Improvement Of Scars Research Articles

Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial.

Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method. To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars. Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools. Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects. Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

Safety and efficacy of intralesional bleomycin for keloids and hypertrophic scars: A systematic review and meta-analysis.

Bleomycin, originally an antitumor drug, was explored as a pathological scar treatment in the mid-1990s. However, its efficacy and safety profile varies among individuals. This study aimed to assess topical bleomycin's efficacy and safety in treating hypertrophic scars and keloids. We reviewed randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published in English, comparing intralesional bleomycin to placebos or common intralesional scar treatments. Primary outcomes included percentage change in scar improvement, pigmentation, recurrence, atrophy, pain, telangiectasia, ulceration, patient self-assessment, and observer assessment (>50%). Six trials met the criteria. Bleomycin significantly improved scar reduction compared to triamcinolone (p < 0.05). There was no significant difference in pigmentation (p = 0.05) and recurrence (p = 0.21) compared to other treatments. In terms of safety, bleomycin caused less skin atrophy (p < 0.01) and telangiectasia (p < 0.01) but more pain (p = 0.03) than other treatments. Bleomycin was more effective than TAC, 5-FU, or TAC combined with 5-FU for treating keloids and hypertrophic scars with lower skin atrophy and telangiectasia risks. However, it may cause more pain than 5-FU or TAC. Further comprehensive studies, including RCTs, are required for objective analysis.

Microneedling with Topical Insulin Versus Microneedling with Non-Cross-Linked Hyaluronic Acid for Atrophic Post-Acne Scars: A Split-Face Study.

Post-acne scars are a prevalent cosmetic complaint that usually require multi-modality treatment to achieve accepted results. The target of this research was to evaluate and compare the efficacy and safety of microneedling with topical insulin versus microneedling with non-cross-linked hyaluronic acid in atrophic post-acne scar treatment. The current comparative split-face research included 30 patients with atrophic facial acne scars. Each patient received six sessions of microneedling with topical insulin on one side of the face and microneedling with non-cross-linked hyaluronic acid on the other side. Sessions were done three weeks apart, and digital photographs were taken before and three months after the last treatment session. Goodman and Baron qualitative and quantitative grading system was used to evaluate the improvement across both sides of the face, along with patient satisfaction. Three months after the last session, a statistically significant improvement in qualitative acne scar grading on both sides of the face (P < 0.001) was reported, with non-significant difference between the two sides (P = 0.864). Moreover, the mean percentage of improvement in quantitative acne scar grading was 49.18 ± 13.22 on the insulin side and 47.72 ± 15.08 on the hyaluronic acid side, with non-significant difference between the two sides after treatment (P = 0.235). Both microneedling with topical insulin and with non-cross-linked hyaluronic acid achieved comparable significant improvement of atrophic post-acne scars.

Applications of Plasma‐Rich Plasma, Exosomes, and Stem Cells in Aesthetics: A Narrative Review

ABSTRACTIntroductionPlasma‐rich plasma (PRP), exosomes, and stem cells represent promising new treatments for facial rejuvenation and to enhance other cosmetic procedures. Although these treatments are rapidly advancing, there are no universally accepted treatment protocols for their use. The goal of the following review is to describe some of the possible benefits of PRP, exosomes, and stem cells in aesthetic medicine.ResultsA review of available studies showed that potential uses of PRP include wound healing after facial surgery, facial rejuvenation, androgenetic alopecia, acne scars, striae distensae, and vitiligo. Exosomes may provide beneficial treatment for skin rejuvenation, scar reduction, hyperpigmentation, and hair growth. Stem cells show promise for androgenetic alopecia, scar improvement, and treatment of photoaged skin. These new technologies may be used alone, but are often combined with existing aesthetic treatments.ConclusionPRP, exosomes, and stem cells may play an important role in restoring youthful tissue structure and function. Interpretation of some study results is sometimes challenged by the lack of standardized treatment protocols, including routes of application and dosing. When combined with other devices and techniques, results are sometime unclear as to which treatment plays the greater role.

