotherapy was the most satisfactory methods for patients, followed by PRP monotherapy. Therefore, Er + PRP and FCL + PRP can be used as the first choice for clinical treatment of acne scars. Additionally, using FCL alone is also an effective and elective treatment method due to its affordable cost and comfort.

Radiofrequency-assisted subcision combined with polycaprolactone-based dermal fillers in the management of atrophic facial acne scars: A pilot investigative study.

The scar's appearance and psychological burden are the most esthetically challenging issues in acne vulgaris. This study investigated the effectiveness and safety profile of combined radiofrequency-assisted subcision, which, even though effective on both Icepeak and Rolling subtypes, is only mildly effective on boxcar lesions, and polycaprolactone-based dermal filler with collagen stimulation potency in managing atrophic postacne scars. Our quasi-experimental single-arm study, after the inclusion of 10 cases over the age of 18 with moderate to severe mixed atrophic facial acne scarring, was carried out in two 3-month separate sessions, during and after the intended intervention of which the experienced lesion improvements and also adverse events were documented. Moreover, all cases were followed for 3 months after the last session, evaluating the differences in the mentioned outcomes. We found the combined intervention to be highly effective in improving the intended outcomes, with the total number of acne lesions (p-value < 0.001), along with the total number of Ice peak (p-value = 0.002), Rolling (p-value < 0.001), and boxcar (p-value = 0.023) lesions demonstrating statistically significant changes. Radiofrequency-assisted subcision combined with polycaprolactone-based dermal fillers can be an effective intervention in managing postacne scars. However, we recommend that randomized clinical trials with larger sample sizes be carried out for a more precise conclusion.

A comparative study of efficacy of fractional carbon dioxide laser with and without platelet rich plasma in treatment of facial acne scars

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace.

There is limited basic research on carbon dioxide (CO2 ) fractional laser, indicating blind spots in CO2 fractional laser treatment of certain diseases. This study aimed to organize previous literature, summarize the current research, and speculate on possible future development. We searched document data on fractional CO2 lasers from the Web of Science core collection database and retrieved 928 articles from 2004 to 2021. CiteSpace software was used to analyze the main institutions, authors, subject hotspots, and research frontiers in global CO2 fractional laser research. The results revealed that 928 related papers were published in the past 18 years (2004-2021), and the number has increased annually. The publications were written by 3239 authors from 626 institutions in 60 countries/regions. The United States (US) dominates this field (312 documents), followed by Italy (289), and South Korea (88). Lasers in Surgery and Medicine is the journal with the most publications and citations, and Uebelhoer is the central author. The main research hotspots include vulvovaginal atrophy, fractional photothermolysis, keloids, drug delivery, gene expressions, facial acne scarring, resurfacing, vitiligo, and photo damage. Using CiteSpace, this paper draws a map of authors, institutions, and keywords in fractional CO2 laser from 2004 to 2021; summarizes the main authors, institutions, research hotspots, and cutting-edge topics of global fractional CO2 laser technology in recent years; and summarizes the current application status of global fractional CO2 laser in disease treatment. It also provides new ideas for the future application and research of fractional CO2 lasers.

Combination treatment with 30% salicylic acid and fractional CO2 laser for acne scars: A 20-week prospective, randomized, split-face study.

Multiple approaches are used to treat acne scars, but some are expensive, ineffective, and cause complications. We aimed to evaluate the efficacy and safety of ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid in the treatment of acne scars in a prospective split-face control study. Twenty patients with facial symmetrical acne scars were enrolled. One side of face was randomly treated with 30% supramolecular salicylic acid, and two sides were treated with ultra-pulsed CO2 fractional laser. The Echelle d'evaluation clinique des cicatrices d'acne (ECCA) scale was used to evaluate the clinical efficacy before and 3 months after treatment, and a quartile scale was used to self-evaluate the improvement of patients. A visual analog scale was used to record pain scores after each treatment, and side effects and other adverse reactions on the face were recorded. All the patients completed treatment and follow-up. There was statistical difference in ECCA scores of bilateral facial acne scars after three treatments (p < 0.001). ECCA scores on the combined side were lower after three treatments than those on the laser side (p=0.003). The patient satisfaction quartile scale on the combined side was higher than that on the laser side alone (p=0.015). Ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid has better efficacy in the treatment of acne scars than laser alone, and patient self-assessment of combined treatment has a greater degree of improvement in acne scars, and does not increase patient pain scores and related adverse reactions.

