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PEER-REVIEW | DERMATOLOGY |


WITH MICRONEEDLING TO TREAT


FRACTIONAL RF A ACNE ANDCNE SCARS


Ashraf Badawi, Belkais Marwan, and Soheila Tirzan discuss the use of this procedure, its mechanism of action, efficacy, and treatment outcomes for acne scars and active acne


ABSTRACT The demand for safe and effective rejuvenation technology has increased tremendously over the last few years. The reasons behind this may be the increased awareness of the different products and procedures used for rejuvenation. A large part of this increased awareneness can be credited to the marketing activities of service providers and the manufacturers of products. A significant challenge and a large part of the rejuvenation market are acne scars. Proper management of active acne to prevent scar formation, as well as therapeutic modalities to improve existing scars, are a big concern for aesthetic service providers. One of the new methods of rejuvenation, which gathers both the efficacy and relative safety, is a technology involving fractional radiofrequency and microneedling.


ASHRAF BADAWI, MD, PHD, Medical Laser Applications Department, National Institute of Laser Enhanced Sciences, Cairo University, Egypt; Lakeshore Woods Laser Center, Oakville, ON, Canada and Kuwait City, Kuwait; BELKAIS MARWAN, MD, Advanced Speciality Clinics, Dubai, UAE; SOHEILA TIRZAN, RN, Lakeshore Woods Laser Center, Oakville, ON, Canada and Kuwait City, Kuwait


email: ashrafbadawi@hotmail.com


O


KEYWORDS fractional radiofrequency, microneedling, acne vulgaris, acne scars


52 ❚


VER THE LAST 5–10 YEARS, demographic changes have resulted in increased demand for aesthetic procedures to address the effects of intrinsic ageing, excessive sun exposure, and other factors that


contribute to unwanted skin laxity and an accelerated appearance of rhytides. This has driven an increase in the popularity of energy-based devices for the treatment of a variety of skin conditions. To reduce the appearance of


wrinkles, physicians have turned to a number of treatment options, ranging in degree of invasiveness and side-effect profile. These include treatment with topical retinoids, chemical peels, microdermabrasion, non-invasive and invasive energy-based devices, and surgical reconstruction1–7


. Unlike ablative lasers, fractional


laser treatment has been shown to be clinically efficient in managing acne scars and other dermatologic


June 2013 | prime-journal.com


diseases with cosmetic problems, without causing direct damage to the epidermis8


. Although conventional


fractional treatment has the disadvantages of inaccurate depth control and possible indirect damage to the epidermis, recently introduced, minimally-invasive, fractional microneedle radiofrequency (MRF) devices have been used to overcome such problems by creating radiofrequency (RF) thermal zones with minimal epidermal injury9


. Using the microneedle delivery


system, it is possible to deliver an exact amount of RF energy at accurate depths and at the discretion of the operator. After damage to the reticular dermis, long- term dermal remodelling, neoelastogenesis, and neocollagenesis result in dermal thickening10


. In 2008, the US Food and Drug Administration (FDA)


approved fractional RF for skin rejuvenation, which can achieve fractional and contiguous treatment patterns, while sparing the epidermis and key adnexal structures that contribute to rapid healing. In addition to skin rejuvenation, fractional RF has been reported to induce textural improvement with regard to skin smoothness and tightness10


. In 2008, the FDA


approved fractional RF for skin rejuvenation, which can achieve fractional and


contiguous treatment patterns while sparing the epidermis and key


adnexal structures that contribute to rapid healing.


Fractional radiofrequency with microneedling in acne scars Acne can result in a variety of subtypes of scars; depending on the depth and severity of the inciting inflammation. Atrophic scarring limited to the epidermis and papillary dermis results in superficial macular scarring, which may be erythematous or hyperpigmented11


. Involvement of the


reticular dermis can result in ice-pick scars, boxcar scars, rolling


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