| DERMATOLOGY | PEER-REVIEW


Figure 1 Active acne and acne scar (A) before and (B) after three treatments with microneedle radiofrequency


scars, hypertrophic scars, and keloids11,12


. Ice-pick scars


have a narrow aperture and penetrate deep into the dermis or subcutaneous tissue. Boxcar scars have sharp cliff-drop-like vertical margins and a larger, flatter base. Boxcar scars can be further subdivided into superficial and deep boxcar scars. Rolling scars occur from dermal tethering to the underlying superficial musculoaponeurotic system, with the appearance of gently sloping edges12


. Chemical peels, subcision, augmentation using dermal


fillers, ablative and non-ablative lasers, dermabrasion, dermal grafting, punch excision, punch elevation, punch grafting, and surgical excision are all available for the treatment of acne scarring11–13


. The following lasers


improvement in acne scarring after five treatments over a 1-month period using the fractionated 1550 nm erbium-doped laser 21


. A meta-analysis reported that acne scars improved at


least 50% with four to five treatments per month using a fractionated non-ablative laser22


improvement after a single treatment with a fractionated CO2


laser, and in a study by Chapas et al24 The technology of


microneedling with fractional RF might be a good step


have also all been applied for acne scarring: ■ Pulsed dye laser14 ■ Non-ablative 1064 nm Nd:YAG15 ■ Non-fractionated 1320 nm Nd:YAG ■ Non-fractionated 1450 nm diode14,16 ■ Erbium-doped lasers (1410 nm, 1540 nm, and 1550 nm) ■ Fractionated 1320/1440 nm ■ Fractionated 2940 nm Er:YAG laser ■ Fractionated 10600 nm CO2


laser17 full-face CO2 .


studiesshowing more favourable results with CO2 The non-fractionated, high-energy, pulsed CO2


The standard treatment for acne scarring is traditional, or Er:YAG laser resurfacing, with lasers18 laser


.


improves acne scars by an average of 80% with a single treatment 18


. Although ablative laser resurfacing produces


the most dramatic improvement in acne scarring and texture, there is a significant risk of dyspigmentation, scarring, infection, and prolonged healing19


.


The first publication on fractionated laser resurfacing was by Manstein et al in 200420


. Fractional


photothermolysis had the advantage over ablative laser resurfacing owing to a shorter recovery, lack of general anaesthesia, and lower risk of scarring, dyspigmentation, and infection13


forward owing to efficacy and safety of the procedure in all skin types.


.


by an average of 66.8%. Peterson et al25


. After the development


of fractionated non-ablative lasers, fractionated ablative lasers emerged. Cho et al23


treatments with a fractionated CO2


found an average of 60% , two to three laser improved acne scarring reported


improvements in acne scarring and texture of more than 60% with five treatments per month using a combination of fractionated laser with RF device and a fractionated bipolar RF


device. The improvement of scarring is comparable with those of other non-ablative fractionated lasers. Rolling scars and boxcar scars improved more dramatically than ice-pick scars 25


Advantages of MRF One of the greatest advantages of MRF is its application in all skin types26


. Patients with Fitzpatrick skin


Figure 2 Active acne and acne scar (A) before and (B) after three treatments with microneedle radiofrequency


. Although originally described for


rejuvenation of the ageing face, this concept was soon applied to acne scarring. In a small cohort of skin types IV–VI, 80% of patients had a minimum of 50–75%


prime-journal.com | June 2013 ❚


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