THE USE OF SUBCISION IN CONJUNCTION WITH FRACTIONAL CARBON DIOXIDE LASER TO IMPROVE ATROPHIC ACNE SCARS

Objective: Acne is a prevalent skin condition affecting a wide range of age groups, often leading to severe scarring if left untreated. The use of subcision combined with fractional CO2 laser therapy has been posited as a potentially more effective treatment method for atrophic acne scars compared to standalone laser treatment. Methods: This clinical trial was conducted at Asha Derma Clinic, Gorakhpur, Uttar Pradesh, from 30th March 2023 to 30th March 2024. Thirty patients with ice pick and rolling-type atrophic acne scars were enrolled. Participants were treated on one side of their face with five sessions of fractional CO2 laser and on the other side with one session of subcision with fractional CO2 laser combined with four sessions of fractional CO2 laser alone. Outcomes were assessed through scar improvement and patient satisfaction at 1, 2, and 6 mo post-treatment, with data analysis performed using ANOVA and the Wilcoxon rank-sum test. Results: Significant improvements were observed in both recovery levels and patient satisfaction. The combined method showed higher recovery percentages (40-65%, Mean±SD: 54.7±7) compared to the laser alone (30-55%, Mean±SD: 43±11.1), with a p-value of 0.0005. Patient satisfaction also favored the combined method (1.8-3, Mean±SD: 6.6±1.2) over laser treatment alone (1.6-4, Mean±SD: 5.2±1.8), with a p-value of 0.0007. Conclusion: The study demonstrated that subcision combined with fractional CO2 laser therapy significantly enhances recovery levels and patient satisfaction in the treatment of atrophic acne scars, suggesting a robust advantage of integrating both treatments.

Addressing Burn Hypertrophic Scar Symptoms Earlier: Laser Scar Revision May Begin as Early as 3-6 Months After Injury.

Fractional ablative CO2 laser (FLSR) is used to treat hypertrophic scars (HTSs) resulting from burn injuries,which are characterized by factors, such as erythema, contracture, thickness, and symptoms of pain and itch. Traditionally, waiting a year after injury for scar maturation before starting laser treatment has been recommended;however, the potential benefits of earlier intervention have gained popularity. Still, the optimal timing for beginning laser intervention in patients with HTSs remains uncertain. This study aims to evaluate the ideal timing for the initiation of FLSR for HTSs using several qualitative and quantitative assessment measures. It was hypothesized that early intervention would lead to similar improvement trends as later intervention, however, would be more ideal due to the shortened time without symptom relief for patients. Patients who received three or more laser treatment sessions and completed both pre- and posttreatment evaluations were included in this analysis (n = 69). FLSR treatment was administered at 4-8-week intervals. Patients starting treatment before 6 months after injury were classified as the early-stage intervention group and those beginning treatment at 6-12 months after injury were classified as the late-stage intervention group. Demographic data, including the age of patients at the time of first treatment, age of scars at the time of first treatment, biological sex, ethnicity, Fitzpatrick skin type, and use of laser-assisted drug delivery, were collected by retrospective chart review. Patients were evaluated on six subjective scales and objectively for scar stiffness with durometry. For all scales, higher scores indicate worse scars. A two-way ANOVA, Student's t-test, and Mann-Whitney U-test were used to compare scores from the pre- to posttreatment evaluations. There were no significant differences between the groups for any of the demographic or scar-specific variables; thus, differences in outcome can be attributed to the timing of intervention. Both groups demonstrated an improvement in scars with treatment over time (p < 0.05). Both early- and middle-stage initiation showed scar symptom improvement in five out of six scales. In the late-stage intervention, the Patient and Observer Scar Assessment Scale-Patientaverage score did not show improvement. In the early-stage intervention, the Vancouver Scar Scaletotal did not show improvement. Quantitative evaluation of scar stiffness by durometry did not show symptom improvement in either group. The Scar Comparison Scaledemonstrated the greatest improvement across groups. Laser treatment led to scar improvement in at least one scale at each stage of initiation. Both intervention timelines resulted in equivalent outcomes, and early intervention should be considered when initiating FLSR treatment in burn scars to alleviate symptoms earlier.

Prospective Clinical Trial Demonstrating the Efficacy of Hyaluronic Acid Filler for the Improvement of Atrophic Facial Scars up to 2 years.

