| DERMATOLOGY | PEER-REVIEW Soft tissue filler use for
acne scarring would be an attractive option to most practitioners as they require little invasive technique.
form HA has a short duration time in the tissue, owing
to enzymatic degradation and free radical metabolisation. To avoid these effects, HA gel is modified through cross-linking to form a water-insoluble polymer hydrogel, more resistant to degradation, but with a similar biocompatibility as non-modified HA. Based on the experience of other authors, many of the available HA preparations are too short-lived (approximately 3–6 months24, 25
to appropriately treat moderate to severe
acne scars) and use of such products for this purpose would require a significant total injection volume over time, with frequent re-treatments, contributing to a greater total cost and time commitment for the patient. More viscous forms of HA, such as Perlane (Medicis
Aesthetics, Inc., Scottsdale, AZ) or Juv• derm VOLUMA (Allergan, Inc., Santa Barbara, CA), may be appropriate for patients with atrophic scars. The ideal filler for this purpose would be long-lasting, biocompatible, and would not elicit further inflammation or granuloma formation in skin already damaged by acne26
. Soft tissue filler use for acne scarring would be an
attractive option to most practitioners as they require little invasive technique and could be used in combination with other treatment modalities, such as microneedling or laser resurfacing. Although studies have shown that HA injections do stimulate collagen formation in the short term, this effect is probably more related to the physical act of injection, rather than to the HA itself. Subcision is a term introduced by Orentreich and to describe the minor surgical procedure for
Orentreich27
treating depressed acne scars and wrinkles, using a hypodermic needle inserted through a puncture in the
prime-journal.com | March 2013 ❚
Figure 3 23-year-old female patient (A) during treatment with Radiesse, and (B) 2 weeks after treatment
skin surface and its sharp edges manoeuvred under the defect to make subcuticular cuts or ÔcisionsÕ . The principle of this procedure is to break the fibrotic strands, which tether the scar to the underlying subcutaneous tissue. The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms during the course of normal wound healing28
.
Methods A series of 27 patients (17 male, 10 female; skin phototypes I–IV), with varying degrees of atrophic acne scarring, were treated in a single-centre, prospective, controlled study over a 1-year period. Patients were randomly selected on the basis that they did not want to present for laser resurfacing as a treatment for their problem. This
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