Arch Facial Plast Surg. 2005 Jul-Aug;7(4):251-5

Authors: Carniol PJ, Vynatheya J, Carniol E

OBJECTIVE: To evaluate the efficacy of treatment of established acne scars with a sequential combination of treatment using a 1450-nm, midinfrared, nonablative diode laser with dynamic cooling spray and 30% trichloroacetic acid peels.

METHODS: In this prospective study 9 patients with atrophic rolling, boxcar, or both types of scars received 4 monthly treatments using a 1450-nm, midinfrared, nonablative, diode laser with dynamic cooling spray followed by 2 bimonthly treatments with 30% trichloroacetic acid peels. Blinded evaluators and the patients rated the results.

RESULTS: The group of patients in this study had a greater improvement in their acne scars than has been reported for nonablative laser treatments by other authors. Comparing the results of treatment 2 months after the laser treatments with 2 months after the chemical peels, the patients had a greater improvement after the additional chemical peels. There were no complications in this study. The patients were able to continue all of their regular activities throughout the study.

CONCLUSION: This sequential treatment regimen using the 1450-nm, midinfrared, nonablative diode laser with dynamic cooling spray and 30% trichloroacetic acid peels produced a noticeable improvement in the acne scars without any associated morbidity.

PMID: 16027346 [PubMed - indexed for MEDLINE]

AAD launches today include the Aesthera’s acne system with the peer reviewed clinical paper titled “Treatment of Acne with Photopneumatic Therapy,” by Tina S. Alster MD et al. The paper studies the clinical efficacy of Photopneumatic Therapy for the treatment of mild to severe facial acne. “Our study noted greatest improvement in patients with severe acne. We are pleased with treatment outcomes, especially for severe acne,” said study co-investigator Dr. Alster. The study was performed using Aesthera’s ISOLAZ system, the only FDA cleared device for the treatment of Comedonal and Pustular Acne.

Aesthera is launching Profusion(TM) – (Pro for Professional and Fusion is a Combination) – a skin therapy that combines the Photopneumatic light treatments with the delivery of Aesthera’s proprietary skincare to enhance skin treatment outcomes for acne, skin rejuvenation and body tightening. “Profusion’s novel mechanism has tremendous therapeutic potential for innovative new applications. We are very excited about its clinical potential,” says Vic Narurkar, MD, Chair of Dermatology at the California Pacific Medical Center (CPMC) in San Francisco, CA. “Profusion Skin Therapy is the fastest growing procedure in our practice. We routinely perform it in combination with the majority of skin treatments we offer,” he adds. New applications of the technology include body tightening and skin lightening.

Body Tightening Technology. What’s it all about?

It is about Photopneumatic(TM) Technology, a delivery mechanism, and the applicator that will allow for high treatment precision and focused energy delivery. The patient benefits of Aesthera’s unique solution will be fast, painless, and extremely precise treatments.

Photopneumatic Therapy, that powers the Isolaz(TM) and Isolaz Pro(TM) system, is a proprietary combination of pneumatic energy and broad band light. Photopneumatic devices are the only laser or light based devices cleared by FDA for the treatment of inflammatory acne, comedonal acne and pustular acne. They are also cleared for the treatment of mild to moderate inflammatory acne. Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic Therapy is also cleared for the treatment of benign vascular and pigmented lesions and hair removal.

This is a short review of a new study by a group of Indian reserchers:
Kubba R, Bajaj AK, Thappa DM, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar AJ, Khopkar U, Kohli M, Kuriyipe VP, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu KK, Sacchidanand S, Sharma VK, Thomas J. Acne in India: Guidelines for management – IAA Consensus Document: Acne scars. Indian J Dermatol Venereol Leprol 2009;75(Suppl 1):S52-S3. Available from: http://www.ijdvl.com/text.asp?2009/75/7/52/45487 .

LaserOffers.com reviewed the part of the study that directly pertains to our focus on the use of lasers.

Acne scars are classified as atrophic and hypertrophic. Atrophic acne scars are further classified as ice-pick, rolling, and boxcar. The European acne group (ECCA) has renamed the atrophic acne scars as V-shaped (ice-pick), U-shaped (boxcar), and W-shaped (rolling). Scar characteristics can be further assessed with specialized techniques such as silicon elastomer mold which is then examined under a light microscope. Proper classification of acne scars is essential to assess the severity of cosmetic disfigurement and to choose the appropriate therapeutic intervention.

Resurfacing techniques

These include TCA peeling, phenol peeling, microdermabrasion, laser abrasion, selective thermolysis with Fraxel laser, and resurfacing by radiofrequency and electrosurgery.

The objective of any of the skin/scar resurfacing treatments is to restore skin contour by inducing neocollagenosis (new collagen growth). Resurfacing is indicated in U and W scars. The main complication is erythema which persists for weeks. There is also risk of pigmentation.

Spot TCA peeling is a good technique for V and deep U scars. A sharp stick (toothpick) soaked in 62% or 100% TCA is brought in contact with the target and the contact is maintained till whitening appears. It is a painful procedure and multiple sessions are required.

Microdermabrasion involves planing of the skin by mechanized means utilizing the projection of micromarbles consisting of aluminum oxide on scars. Six to seven sessions, at two week intervals are needed. In one session, twenty passes are made on each area until superficial bleeding appears. Six to seven session microdermabrasion has low efficacy and may be useful in superficial U scars. Chemabrasion is when microdermabrasion is combined with a peeling agent.

Lasers are increasingly being used to treat acne scars. Intense Pulse Light (IPL) acts by heating the dermis and stimulating neocollagenosis. It has weak activity and may be helpful in red, hypertrophic scars. Light-Emitting Diode (LED) does not warm but acts by photomodulation. It is a safe and painless procedure but the efficacy is low. It is being used for superficial U scars, erythema (acne macules), and pigmentation. Ablative laser resurfacing, although effective, is associated with excessive tissue reaction as erythema and edema, and complications such as pigmentation and scarring. It is less suited for skin types V-VI. Fractional photothermolysis, a new concept, using 1,550-nm erbium-doped fiber laser (Fraxel® ) appears to be very promising. Fractional photothermolysis creates microscopic thermal wounds to achieve skin rejuvenation without significant side effects. In a study from USA, 53 patients (skin types I-V) with mild to moderate atrophic facial scars were treated with three treatment sessions at monthly intervals. Clinical improvement averaged 51-75% in nearly 90% of patients. Clinical response rates were independent of age, gender, or skin type. Side effects included transient erythema and edema in most patients, but no dyspigmentation, ulceration, or scarring. It was concluded that atrophic scars can be effectively and safely reduced with 1,550-nm erbium-doped fiber laser. Fractional thermolysis is an expensive treatment, and typically 4-8 sittings are required depending on the depth of scars. A single treatment with Fraxel® in the U.S. may cost $1,500.