Hyaluronic acid (HA) filler longevity has been studied for wrinkles. However, its long-term use for treating atrophic facial scars has not yet been analyzed in long-term prospective studies. Analyze the safety and duration of a HA filler for the use in atrophic scars. Fifteen subjects received VYC-17.5L in atrophic scars on 1 randomized cheek and saline on the other, with 1 optional touch-up treatment and crossover after the short-term trial. Grading for this long-term extension was done on Day 720, using the Global Aesthetic Improvement Scale (GAIS) and the Quantitative Global Scarring Grading System. On Day 720, a live blind evaluator rated the VYC-17.5L assigned side as having significant reduction in scar severity (-7.2 [t(22) = -6.01, p = .00009]) and number of scars (-8.8 [t(22) = -6.25, p = .00006]) as compared with baseline. There was no significant difference in the results from Day 120 to Day 720. Ninety-two percent (11/12) of subjects reported improvement (GAIS), were satisfied with the treatment, thought it looked natural, and had fewer side effects than expected. There were no persistent or late-onset side effects. VYC-17.5L improved rolling atrophic facial scars, and the results were sustained throughout the 2-year trial without side effects.

Role of Vitamin C in Skin Aging Mechanism-A Narrative Review

Background: The cosmetics industry has seen significant growth due to the pursuit of beauty and the increasing demand for anti-aging agents. These agents, derived from active ingredients like polyphenols, retinol, and pro-xylane, are categorized into synthetic, plant, and fermentation components. Among these, synthetic components such as vitamins A, B, and C are widely used. Vitamin C has long been utilized in food and medicine for its beneficial effects, including its crucial role in collagen formation. The aging process, while slow and prolonged, is significantly influenced by vitamin C, making it an indispensable component for skin health. Objective: This study aimed to determine how vitamin C helps reduce aging and controls the mechanisms associated with skin aging. Methods: A comprehensive narrative review was conducted by synthesizing existing literature from electronic databases such as PubMed, Scopus, and Google Scholar. The search included keywords like "Vitamin C," "skin aging," "collagen synthesis," "oxidative stress," and "melanogenesis." Studies included were peer-reviewed, written in English, and published within the last 20 years. Both in vivo and in vitro studies were considered to assess the biochemical functions of vitamin C, its protective roles against UV radiation, and its therapeutic potential in various skin conditions. Data were critically analyzed, focusing on study designs, sample sizes, and statistical analyses. Results: Vitamin C was found to enhance collagen synthesis, with studies showing a significant increase in collagen production (Makrantonaki &amp; Zouboulis, 2007). Its antioxidant properties effectively neutralized reactive oxygen species, reducing oxidative stress and preventing DNA damage, with a reduction of ROS levels by 30-50% in UV-exposed skin cells (Rinnerthaler et al., 2015). Inhibitory effects on melanogenesis were observed, with vitamin C reducing melanin synthesis by 25% (Shimada et al., 2009). Additionally, therapeutic benefits were noted in treating acne, psoriasis, and hyperpigmentation, with a 40% improvement in acne scars (Chawla, 2014) and a 35% reduction in psoriasis symptoms (Soodgupta et al., 2014). Conclusion: Vitamin C plays a crucial role in maintaining skin health and combating aging through various mechanisms, including enhancing collagen synthesis, providing antioxidant protection, inhibiting melanogenesis, and treating skin diseases. Its consistent findings across multiple studies support its continued use in clinical and cosmetic dermatology. Further research with standardized methodologies is recommended to optimize its application and fully understand its potential.

Split face randomized, evaluator blinded study on the effect of multiple subcisions on rolling acne scars.

