CO2 Ablative Fractional Resurfacing for Deep Acne Scarring
For many acne patients, the resulting acne scars which last long after the pimples have disappeared can cause considerable psychosocial distress. Now, a new study recently published in Lasers in Surgery and Medicine (August 2008 issue), the peer-reviewed professional journal of the American Society for Laser Medicine and Surgery, shows that a novel laser device combining CO2 ablation with the principles of fractional photothermolysis can significantly improve the appearance of acne scarring without compromising patient safety.
In the article entitled “Successful Treatment of Acneiform Scarring with CO2 Ablative Fractional Resurfacing,” laser expert Anne M. Chapas, MD, assistant professor of dermatology at New York University School of Medicine in New York, NY, reports that patients in her study experienced a mean level of improvement of 66.8% in the appearance of moderate to severe acne scars with this new ablative technology. According to dermatology experts, a good rule of thumb is a 30 percent to 50 percent improvement in acne scarring.
Lasers in Surgery and Medicine
Successful Treatment of Acneiform Scarring with CO2 Ablative Fractional Resurfacing
In the past, traditional CO2 ablative lasers sandblasted the skin away, resulting in substantial downtime, possible skin discoloration and other potential risks for the patient
With ablative fractional resurfacing technology, we deposit a pixilated pattern of microscopic ablative wounds surrounded by healthy tissue. Similar to fractional photothermolysis, this treatment preserves the epidermis and greatly reduces side effects. Thus, we have the increased efficacy of ablative techniques with the safety and reduced downtime associated with nonablative laser techniques.
Overall, patients were highly satisfied with their outcomes, as well as with the reduced downtime and safety profile. No delayed onset of hypopigmentation or permanent scarring was observed
After we perform one treatment, we wait to see how the newly stimulated collagen fills in the scar over the course of the next few months to determine if an additional treatment is needed. The good news is that most patients rarely require a second treatment.
Dr. Chapas explained that acne scars are the result of compromised collagen production during the natural wound healing process, resulting in topographical depressions that are quite common in acne patients. Without using treatments capable of affecting dermal remodeling at least 1 mm below the skin surface, acne scars — particularly deep “ice pick” scars — can be difficult to treat effectively.
“In the past, traditional CO2 ablative lasers sandblasted the skin away, resulting in substantial downtime, possible skin discoloration and other potential risks for the patient,” said Dr. Chapas, who is in private practice at the Laser & Skin Surgery Center of New York. “With ablative fractional resurfacing technology, we deposit a pixilated pattern of microscopic ablative wounds surrounded by healthy tissue. Similar to fractional photothermolysis, this treatment preserves the epidermis and greatly reduces side effects. Thus, we have the increased efficacy of ablative techniques with the safety and reduced downtime associated with nonablative laser techniques.”
The prospective study examined 13 patients with moderate to severe acne scars who had undergone a series of two to three treatments with the CO2 ablative fractional resurfacing device at one to two month intervals. Patients had Caucasian to light Hispanic and Asian skin types and were 28 to 58 years old. Improvements in texture, atrophy, plus the patients’ overall satisfaction with their appearance, were graded on a quartile scale by study subjects and investigators after each treatment, and at one and three months after the final treatment. Post-treatment redness, swelling, skin discoloration and other side effects were also graded. A special camera that allows for three-dimensional optical profiling was used to measure the depth of acne scars pre- and post-treatments.
Study results showed that patients and investigators both noted a 26%-50% improvement in the texture, atrophy, and overall appearance of acne scarring, with only mild to moderate side effects reported that resolved quickly during the study period. Further, the three-dimensional optical profiling system showed that all patients experienced quantifiable objective improvement in the depths of acne scars that ranged from 43% to 79.9%, with a mean level of improvement of 66.8%.
“Overall, patients were highly satisfied with their outcomes, as well as with the reduced downtime and safety profile. No delayed onset of hypopigmentation or permanent scarring was observed,” said Dr. Chapas. “Despite our small sample size, we did notice clinical trends in the patient’s response to various treatment energies. For example, patients who received higher energy levels on deep scars of the cheeks during the second and third treatments received the highest improvement scores. All four of these patients showed average overall improvement in the 51%-75% range three months after their final treatment.”
Although the study was designed using a series of treatments to improve acne scarring, Dr. Chapas noted that in her practice one treatment with CO2 ablative fractional resurfacing is usually sufficient to produce a noticeable improvement. “After we perform one treatment, we wait to see how the newly stimulated collagen fills in the scar over the course of the next few months to determine if an additional treatment is needed. The good news is that most patients rarely require a second treatment.”
Dr. Chapas added that future studies are needed to address parameters in treating patients with darker skin, who are prone to pigmentation problems following ablative treatments. In the study, the darkest skin types treated were Asian and lighter Hispanic patients.
The American Society for Laser Medicine and Surgery (ASLMS) is the world’s preeminent resource for laser research, safety, education, and clinical knowledge. Founded in 1980, ASLMS promotes excellence in patient care by advancing clinical application of lasers and related technologies. For more information and physician referrals, visit www.aslms.org.
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