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Attia E. Atrophic Postacne Scar Treatment: Narrative Review. JMIR DERMATOLOGY 2024; 7:e49954. [PMID: 38381492 PMCID: PMC10918545 DOI: 10.2196/49954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/16/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.
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Affiliation(s)
- Enas Attia
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Dermatology, Ain Al Khaleej Hospital, Abu Dhabi, United Arab Emirates
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Lotfi E, Kaveh R, Nezhad NZ, Iranmanesh B, Hosseini SA, Ahramiyanpour N. Endo-radiofrequency subcision in the treatment of acne scars: a pilot investigative study. Lasers Med Sci 2023; 38:154. [PMID: 37400740 DOI: 10.1007/s10103-023-03819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Acne vulgaris is a common condition, mostly involving teenagers. Post-acne scarring can cause many psychosocial problems. Treatments include topical agents, chemical peels, ablative lasers, fractional lasers, and more invasive approaches like subcision and surgery. We aimed to build on data regarding the efficacy and safety of endo-radiofrequency subcision in treating acne scars. This trial involved 30 patients (26 females and 4 males) suffering from acne scars. Patients were treated with endo-radiofrequency subcision. Outcomes were measured by Goodman and Baron scores (GBA), Patient's Global Assessment (PGA), and Investigator's Global Assessment (IGA). All 30 patients completed the trial. The mean baseline quantitative Goodman and Baron score was 13.2 ± 4.31, which improved to 5.37 ± 2.83 by the end of the study (P < 0.001). A significant improvement was also noted in the Goodman and Baron qualitative assessment of acne scars (P < 0.001). According to the PGA, the improvement rate was 25-50% in most patients (60%), while according to the IGA, the improvement rate was 25-49% in most patients (50%). Eleven patients (36.7%) were satisfied with the treatment process, while the other 19 patients (63.3%) were very satisfied. Side effects were minimal and transient. A single session of endo-radiofrequency subcision is a fairly safe and effective treatment, with a high satisfaction rate among treated patients.
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Affiliation(s)
| | - Roxana Kaveh
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Behzad Iranmanesh
- Department of Dermatology, Afzalipour Faculty of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | | | - Najmeh Ahramiyanpour
- Department of Dermatology, Bushehr University Of Medical Sciences, Bushehr, Iran.
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Lobo Y, Lim DS. Surgical Subcision for Acne Scars: A Review of Instrumentation. Dermatol Surg 2023; 49:355-362. [PMID: 36943759 DOI: 10.1097/dss.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Subcision is a surgical technique for managing atrophic acne scars. Over time, new instruments have emerged to increase the efficiency, efficacy, and safety of the subcision procedure, including sharp, blunt, and energy-assisted devices. OBJECTIVE To review the instrumentation used for the subcision of acne scars and to provide clinicians with practical information regarding the selection of instrumentation, with a focus on advantages and disadvantages. METHODS A search of PubMed, MEDLINE, and Google Scholar was conducted for articles from January 2000 to June 2022 describing the use of subcision alone for the management of acne scarring. Demographic and clinical data were collected from the included articles. RESULTS A total of 417 patients from 17 articles were included; 155 patients underwent sharp subcision, 235 patients underwent blunt subcision, and 27 patients underwent energy-assisted subcision. The main indication for subcision was atrophic facial acne scars. Subcision using sharp, blunt, and energy-assisted instruments were all effective in treating atrophic acne scars. Adverse effects common to all subcision methods included erythema and edema. CONCLUSION Subcision is a safe and effective modality for the revision of selected acne scars and is a valuable skill set for dermatologists who perform scar revision to master.