Acne scarring results from a common inflammatory condition present in many people. These scars can have an impact on quality of life by influencing self-esteem and social acceptance. Current acne scarring treatments, such as chemical peels and laser treatments, often have limited success due to their time-consuming nature and the variability of acne scar types. The subcision technique has shown promise for the treatment of rolling acne scars. There are few studies to date that examine the effects of multiple subcision treatments on rolling acne scars. We evaluated whether the use of multiple subcision treatments improved the appearance of rolling acne scars compared to no treatment. Five patients with rolling acne scars on both sides of their face who met inclusion and exclusion criteria were enrolled in the study. One side of the face was randomized to receive treatment, while the contralateral side of the face received no treatment. Subjects underwent five sequential subcision treatments, spaced 4 weeks apart, with two follow-up visits at weeks 20 and 36 from the 1st treatment. Photographs were taken before and after the initial treatment visit and at each subsequent visit. Acne scar appearance was evaluated by the subject, a blinded live rater, and two double-blinded dermatologist raters. Evaluations of treatment outcomes involved overall acne scar appearance on a 5-point scale, acne scar improvement on a percentage scale, a modified quantitative global scarring grading system, and potential treatment side effects. There was a greater decrease in global scarring scores in the multiple subcision side compared to the control side. There was a greater difference in the average acne scar appearance scores between the Week 36 follow-up visit and baseline for the multiple subcision side compared to that of the control side. 50% of patients reported being more satisfied with the treatment side compared to the control side in regard to overall improvement. The study results suggest that multiple subcision treatments may improve the appearance of rolling acne scars compared to no treatment.

Subcision with and without suction for acne scars: a split-faced, rater-blinded randomized control trial.

Therapeutic options for acne scars include subcision and suction with microdermabrasion, but these treatment modalities have not been studied in conjunction. To compare effectiveness of subcision alone versus subcision with suction for the treatment of facial acne scars. Randomized, split-faced, evaluator-blinded control trial. Participants underwent one subcision treatment on both sides of the face followed by 10 sessions of suction to one side. Photographs at baseline, 1-month, and 4-months were assessed. Primary outcome measures were the validated Acne Scar Severity Scale (ASSS) (0 = no acne scarring, 4 = severe), Acne Scar Improvement Grading Scale (ASIGS) (-100to100%), and modified Quantitative Global Scarring Grades (QGSG) (point-based questionnaire instrument), as well as subject preference. Twenty-eight treatment areas and 154 treatments were analyzed. Dermatologist raters found no differences between subcision alone and subcision-suction at 1-month or 4-months. Mean subject-assessed percent improvement for subcision-suction was higher than that for subcision alone at 1-month (37% versus 24%, p = 0.04) but not at 4-months (p = 0.37). Subjects preferred combination therapy to monotherapy at 1-month (50% vs. 21%) and 4-months (43%vs.21%). While blinded raters did not detect significant differences, subjects perceived combination treatment as working more quickly than monotherapy, and preferred combination treatment at all time points.Clinical trial registration NCT01696513 on Clinicaltrials.gov.

Poly‐d,l‐lactic acid‐enhanced atrophic scar treatment via transdermal microjet drug delivery in Asians

Acne vulgaris often results in permanent scars, with atrophic scars being the most common type and posing a significant therapeutic challenge due to their prevalence and impact on patients' quality of life. Various treatment options exist, including the use of poly-d,l-lactic acid delivered via different methods. This study aimed to assess the efficacy and safety of poly-d,l-lactic acid delivered via laser-assisted needle-free microjet injection for treating atrophic scars. Five Korean participants with atrophic facial scars were recruited. Poly-d,l-lactic acid solution was administered via the Mirajet system in five sessions, with clinical assessments conducted at baseline, before each session, and at 12-week and 22-week follow-ups. Outcome measures included the Global Aesthetic Improvement Scale and patient satisfaction scores. Positive results were observed at the 12-week and 22-week follow-ups, with high patient satisfaction and improvements in atrophic scars and skin texture. Mild discomfort and transient side effects were reported, with no adverse events observed during the follow-up period. Poly-d,l-lactic acid delivered by a laser-assisted needle-free microjet injector was judged to be effective for improving atrophic the facial area. Further research, particularly through randomized controlled trials, is needed to validate these findings and assess the longer-term safety and sustainability of outcomes.

Treatment of Acne Scars with Microneedling and Chemical Reconstruction of Scarred Skin Therapy (CROSS) Using Penol/Croton Oil Combination.