Projective Personification Approach to the Experience of People With Acne and Acne Scarring—Expressing the Unspoken

The association of acne with emotional and social well-being is not limited to active acne because acne scarring can extend long after cessation of active lesions. To explore the psychosocial burden of facial and truncal acne (FTA) and acne scars (AS) in a spontaneous manner using qualitative research. This qualitative study recruited participants via local panels. A personification exercise, "Letter to my Disease," was developed for participants of 2 independent arms, FTA and AS, of an international qualitative study in the form of letter completion. Study outcomes comprised perceptions, psychosocial effects of FTA and AS, and coping behaviors. A total of 60 participants were recruited for the FTA and AS study. Among participants with FTA, 17 were women (57%), 21 (70%) were aged 13 to 25 years, and 9 (30%) were aged 26 to 40 years. Twenty-six (87%) participants had severe active acne and 4 (13%) had moderate active acne. Among participants with AS, 18 were women (60%), 9 (30%) were aged 18 to 24 years, and 21 (70%) were aged between 25 and 45 years. Of these 60 participants, 56 (FTA, 28 and AS, 28) completed the projective exercise, "Letter to my Disease," the analysis of which is presented in the current study. During completion of the letter exercise, participants spontaneously expressed emotional and physical burden as well as the social stigma associated with their skin condition. Three major themes emerged, namely, (1) burden of the condition, (2) attitudes and beliefs, and (3) relationship to the personified condition. Consistent with their skin condition, participants associated acne, through personification, with the character of an intruder and unwanted companion responsible for their poor self-esteem and emotional impairment. The findings of the joint analyses of letters (FTA and AS), as a catalytic process and free-expression space, outline the continuous burden of active acne starting from adolescence and then continuing into adulthood and beyond active lesions with AS, and highlight the struggle for self-acceptance.

A novel technique in reducing sebum production and improving atrophic acne scars.

Fractional microneedling radiofrequency (FMR) has gained popularity for the treatment of acne scars, owing to favorable outcomes and short downtimes. This study aimed to investigate FMR use in reducing facial sebum production and treating acne scars. This single-center, prospective, evaluator-blinded trial compared sebum production after three sessions of FMR (Fractora® 24-pin coated tip) performed one-month apart. Results were evaluated with a sebumeter (Cutometer®), sebaceous gland histology, and subjects' assessment. Acne scars were graded according to the Echelle d'Evaluation clinique des Cicatrices d'acné scale, Goodman and Baron's qualitative grading system, acne scar volume measurement, and subjects' assessments. Sebumeter results revealed a significantly decreased (p < 0.05) sebum production since the first treatment, sustained throughout the study period. Histological assessment showed decreased density and size of sebaceous glands. The mean acne scar volume decreased significantly, without a significant increase in the mean melanin levels. Fractora® 24-pin coated tip can be used as an alternative for patients with acne scars, who wish to concomitantly reduce their facial oiliness. A significant decrease in facial oiliness and acne scars' volume can be seen after a single treatment session, with up to 15.48% decrease in facial oil production.

Efficacy and tolerability of a microneedling device for treating wrinkles on the face.

A microneedling pen has been cleared by the US Food and Drug Administration, indicated for improving the appearance of adult facial acne scars. The objective of this study was to assess the device's effectiveness for treating wrinkles of the face area. Healthy adults seeking to improve the appearance of face wrinkles were enrolled (N=35), receiving four monthly microneedling procedures by a trained aesthetician who treated the face skin per manufacturer instructions. Wrinkle assessments were performed by two trained blinded raters by comparing baseline images of each subject with images obtained at 90days post-procedure. Subsequently, the two raters were unblinded for the Clinician's Global Aesthetic Improvement Scale (CGAIS) assessment. Subjects completed the Subject's Global Aesthetic Improvement Scale (SGAIS) and a Satisfaction Questionnaire at 30 and 90days post-treatment. The study was completed by 32subjects with a mean (SD) age of 56.3 (5.0) years. Wrinkle assessments demonstrated significant improvement in the face areas (p<0.001). The SGAIS scores showed significant improvements after 30 and 90days post-treatment (for each, p<0.001). The CGAIS scores also showed significant improvements at 90days post-treatment (p<0.001). Most subjects reported some level of improvement in their appearance at 30days (73.3%) and 90days (68.8%) post-treatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the treatment procedure (87.5%) and would recommend microneedling to friends and family members (80.6%) on the face and neck. Microneedling is a viable, minimally invasive option for treating wrinkles of the face. gov Identifier: NCT03803059.

Efficacy and Tolerability of a Microneedling Device for Treating Wrinkles on the Neck.

BackgroundA microneedling pen has been cleared by the US FDA and is indicated for improving the appearance of facial acne scars in adults.ObjectivesThe aim of this study was to assess the effectiveness of this microneedling pen for treating wrinkles. This paper focuses on the results on the neck, an area of recent importance with video meetings placing physical stress on the neck area, leading to wrinkles.MethodsHealthy adult men and women were enrolled (N = 35). Subjects received 4 monthly microneedling procedures at depths of up to 2.5 mm. Wrinkle assessments were performed by 2 trained blinded raters by comparing images of each subject at baseline and at 90 days postprocedure. The 2 raters were unblinded for the Clinician’s Global Aesthetic Improvement Scale assessment. Subjects completed the Subject’s Global Aesthetic Improvement Scale and a questionnaire regarding satisfaction with the treated areas of the face and neck at 30 and 90 days posttreatment.ResultsThe study was completed by 32 subjects. Wrinkle assessments demonstrated significant improvement in the neck areas (P < 0.001). Both Global Aesthetic Improvement Scales showed significant improvements at 90 days posttreatment (P < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) posttreatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the results (87.5%), and would recommend microneedling to friends and family members (80.6%).ConclusionsMicroneedling is a viable, minimally invasive option for treating wrin kles of the neck.Level of Evidence: 4

Microneedle fractional radiofrequency for atrophic acne scars: In vivo evaluation of results by 3D analysis and reflectance confocal microscopy.

The efficacy of microneedle fractional radiofrequency (MFR) for the treatment of atrophic acne scars has been recently described, but accurate in vivo microscopic documentation of the processes occurring has never been reported. The aim of this study is to describe in vivo morphological atrophic acne scars' variations after treatment with MFR by means reflectance confocal microscopy (RCM) and three-dimensional (3D) imaging. A total of 11 patients requiring treatment for atrophic facial acne scars were treated with four monthly sessions of MFR. 3D imaging and RCM were assessed at baseline and 1month after last session. Clinical improvement, according to Global Assessment Improvement Scale, and patients' satisfaction were evaluated. Clinical improvement was observed in all the treated patients, although better results were obtained for boxcar scars (p=0.043). 3D imaging revealed a significant improvement in terms of mean scars' depth (p<0.001). Otherwise, RCM highlighted collagen remodeling with restoration of a reticular structure. Our study confirms the efficacy and safety of MFR in acne scars' treatment and provides the microscopic description of the results using RCM.

Q-Switched 1064-nm Nd: YAG laser versus fractional carbon dioxide laser for post acne scarring: A split-face comparative study.

Many treatment modalities are available for post acne scarring. However, the response to the treatment is extremely variable among patients. The aim of this study was to compare the efficacy and safety of Q-switched Nd: YAG (1064nm) and fractional CO2 (10,600nm) lasers in the treatment of atrophic post acne scars. This study included 20 patients with atrophic facial post acne scars graded according to Sharquie's score. All subjects received four sessions of laser treatment with a 4-week interval between the sessions. The study was designed as a double-blinded, comparative, split-face study applying Q-switched 1064-nm Nd:YAG laser to the right side of the face and fractional CO2 laser to the left side. Q-switched 1064-nm Nd: YAG laser achieved significantly higher improvement percentage when compared to fractional CO2 lasers (33.33% versus 17.37% Sharquie's score reduction, respectively). There was a significant negative correlation between the percentages of improvement and the patients' age on both sides and a significant positive correlation with the baseline Sharquie scores on both sides. Q-Switched 1064-nm Nd: YAG laser could be a promising safe option for the management of atrophic post acne scars.

Effect of Cognitive Behavior Oriented Psychological Intervention on the Psychological Status of Depressed Facial Acne Scar Patients Undergoing Fractional Photothermolysis

To explore the effect of cognitive behavior oriented psychological intervention on the psychological status of depressed facial acne scar patients receiving fractional photothermolysis. The study enrolled 48 depressed facial acne scar patients who received treatment at our hospital between May 2018 and May 2021. They were randomized to the control group and the fractional photothermolysis group with 24 patients in each group using the random number table method. They received nursing intervention and cognitive behavior-oriented psychological intervention, respectively. The Hamilton Anxiety and Hamilton Depression scores were lower after intervention than before intervention in both groups,and the fractional photothermolysis group had lower Hamilton Anxiety and Hamilton Depression scores than the control group ( P < 0.05). The interpersonal sensitivity had hostility and phobic anxiety scores were lower after 12 weeks of treatment than before intervention in both groups, and the fractional photothermolysis group had lower interpersonal sensitivity hostility and phobic anxiety scores than the control group ( P < 0.05). The H, M, V, and P scores after 12 weeks of intervention were both lower in the 2 groups than those before intervention. The humanistic care quality of service nursing care and health education scores were lower after intervention before intervention in both groups and the fractional photothermolysis group had significantly lower humanistic care quality of service nursing care and health education scores than the control group ( P < 0.05). Cognitive behavior-oriented psychological intervention can effectively improve the psychological status and psychological health of depressed facial acne scar patients receiving fractional photothermolysis.

An objective assessment of microneedling therapy in atrophic facial acne scars.

Microneedling therapy is one of the recent advances in treating acne facial scars. To evaluate the efficacy of microneedling therapy in the treatment of atrophic acne facial scars. A total number of 10 patients between the age group of 20 and 40 years (8 women and 2 men) who complained of acne scars from November 2012 to August 2014 were selected for the study. Microneedling therapy was performed following the application of the Eutectic Mixture of Local Anesthetics in an interval of 2 months. All patients underwent three sessions. A follow-up of 2 months after the last sitting was carried out. Cochran's Q-paired test, Kendall's W-test, and Pearson's correlation were used for statistical analysis. Patients in our study had three forms of acne scars: box-scar, icepick form, and rolling scars. Patients were told to rate the outcome of the treatment at the end of the follow-up. Three observers randomly selected were shown the pre- and postoperative photographs of the patients to rate the treatment outcome. Statistically there was no interobserver bias. Ninety percent reduction in number of scars and depth of scars was noted at the end of three sittings. The improvement in pigmentation was insignificant. Seventy percent improvement in the skin texture was noted. Nine patients suffered from transient postinflammatory erythema and six patients had postoperative swelling. Microneedling therapy is a safe and effective method of treating acne scars.

Autologous platelet concentrates for facial rejuvenation.

Autologous platelet concentrates (APCs) are promising therapeutic agents in facial rejuvenation since they are a great source of cytokines, growth factors and other biologically active substances. Obtained from the patient’s blood, they have the advantages of reducing immunological reactions, making the procedure safer, well tolerated, with minimal adverse effects and lower cost. Currently, they are used for facial rejuvenation both in combination with microneedling and in mesotherapy techniques, as well as to treat facial acne scars, melasma and wounds after laser ablative treatments. This review summarizes current knowledge on the use of APCs, ranging from basic concepts related to their composition and mechanisms of action to up-to-date information on their clinical efficacy. Methodology MEDLINE (PubMed) was searched from inception through 2021 for English language publications on APCs for facial rejuvenation.Results A total of 100 files were found. Based on the available literature, APCs for skin rejuvenation are safe and well tolerated. The most studied product is the first-generation material, platelet-rich plasma (PRP).Conclusions The results are in general favorable, but the quality of the studies is low. The second and third generation products, platelet-rich fibrin (PRF) and injectable platelet-rich fibrin (i-PRF), respectively, are easier to be obtained and, at least in vitro , seem to induce greater collagen production than PRP, especially under lower relative centrifugation forces, but to date only a few clinical trials evaluating these products exist. More high-quality trials with appropriate follow-up are necessary to provide adequate evidence that may help to improve the treatment regimens with APCs. Many aspects should be considered when designing clinical trials to evaluate APCs, such as the patients’ characteristics that best predict a favorable response, the optimal number of sessions and the interval between them, the characteristics of the studies and the development of better instruments to evaluate skin aging.