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Affiliation(s)
- Yolanka Lobo
- Department of Dermatology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Ahramiyanpour N, Rastaghi F, Parvar SY, Sisakht AK, Hosseini SA, Amani M. Subcision in acne scarring: A review of clinical trials. J Cosmet Dermatol 2023; 22:744-751. [PMID: 36315903 DOI: 10.1111/jocd.15480] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/23/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
Post-acne scarring is the most common permanent consequence of acne vulgaris. Subcision is an intervention in which a needle or blunt cannula is inserted under the scar and moved back and forth to cut fibrotic strands and form new connective tissue, thereby elevating the atrophic scars. In this study, we reviewed the efficacy and adverse effects of different subcision techniques alone or in combination with other modalities to manage acne scars. The terms (subcision), (subcision AND acne scar), and (subcision AND scar) were searched in PubMed and Google Scholar. We included all available reports on clinical trials written in English and published before June 2022. A total of 16 relevant articles were identified after reviewing the abstracts and full texts. Four articles compared blunt cannula-based subcision as a modified technique with needle-based subcision as a conventional method, while the others investigated the combination of subcision with other modalities. According to our findings, subcision is a safe and effective method for treating atrophic acne scars. Needle-based subcision and cannula-based subcision offer comparable efficacy, with the latter causing fewer side effects and inducing greater patient satisfaction. Combining subcision with the application of autologous tissues (platelet gel) or artificial materials (hyaluronic acid gels and threads) as fillers can improve outcomes and prevent the re-depressing of scars, as can its combination with frequent suctioning. Combinations with microneedling or fractionated microneedle radiofrequency have also been safe and effective. We conclude that modifications of the subcision procedure lessen its side effects, and combination therapies improve its efficacy.
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Affiliation(s)
- Najmeh Ahramiyanpour
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Rastaghi
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Yasamin Parvar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Molecular Dermatology Research Center, Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Karimi Sisakht
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Maliheh Amani
- Department of Dermatology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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Vempati A, Zhou C, Tam C, Khong J, Rubanowitz A, Tam K, Hazany S, Vasilev R, Hazany S. Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments. Clin Cosmet Investig Dermatol 2023; 16:125-134. [PMID: 36698445 PMCID: PMC9868281 DOI: 10.2147/ccid.s397888] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
Subcutaneous incisionless surgery, also known as subcision, is a minimally invasive procedure that is commonly indicated for the treatment of atrophic acne scars. In recent years, many new techniques have been developed to maximize results from this procedure. This review article aims to identify an updated list of instruments and combinatorial treatments available for atrophic acne scar patients undergoing subcision. We constructed a comprehensive PubMed search term and performed triple-blinded screening on all resulting studies for mentions of subcision as indicated by acne scarring. Our results show that there are four main categories of subcision tools that are commonly employed to treat atrophic acne scars: needles, cannulas, wires, and blunt-blade instruments. Usage of these devices varies by scar depth, personal preference, and combinatorial treatment options. Overall, subcision is a particularly effective treatment for atrophic acne scars, and there is vast potential for further innovation with this technique.
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Affiliation(s)
- Abhinav Vempati
- Scar Healing Institute, Los Angeles, CA, USA,Correspondence: Abhinav Vempati, Scar Healing Institute, Los Angeles, CA, USA, Tel +1 424 225 2453, Fax +1 310 571 8435, Email
| | | | - Curtis Tam
- Scar Healing Institute, Los Angeles, CA, USA
| | - Jeffrey Khong
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kevin Tam
- Scar Healing Institute, Los Angeles, CA, USA
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Lotfi E, Shafie'ei M, Ahramiyanpour N. Radiofrequency‐assisted subcision combined with polycaprolactone‐based dermal fillers in the management of atrophic facial acne scars: A pilot investigative study. Skin Res Technol 2022; 28:865-871. [PMID: 36321243 PMCID: PMC9907701 DOI: 10.1111/srt.13228] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The scar's appearance and psychological burden are the most esthetically challenging issues in acne vulgaris. This study investigated the effectiveness and safety profile of combined radiofrequency-assisted subcision, which, even though effective on both Icepeak and Rolling subtypes, is only mildly effective on boxcar lesions, and polycaprolactone-based dermal filler with collagen stimulation potency in managing atrophic postacne scars. METHODS Our quasi-experimental single-arm study, after the inclusion of 10 cases over the age of 18 with moderate to severe mixed atrophic facial acne scarring, was carried out in two 3-month separate sessions, during and after the intended intervention of which the experienced lesion improvements and also adverse events were documented. Moreover, all cases were followed for 3 months after the last session, evaluating the differences in the mentioned outcomes. RESULTS We found the combined intervention to be highly effective in improving the intended outcomes, with the total number of acne lesions (p-value < 0.001), along with the total number of Ice peak (p-value = 0.002), Rolling (p-value < 0.001), and boxcar (p-value = 0.023) lesions demonstrating statistically significant changes. CONCLUSION Radiofrequency-assisted subcision combined with polycaprolactone-based dermal fillers can be an effective intervention in managing postacne scars. However, we recommend that randomized clinical trials with larger sample sizes be carried out for a more precise conclusion.
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Affiliation(s)
| | | | - Najmeh Ahramiyanpour
- Department of Dermatology Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences Kerman Iran
- Pathology and Stem Cell Research Center Kerman University of Medical Sciences Kerman Iran
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Nilforoushzadeh MA, Heidari-Kharaji M, Fakhim T, Torkamaniha E, Nouri M, Rafiee S, Roohaninasab M, Behrangi E, Jaffary F. Endo-Radiofrequency subcision for acne scars treatment: A case series study. J Cosmet Dermatol 2022; 21:5651-5656. [PMID: 35770321 DOI: 10.1111/jocd.15195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acne scars have important psychosocial suffering for patients. Several interventions have been utilized to treat acne scars that have different degrees of efficacy and side effect. Multimodal method can attain better results to improving the physical appearance of the patients that can significantly increase the quality of life. Subcision is a recognized treatment procedure particularly for rolling acne scars, but it needs modification to increase the effect of procedure. AIMS The aim of the study was to assess the efficacy and safety of Endo-Radiofrequency (Endo-RF) subcision in acne scars treatment. METHODS In this study, 9 adult patients with atrophic acne scars were enrolled. The patients receive Endo-RF subcision one time and followed up for 6 months. Outcome was measured using biometric assessment by Visioface 1000 D, Mexameter and skin ultrasound imaging system, post-treatment photographs and patient's satisfaction. RESULTS The results showed that patients had significant improvement from baseline according to the reduction of the number of skin fine and large pore (p < 0.05) and spots (p < 0.05). Also, the density and thickness of the dermis and epidermis were significantly increased (p < 0.05). CONCLUSIONS Endo-RF subcision modality can consider as a safe and effective method for acne scar treatment.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Maryam Heidari-Kharaji
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.,Institut National de la Recherche Scientifique (INRS)-Centre Armand-Frappier Santé Biotechnologie (CAFSB), Laval, QC, Canada
| | - Tannaz Fakhim
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| | - Elham Torkamaniha
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.,Department of Microbial Biotechnology, Islamic Azad University, Kish Branch, Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Rafiee
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Doctor Shohreh Rafiee Dermatology Clinic, Tehran, Iran
| | - Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Jaffary
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Skin Disease and Leishmaniasis Research Center (SDLRC) Isfahan University of Medical Science, Isfahan, Iran
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Ebrahim HM, Artima AY, Elardi A, Mohamed Morsi H. Clinical and Histopathological evaluation of different tools for the Subcision of Atrophic Acne Scars. J Cosmet Dermatol 2021; 21:1127-1134. [PMID: 34806274 DOI: 10.1111/jocd.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne scarring can lead to social and psychological distress. OBJECTIVE To compare the safety, efficacy, and long-term improvement of subcision using tri-beveled hypodermic (Th) needle versus cannula for the treatment of atrophic post-acne scars. METHODS Forty-six patients with atrophic post-acne scars were treated with subcision using (Th) needle on one side of the face and a blunt cannula on the other side of the face for 6 sessions one month apart. The primary outcome was based on the clinical improvement and patient satisfaction score. Skin biopsies were taken at baseline and 3months after the final session. Follow-up was 9 months. RESULTS Three months after the final session, a statistically highly significant difference was detected in both sides from the baseline (p < 0.001). The overall improvement was 73.9% on the (Th) needle side versus 65.2% on the cannula side (p = 0.68). There was no significant difference in acne severity scarring grade between both sides (p = 0.86). The mean number of sessions was significantly less in the (Th) needle side (p < 0.001). Collagen deposition and reorganization were achieved with both modalities. Patient satisfaction showed no significant difference between both sides. The side effects were mild and significantly higher in the (Th) needle side (p = 0.001). CONCLUSION Both modalities are effective and economic techniques. However, using a cannula is associated with much fewer side effects, more convenient for the patients and physicians compared to the (Th) needle.
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Affiliation(s)
| | | | - Amal Elardi
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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