Microneedling has been shown to release growth factors, which improves the appearance of acne scars by itself and in combination with different therapy modalities. Combining microneedling with Chemical Reconstruction of Scarred Skin (CROSS) therapy using a 60% phenol and 0.2% croton oil combination results in a significant improvement of acne scarring. To assess the safety and efficacy of combination treatments using microneedling in combination with CROSS therapy that contains 60% phenol and 0.2% croton preparation in patients with Fitzpatrick skin types III to V.&nbsp; Materials and Methods: Patients were treated over a 5-year period for atrophic acne scars using microneedling combined with CROSS. Most of the patients had combination atrophic scarring. High-quality before and after photographs were taken of the patients to assess the improvement in the scars.&nbsp; Results: Most of the patients (89.5%) had Fitzpatrick skin types IV through V.&nbsp; Analysis was done on a maximum of 3 microneedling sessions with 1 to 3 CROSS sessions. Photographic evaluation using the Global Aesthetic Improvement Scale showed an 18% grade-1 improvement and 81% grade-2 improvement. The Goodman and Baron Qualitative scar grading system showed a 62% grade-1 improvement and 38% grade-2 improvement. Combination treatments work best for atrophic scars. This is the first published report of using microneedling with a 60% phenol/0.2% croton oil combination. It proved to be very effective and safe in treating atrophic acne scars in Fitzpatrick skin types III to V, with minimal side effects and a quick recovery. J Drugs Dermatol. 2024;23(6):418-422.&nbsp; &nbsp;&nbsp; doi:10.36849/JDD.7657.

Shedding Light on Acne Scars: A Comprehensive Review of CO2 vs. Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser Therapy.

Acne scars pose a significant cosmetic concern and can have a profound impact on individuals' self-esteem and quality of life. Laser therapy has emerged as a promising treatment modality for improving the appearance of acne scars by promoting collagen remodeling and tissue regeneration. This comprehensive review compares two commonly used laser modalities, CO2 and erbium-doped yttrium aluminum garnet (Er:YAG), focusing on their mechanisms of action, efficacy, safety profiles, and patient outcomes. While CO2 lasers offer deeper tissue penetration and the potential for more significant improvement in severe acne scars, Er:YAG lasers provide a gentler approach with a lower risk of post-inflammatory hyperpigmentation. Recommendations for clinical practice include tailoring treatment approaches to individual patient characteristics, educating patients about treatment expectations and post-treatment care, considering combination therapies for enhanced outcomes, and implementing regular follow-up care. Areas for further research include long-term outcome studies, investigation of laser therapy in ethnically diverse populations, exploration of combination therapies, and evaluation of emerging laser technologies. This review aims to provide clinicians and patients with valuable insights to inform treatment decisions and optimize outcomes in managing acne scars.

Efficacy of autologous platelet rich plasma with subcision vs platelet rich plasma with microneedling in atrophic acne scars: A single-center, prospective, intra-individual split-face comparative study.

Severe post-acne scarring has been implicated as a cause of considerable psychological distress, mainly among adolescents. Subcision and microneedling are cutting-edge treatment options available nowadays. In this study, we aimed to compare the efficacy of microneedling with platelet-rich plasma (PRP) against subcision with PRP in treating atrophic post-acne scars in a split-face study design. Fifty patients with atrophic post-acne facial scars were included in this prospective interventional study. Group A included the left side of the face managed by microneedling with PRP and group B included the right side of the face that was subjected to subcision with PRP. Results were assessed based on Goodman and Baron qualitative and quantitative grading. In our study, at the end of the treatment, on the left side, 5 (10%) had 1 grade of improvement showing good response, 35 (70%) had 2 grades of improvement showing very good response, and 10 (20%) had 3 grades of improvement showing excellent response. On the right side, 1 (2%) patient had no improvement in acne grade showing poor response, 9 (18%) had 1 grade of improvement showing good response, 25 (50%) had 2 grades of improvement showing very good response, whereas 15 (30%) had 3 grades of improvement showing excellent response. Till date, apart from ours no other study has compared the two modalities head-to-head with adjuvant PRP in both groups. Although both modalities showed statistically significant results individually, there was no significant difference in qualitative improvement of acne scars between the two groups.

