Facial Plast Surg 2018; 34(02): 205-219
DOI: 10.1055/s-0037-1606096
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars

Yaqin Xu
1   Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Yunhua Deng
1   Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
› Author Affiliations
Further Information

Publication History

Publication Date:
05 January 2018 (online)

Abstract

Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords “scar(s),” “acne vulgaris,” “carbon dioxide,” and “fraction* laser(s)” for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.

 
  • References

  • 1 Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol 1994; 19 (04) 303-308
  • 2 Cotterill JA, Cunliffe WJ. Suicide in dermatological patients. Br J Dermatol 1997; 137 (02) 246-250
  • 3 Thomas DR. Psychosocial effects of acne. J Cutan Med Surg 2004; 8 (Suppl. 04) 3-5
  • 4 Cunliffe WJ. Acne and unemployment. Br J Dermatol 1986; 115 (03) 386
  • 5 Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol 2001; 45 (01) 109-117
  • 6 Goodman GJ, Baron JA. Postacne scarring--a quantitative global scarring grading system. J Cosmet Dermatol 2006; 5 (01) 48-52
  • 7 Sobanko JF, Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol 2012; 13 (05) 319-330
  • 8 Fife D. Practical evaluation and management of atrophic acne scars: tips for the general dermatologist. J Clin Aesthet Dermatol 2011; 4 (08) 50-57
  • 9 Orringer JS, Kang S, Johnson TM. , et al. Connective tissue remodeling induced by carbon dioxide laser resurfacing of photodamaged human skin. Arch Dermatol 2004; 140 (11) 1326-1332
  • 10 Ward PD, Baker SR. Long-term results of carbon dioxide laser resurfacing of the face. Arch Facial Plast Surg 2008; 10 (04) 238-243 , discussion 244–245
  • 11 Prado A, Andrades P, Danilla S. , et al. Full-face carbon dioxide laser resurfacing: a 10-year follow-up descriptive study. Plast Reconstr Surg 2008; 121 (03) 983-993
  • 12 Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004; 34 (05) 426-438
  • 13 Waibel J, Beer K, Narurkar V, Alster T. Preliminary observations on fractional ablative resurfacing devices: clinical impressions. J Drugs Dermatol 2009; 8 (05) 481-485
  • 14 Hantash BM, Bedi VP, Kapadia B. , et al. In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med 2007; 39 (02) 96-107
  • 15 Hantash BM, Bedi VP, Chan KF, Zachary CB. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med 2007; 39 (02) 87-95
  • 16 Magnani LR, Schweiger ES. Fractional CO2 lasers for the treatment of atrophic acne scars: a review of the literature. J Cosmet Laser Ther 2014; 16 (02) 48-56
  • 17 Chapas AM, Brightman L, Sukal S. , et al. Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med 2008; 40 (06) 381-386
  • 18 Walgrave SE, Ortiz AE, MacFalls HT. , et al. Evaluation of a novel fractional resurfacing device for treatment of acne scarring. Lasers Surg Med 2009; 41 (02) 122-127
  • 19 Qian H, Lu Z, Ding H, Yan S, Xiang L, Gold MH. Treatment of acne scarring with fractional CO2 laser. J Cosmet Laser Ther 2012; 14 (04) 162-165
  • 20 Hsiao PF, Lin YC, Huang CC, Wu YH. Efficacy and safety of a single treatment using a 10,600-nm carbon dioxide fractional laser for mild-to-moderate atrophic acne scars in Asian skin. Zhonghua Pifuke Yixue Zazhi 2013; 31 (02) 59-63
  • 21 Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, Oh SH. The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 2009; 35 (12) 1955-1961
  • 22 Huang L. A new modality for fractional CO2 laser resurfacing for acne scars in Asians. Lasers Med Sci 2013; 28 (02) 627-632
  • 23 Trelles MA, Shohat M, Urdiales F. Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: a clinical and histologic study. Aesthetic Plast Surg 2011; 35 (01) 31-42
  • 24 Ahmad TJ, Muzaffar F, Nabi H, Malik S, Noreen A, Hayat R. Efficacy and safety of ablative fractional carbon dioxide laser for acne scars. J Pak Assoc Dermatol 2012; 22: 41-44
  • 25 Kim HW, Chang SE, Kim JE, Ko JY, Ro YS. The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin. Dermatol Surg 2014; 40 (12) 1361-1366
  • 26 Wang YS, Tay YK, Kwok C. Fractional ablative carbon dioxide laser in the treatment of atrophic acne scarring in Asian patients: a pilot study. J Cosmet Laser Ther 2010; 12 (02) 61-64
  • 27 Schweiger ES, Sundick L. Focal acne scar treatment (FAST), a new approach to atrophic acne scars: a case series. J Drugs Dermatol 2013; 12 (10) 1163-1167
  • 28 Alajlan AM, Alsuwaidan SN. Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines. Lasers Surg Med 2011; 43 (08) 787-791
  • 29 Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R. Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol 2010; 63 (02) 274-283
  • 30 Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med 2012; 44 (06) 447-452
  • 31 Kim S, Cho KH. Clinical trial of dual treatment with an ablative fractional laser and a nonablative laser for the treatment of acne scars in Asian patients. Dermatol Surg 2009; 35 (07) 1089-1098
  • 32 Jung JY, Lee JH, Ryu DJ, Lee SJ, Bang D, Cho SB. Lower-fluence, higher-density versus higher-fluence, lower-density treatment with a 10,600-nm carbon dioxide fractional laser system: a split-face, evaluator-blinded study. Dermatol Surg 2010; 36 (12) 2022-2029
  • 33 Yuan XH, Zhong SX, Li SS. Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial. Dermatol Surg 2014; 40 (05) 545-552
  • 34 Bjørn M, Stausbøl-Grøn B, Braae Olesen A, Hedelund L. Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Lasers Surg Med 2014; 46 (02) 89-93
  • 35 Cho SB, Lee SJ, Cho S. , et al. Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation. J Eur Acad Dermatol Venereol 2010; 24 (08) 921-925
  • 36 Reinholz M, Schwaiger H, Heppt MV. , et al. Comparison of two kinds of lasers in the treatment of acne scars. Facial Plast Surg 2015; 31 (05) 523-531
  • 37 Asilian A, Salimi E, Faghihi G, Dehghani F, Tajmirriahi N, Hosseini SM. Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. J Res Med Sci 2011; 16 (09) 1189-1195
  • 38 Zhang Z, Fei Y, Chen X, Lu W, Chen J. Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg 2013; 39 (04) 559-566
  • 39 Azzam OA, Atta AT, Sobhi RM, Mostafa PI. Fractional CO(2) laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study. J Drugs Dermatol 2013; 12 (01) e7-e13
  • 40 Ahmed R, Mohammed G, Ismail N, Elakhras A. Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J Cosmet Laser Ther 2014; 16 (01) 8-13
  • 41 Cameli N, Mariano M, Serio M, Ardigò M. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg 2014; 40 (05) 553-561
  • 42 Faghihi G, Keyvan S, Asilian A, Nouraei S, Behfar S, Nilforoushzadeh MA. Efficacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: A split-face randomized clinical trial. Indian J Dermatol Venereol Leprol 2016; 82 (02) 162-168
  • 43 Gawdat HI, Hegazy RA, Fawzy MM, Fathy M. Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg 2014; 40 (02) 152-161
  • 44 Lee JW, Kim BJ, Kim MN, Mun SK. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial. Dermatol Surg 2011; 37 (07) 931-938
  • 45 Zhou BR, Zhang T, Bin Jameel AA. , et al. The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation. J Cosmet Laser Ther 2016; 18 (03) 138-148
  • 46 Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatol Surg 2013; 39 (1 Pt 1): 111-120
  • 47 Dreno B, Khammari A, Orain N. , et al. ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology 2007; 214 (01) 46-51
  • 48 Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. Adolesc Health Med Ther 2016; 7: 13-25
  • 49 Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol 2009; 129 (09) 2136-2141
  • 50 Lauermann FT, Almeida Jr HL, Duquia RP, Souza PR, Breunig JdeA. Acne scars in 18-year-old male adolescents: a population-based study of prevalence and associated factors. An Bras Dermatol 2016; 91 (03) 291-295
  • 51 Alster T, Zaulyanov L. Laser scar revision: a review. Dermatol Surg 2007; 33 (02) 131-140
  • 52 Baum CL, Arpey CJ. Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Dermatol Surg 2005; 31 (06) 674-686 , discussion 686
  • 53 de Campos Peseto D, Carmona EV, Silva KC. , et al. Effects of tretinoin on wound healing in aged skin. Wound Repair Regen 2016; 24 (02) 411-417
  • 54 Yoon JH, Park EJ, Kwon IH. , et al. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J Dermatolog Treat 2014; 25 (02) 142-146
  • 55 Araviiskaia E, Dréno B. The role of topical dermocosmetics in acne vulgaris. J Eur Acad Dermatol Venereol 2016; 30 (06) 926-935
  • 56 Casetti F, Wölfle U, Gehring W, Schempp CM. Dermocosmetics for dry skin: a new role for botanical extracts. Skin Pharmacol Physiol 2011; 24 (06) 289-293
  • 57 Guerrero D. Dermocosmetic management of hyperpigmentations. Ann Dermatol Venereol 2012; 139 (Suppl. 04) S166-S169
  • 58 Oh BH, Hwang YJ, Lee YW, Choe YB, Ahn KJ. Skin characteristics after fractional photothermolysis. Ann Dermatol 2011; 23 (04) 448-454
  • 59 Naouri M, Atlan M, Perrodeau E. , et al. High-resolution ultrasound imaging to demonstrate and predict efficacy of carbon dioxide fractional resurfacing laser treatment. Dermatol Surg 2011; 37 (05) 596-603