A prospective, nonrandomized, open-label study, comparing the efficacy, safety, and tolerability of fractional CO<sub>2</sub> laser versus fractional microneedling radio frequency in acne scars

Background Ablative fractional CO2 laser (AFL) is an established first‐line energy‐based treatment for acne scars. Microneedle radiofrequency (MNRF) is an emerging treatment, also targeting the skin in fractions. No studies have so far compared AFL with MNRF for acne scars in a direct controlled, side‐by‐side comparison. In this study, we compared AFL and MNRF treatments for acne scars in a randomized split‐face trial with blinded response evaluation, objective measures, and patient‐reported outcomes. Study Design/Materials and Method Fifteen patients with moderate to severe acne scars were included. At baseline each patient had two similar test areas identified, these were randomized to receive a single treatment with either AFL or MNRF. Standardized multilayer techniques were applied with AFL and MNRF, first targeting the scar base, thereafter the entire scar area. Outcome measures included blinded evaluation of clinical improvement of scar texture (0–10 scale) at 1‐ and 3‐months follow‐up, local skin reactions (LSR), pain according to Visual Analogue Scale (VAS), skin integrity quantified by transepidermal water loss, and patient satisfaction. Results Fifteen patients completed the study with a median test area size of 24.6 cm2 (interquartile range [IQR] 14.9–40.6). A single treatment with AFL or MNRF equally resulted in a median 1‐point texture improvement after 3 months follow‐up (p < 0.001). Best responders achieved up to a 3‐point improvement (n = 3 test areas, 10% of treatment areas). Erythema and loss of skin integrity was more intense after AFL compared with MNRF after 2–4 days (p < 0.001). Patients reported MNRF (VAS 7.0) to be significantly more painful than AFL (5.5) (p = 0.009). Patients were generally satisfied with the overall outcome on a 10‐point scale at median 6 for both treatments (IQR 5–7). Conclusion AFL and MNRF treatments are equally effective at improving texture in skin with acne scars. AFL resulted in more pronounced LSRs whereas MNRF was more painful. Patients were generally satisfied with the overall outcome.

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Fractional CO₂‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Hendel

Karmisholt

Hedelund

et al. 2023

Lasers Surg Med

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Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice

Shauly,

Marxen,

Menon

et al. 2023

Aesthetic Surgery Journal Open Forum

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Background Since the initial invention of microneedling, advancements have been made to improve the desired effects. The addition of radiofrequency to microneedling devices was developed within the past decade as a way to induce thermal injury and increase dermal heating to enhance the dermal wound healing cascade. Objectives With an overabundance of literature and mainstream media focused on microneedling and radiofrequency microneedling, this review aims to focus on the available high-quality evidence. Methods A comprehensive review of the literature was performed across PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) databases. Attention was focused on manuscripts that provided objective data with respect to clinical application, innovation, anatomy, and physiology. Results Optimal outcomes are achieved when needle depth is targeted to the reticular dermis. Needle depth should reflect the relative differences in epidermal and dermal thickness throughout the face. A depth of at least 1.5 mm should be used for the forehead and temporal skin, 1.0 mm for the malar region, 2.0 mm (maximum depth for radiofrequency microneedling) for the nasal side walls, 0.5 mm for the perioral skin, and 1.5 mm for the neck. Deeper settings can be used with care to provide some fat reduction in the submentum. Conclusions The authors find herein that radiofrequency microneedling is a safe adjunctive tool to surgical aesthetic procedures. The addition of radiofrequency poses an advance over traditional microneedling devices for skin tightening, with improvements in both safety and efficacy over time. Level of Evidence: 5

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To evaluate the efficacy and safety of laser interventions for facial acne scars: a systematic review and Bayesian network meta-analysis

Zhao¹,

Wang²,

Li³

et al. 2022

Ann Transl Med

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Background: There are numerous laser treatments for acne scars in clinical practice. However, there are no clinical studies comparing all laser methods to provide an evidence-based bias for clinicians to choose the best strategy. Therefore, this systematic review and network meta-analysis was conducted to explore the efficacy of different types of laser treatment on acne scars. This study can provide the most effective treatment for acne scars in clinical practice. Methods:The databases of PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to July 2022. The Cochrane risk of bias assessment tool was used to assess the bias of the included original studies. Bayesian network meta-analysis was used to investigate the efficacy of laser treatment strategies in scar improvement, cure rate, and satisfaction.Results: As shown by the results, the top 3 treatment options for scar improvement were fractional carbon dioxide laser (FCL) + platelet-rich-plasma (PRP) [surface under the cumulative ranking curve (SUCRA): 0.699], 1064Nd (1,064-nm neodymium-doped yttrium aluminum garnet picosecond laser) + 15%VC (Vitamin C; SUCRA: 0.675), and 1064Nd (SUCRA: 0.627). The standard mean difference (SMD) of FCL + PRP was −1.76 (95% CI: −3.49, −0.03), compared with that of FCL. The top 3 treatment options for improving cure rate were Er (Er:YAG laser treatment) + PRP (SUCRA: 0.873), FCL (SUCRA: 0.773), and FCL + 30% salicylic acid (30%SC) (SUCRA: 0.772). The RR of Er + PRP cure rate was 13.86 (95% CI: 1.79, 107.22), compared with non-laser radiofrequency therapy. Conclusions:The findings suggested that combined therapies should be used to treat acne scars. Er + PRP showed the highest cure rate of acne scar, followed by FCL + 30%SC or FCL monotherapy. FCL combined with PRP could improve acne scarring to the greatest extent, and 1064Nd combined with 15%VC can also exert a good effect. As for satisfaction, FCL monotherapy was the most satisfactory methods for patients, followed by PRP monotherapy. Therefore, Er + PRP and FCL + PRP can be used as the first choice for clinical treatment of acne scars. Additionally, using FCL alone is also an effective and elective treatment method due to its affordable cost and comfort.

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A prospective, nonrandomized, open-label study, comparing the efficacy, safety, and tolerability of fractional CO₂ laser versus fractional microneedling radio frequency in acne scars

Cited by 4 publications

References 13 publications

Fractional CO₂‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Fractional CO₂‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice

To evaluate the efficacy and safety of laser interventions for facial acne scars: a systematic review and Bayesian network meta-analysis

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A prospective, nonrandomized, open-label study, comparing the efficacy, safety, and tolerability of fractional CO2 laser versus fractional microneedling radio frequency in acne scars

Cited by 4 publications

References 13 publications

Fractional CO2‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Fractional CO2‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice

To evaluate the efficacy and safety of laser interventions for facial acne scars: a systematic review and Bayesian network meta-analysis

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Product

Resources

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A prospective, nonrandomized, open-label study, comparing the efficacy, safety, and tolerability of fractional CO₂ laser versus fractional microneedling radio frequency in acne scars

Fractional CO₂‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial

Fractional CO₂‐laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split‐face trial