Maintenance Acne Treatment With Topical Tazarotene after Oral Isotretinoin: Overview and Case Reports

Introduction: Acne vulgaris is a common dermatologic disorder that may require treatment over months or years. Acne negatively impacts quality of life, and acne of any severity increases the risk of long-term sequelae such as scarring. Common treatments for severe/nodulocystic acne include oral isotretinoin, an oral antibiotic combined with a topical (benzoyl peroxide or a retinoid), an oral combined contraceptive, or oral spironolactone (females). Though oral antibiotics and isotretinoin are not recommended for long-term use, there is scarce guidance or published research on maintenance therapy. Topical retinoids—a mainstay of initial acne treatment—may be prescribed for maintenance once initial oral treatments are complete. Additionally, some retinoids such as tretinoin and tazarotene are indicated for the treatment of fine wrinkles and certain pigmentation disorders, and some studies have shown that adapalene and tazarotene may also reduce acne-induced scarring. Tazarotene 0.045% polymeric emulsion lotion is a well-tolerated retinoid that has demonstrated efficacy in acne treatment and may reduce acne-induced post-inflammatory hyperpigmentation (PIH) and melasma. Further, tazarotene lotion provides rapid and sustained improvements in skin barrier function/moisturization. Herein is presented a report of patients with acne who received maintenance treatment with topical tazarotene 0.045% lotion after an initial course of oral isotretinoin.&#x0D; Methods: Patients with severe recalcitrant acne vulgaris were treated with once daily oral isotretinoin for at least 20 weeks until deemed clinically clear. All patients received 40 mg isotretinoin once daily for the first 30 days. The dosage was then increased to 1 mg/kg of bodyweight (treatment naïve) or 1.5 mg/kg (repeat treatment). After 20 weeks, patients who achieved clinically clear skin initiated once-daily topical tazarotene 0.045% lotion monotherapy on the day of their last isotretinoin dose. Follow up visits occurred at 6 months and 1-year post-isotretinoin treatment.&#x0D; Results: Patients (n=12) had a mean age of 17.8 years (standard deviation [SD]: 3.8) and the majority were female (58.3%) and White (66.7%). Oral isotretinoin was used for an average of 24.3 weeks (SD: 6.7), with a mean cumulative dose of 184.6 mg/kg. One patient required a repeat course of isotretinoin prior to tazarotene initiation. Post-isotretinoin, patients received tazarotene 0.045% lotion for an average of 13.0 months (SD: 6.7). No patients relapsed and all showed subjective visual improvements in acne-related scarring with tazarotene maintenance treatment. None discontinued tazarotene lotion due to adverse events. &#x0D; Conclusions: There is little guidance or research published on acne maintenance treatment after initial oral isotretinoin or other treatments are complete. Topical tazarotene 0.045% polymeric emulsion lotion has previously demonstrated good efficacy, safety, and tolerability with acne and PIH reductions in patients with moderate-to-severe acne, as well as dyspigmentation reductions in patients with melasma and/or PIH. The case reports presented here show that tazarotene 0.045% lotion may be an effective and safe treatment to prevent relapse after initial oral isotretinoin treatment for severe recalcitrant acne.&#x0D; Funding: Ortho Dermatologics

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars.

The picosecond laser was primarily designed to enhance tattoo removal. Because it has a new innovative mechanism for energy delivery, it has been modified to be used in other conditions such as skin resurfacing, which was usually treated with fractional CO2 laser. Comparing both technologies in managing postburn scars has not been widely addressed. The current prospective comparative randomized intrapatient study was done on 15 patients who presented with unsightly postburn scarring. As a split study, one-half of the affected areas were treated using the picosecond Nd: YAG laser. The other areas were treated with a fractional CO2 laser. After three treatment sessions, the results were analyzed both objectively and subjectively. The assessment by the image analysis system (Antera camera) showed improvement in all the parameters in both groups. The melanin relative variation decreased from 11.65 ± 2.86, 15.85 ± 5.63 to 10.60 ± 1.96, 12.56 ± 3.98, respectively in picosecond laser sites and fractional CO2 sites. The percentage change in overall opinion decreased in in favor of the fractional CO2 laser sites, which is a statistically significant improvement. Instead, color scores revealed a greater reduction in the picosecond sites in comparison with the fractional CO2 sites, as it decreased from 7.67 ± 1.76, 7.73 ± 1.83 to 2.87 ± 1.06, 6 ± 1.2, respectively. When compared with fractional CO2 lasers, picosecond Nd:YAG shows comparable improvements in scars' erythema, texture, and height, with some superiority in the management of hyperpigmented scars.

Surgical Correction of Depressed Scars After Upper Blepharoplasty: A Turnover Orbicularis-Septum Composite Flap Technique.

Depressed scarring is a common complication after incisional upper blepharoplasty and frequently contributes to patient dissatisfaction. Correcting this deformity presents a significant challenge for oculoplastic surgeons. This study aims to investigate the clinical effectiveness of employing the turnover orbicularis-septum composite flap technique in correcting depressed scars after double eyelid surgery. This is a retrospective study of 118 patients who underwent revision blepharoplasty with depressed scar from November 2020 to February 2023. During the revision procedure, the adhesions of the original scar were meticulously dissected, and the residual orbital fat was thoroughly released. The orbicularis-septum composite flap was then inverted downward and smoothly laid over the depressed scar area to address the tissue deficit. After surgery, patient satisfaction was evaluated by assessing the improvement of the depressed scars and the shape of the double eyelid folds. Follow-up assessments were conducted over a period of 6 to 24 months postoperatively. The results were judged as fully satisfied in 78 cases (66.1%), basically satisfied in 32 cases (27.1%), and unsatisfied in 8 cases (6.8%). Among the unsatisfied patients, 5 patients complained of eyelid fold shallow or disappear, and 3 patients complained of asymmetry. All patients exhibited varying degrees of improvement in the depressed scars. The turnover orbicularis-septum composite flap technique provides an effective approach for the treatment of depressed scars with a high satisfaction rate.

Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients.

To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting. The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars. A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomescompared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatmentand one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management. FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.

Is Botox or Dermabond Superior in the Appearance of the Lip Scar After Primary Cleft Lip Repair and Revision? A Systematic Review and Meta-Analysis

Background: Cleft lip scar formation is an inevitable consequence of cleft lip repair (CLR) and is exacerbated by the dynamic movement of the middle face. Various methods to correct or prevent these deformities have been described including silicone sheeting, surgical revisions, laser therapy, and more recently, Botulinum toxin-A (Botox) and Dermabond. This study aims to analyze and compare the impact of Botox versus Dermabond on scar appearance after CLR. Methods: Following PRISMA guidelines, a systematic review was performed on Medline, Embase, Cochrane, and CINAHL using the following keywords: “Dermabond,” “botulinum toxin,” and “cleft lip.” Outcomes of interest were the rates of scar hypertrophy, scar width, Vancouver scar scale (VSS), visual analog scale (VAS), Hollander wound evaluation scale (HWES), and complications. Results: Nine studies were included of which 4 articles analyzed Botox and 5 analyzed Dermabond. Forest plots for scar width at the first and second time point supported the use of Botox to achieve a smaller scar width with P &lt; .0001 (95% CI: −1.09 [−1.56 to −0.63] and 95% CI: −0.94 [−1.37 to −0.50], respectively). A significant increase in VAS was observed with Botox (95% CI: 1.66 [1.27-2.05], P value &lt; .0001) and VSS was insignificant. Of the articles that analyzed Dermabond, scar appearance was comparable to the traditional suture closure group. There were no feeding complications for either intervention. Pooled forest plots for VAS comparing Botox and Dermabond supported the use of Botox with improved VAS (95% CI: 1.66 [1.27-2.05], P &lt; .0001) compared to Dermabond (95% CI: 0.07 [ −0.48 to 0.61], P = .80). Conclusions: The current literature supports the use of Botox for scar improvement following CLR or revision. However, there is limited data to support Dermabond’s utility in improving scars in CLR, which highlights the need for further studies.

Microneedling in the Treatment of Post-burn Hypertrophic Scars.

Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction,is an affordable minimally invasive option that can be combined with other treatments, including ablative ones. The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns. A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints. A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012). Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .