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J Cosmet Med 2022; 6(1): 1-7

Published online June 30, 2022

https://doi.org/10.25056/JCM.2022.6.1.1

Laser resurfacing in acne scarring: a review

Cheuk Hung Lee, MBBS (HK), FHKAM (MED), FHKCP, MScPD (Cardiff), MRCP (UK), DPD (Wales), DipDerm (Glasgow)1 , Kar Wai Alvin Lee, MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), MScClinDerm (Cardiff), MScPD (Cardiff), DipMed (CUHK), DCH (Sydney)1 , Kwin Wah Chan, MBChB (CUHK), MScPD (Cardiff), PgDipPD (Cardiff), PGDipClinDerm (Lond), DipMed (CUHK), DCH (Sydney)1 , Kar Wai Phoebe Lam, MBCHB (OTAGO), MRCS (EDIN), MSCPD (CARDIFF)2 , Tin Hau Wong, MBBS, MRCS (EDIN), MSCPD (CARDIFF)3

1Ever Keen Medical Centre, Hong Kong
2Perfect Skin Solution, Hong Kong
3Medaes Medical Centre, Hong Kong

Correspondence to :
Kar Wai Alvin Lee
E-mail: alvin429@yahoo.com

Received: May 30, 2022; Revised: June 5, 2022; Accepted: June 8, 2022

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Scarring can complicate acne vulgaris and lead to considerable psychosocial implications. Resurfacing and collagen regeneration treatments for acne scars include cryotherapy, chemical peeling, lasers and lights, and radiofrequency. Lasers have become popular among these options. A range of lasers with varying designs, wavelengths, and fractional technologies have become available as treatment choices for acne scars. This review compares the efficacy and adverse effects of these treatments. This is a literature review to determine whether the use of a combination of laser treatments yields superior outcomes compared to a single-device method in the management of acne scars. Our literature review revealed that patient factors, including Fitzpatrick skin phenotype and acne scar subtype, are essential determinants of outcome success in acne treatment with laser. Evidence suggests that ablative CO2 and Er:YAG lasers provide the best curative effects on acne scars in all skin types. Both non-fractional and fractional techniques can effectively treat atrophic acne scars. However, when using a pulse-dye laser to treat hypertrophic scars, the outcomes are variable. Potential complications of ablative lasers include acne flares, infections, and scarring.

Keywords: acne, CO2 laser, Er:YAG laser, laser, scarring

Fig. 1.The laser-induced optical breakdown leads to the formation of vacuoles that promote neocollagenesis and remodeling while the fractional plasma ablation effect leads to the resurfacing effect. LIOB, laser-induced optical breakdown.
  1. Kilkenny M, Merlin K, Plunkett A, Marks R. The prevalence of common skin conditions in Australian school students: 3. Acne vulgaris. Br J Dermatol 1998;139:840-5.
    Pubmed CrossRef
  2. Yeung CK, Teo LH, Xiang LH, Chan HH. A community-based epidemiological study of acne vulgaris in Hong Kong adoles-cents. Acta Derm Venereol 2002;82:104-7.
    Pubmed CrossRef
  3. Well D. Acne vulgaris: a review of causes and treatment op-tions. Nurse Pract 2013;38:22-31; quiz 32.
    Pubmed CrossRef
  4. Layton AM, Henderson CA, Cunliffe WJ. A clinical evalua-tion of acne scarring and its incidence. Clin Exp Dermatol 1994;19:303-8.
    Pubmed CrossRef
  5. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classifica-tion system and review of treatment options. J Am Acad Der-matol 2001;45:109-17.
    Pubmed CrossRef
  6. Wilmink GJ, Opalenik SR, Beckham JT, Abraham AA, Nanney LB, Mahadevan-Jansen A, et al. Molecular imaging-assisted optimization of hsp70 expression during laser-induced ther-mal preconditioning for wound repair enhancement. J Invest Dermatol 2009;129:205-16.
    Pubmed KoreaMed CrossRef
  7. Leclère FM, Mordon SR. Twenty-five years of active laser pre-vention of scars: what have we learned? J Cosmet Laser Ther
  8. Shah M, Foreman DM, Ferguson MW. Neutralising antibody to TGF-beta 1,2 reduces cutaneous scarring in adult rodents. J Cell Sci 1994;107(Pt 5):1137-57.
    Pubmed CrossRef
  9. Ross EV, Sajben FP, Hsia J, Barnette D, Miller CH, McKinlay JR. Nonablative skin remodeling: selective dermal heating with a mid-infrared laser and contact cooling combination. Lasers Surg Med 2000;26:186-95.
    CrossRef
  10. Keller R, Belda Júnior W, Valente NY, Rodrigues CJ. Nonab-lative 1,064-nm Nd:YAG laser for treating atrophic facial acne scars: histologic and clinical analysis. Dermatol Surg 2007;33:1470-6.
    Pubmed CrossRef
  11. Lipper GM, Perez M. Nonablative acne scar reduction af-ter a series of treatments with a short-pulsed 1,064-nm neodymium:YAG laser. Dermatol Surg 2006;32:998-1006.
    Pubmed CrossRef
  12. Maluki AH, Mohammad FH. Treatment of atrophic facial scars of acne vulgaris by Q-Switched Nd:YAG (neodymium: yttrium-aluminum-garnet) laser 1064 nm wavelength. J Cos-met Laser Ther 2012;14:224-33.
    Pubmed CrossRef
  13. Friedman PM, Jih MH, Skover GR, Payonk GS, Kimyai-Asadi A, Geronemus RG. Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month fol-low-up study. Arch Dermatol 2004;140:1337-41.
    Pubmed CrossRef
  14. Yaghmai D, Garden JM, Bakus AD, Massa MC. Comparison of a 1,064 nm laser and a 1,320 nm laser for the nonablative treatment of acne scars. Dermatol Surg 2005;31(8 Pt 1):903-9.
    Pubmed CrossRef
  15. Cohen BE, Brauer JA, Geronemus RG. Acne scarring: a review of available therapeutic lasers. Lasers Surg Med 2016;48:95-115.
    Pubmed CrossRef
  16. Alster TS, McMeekin TO. Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol 1996;35:79-81.
    CrossRef
  17. Patel N, Clement M. Selective nonablative treatment of acne scarring with 585 nm flashlamp pulsed dye laser. Dermatol Surg 2002;28:942-5; discussion 945.
    Pubmed CrossRef
  18. Yoon HJ, Lee DH, Kim SO, Park KC, Youn SW. Acne erythema improvement by long-pulsed 595-nm pulsed-dye laser treat-ment: a pilot study. J Dermatolog Treat 2008;19:38-44.
    Pubmed CrossRef
  19. Brauer JA, Kazlouskaya V, Alabdulrazzaq H, Bae YS, Bernstein LJ, Anolik R, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol 2015;151:278-84.
    Pubmed CrossRef
  20. Chua SH, Ang P, Khoo LS, Goh CL. Nonablative 1450-nm di-ode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study. Dermatol Surg 2004;30:1287-91.
    Pubmed CrossRef
  21. Bellew SG, Lee C, Weiss MA, Weiss RA. Improvement of atro-phic acne scars with a 1,320 nm Nd:YAG laser: retrospective study. Dermatol Surg 2005;31(9 Pt 2):1218-21; discussion 1222.
    Pubmed CrossRef
  22. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm Nd:YAG laser. Dermatol Surg 2003;29:904-8.
    Pubmed CrossRef
  23. Bhatia AC, Dover JS, Arndt KA, Stewart B, Alam M. Patient satisfaction and reported long-term therapeutic efficacy asso-ciated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging. Dermatol Surg 2006;32:346-52.
    Pubmed CrossRef
  24. Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Derma-tol Surg 2007;33:295-9.
    Pubmed CrossRef
  25. Ong M, Bashir S. A systematic review of laser resurfacing for acne scars. JAAD 2012;66(4 Suppl 1):AB213.
    CrossRef
  26. Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, Oh SH. The ef-ficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 2009;35:1955-61.
    Pubmed CrossRef
  27. 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;46:89-93.
    Pubmed CrossRef
  28. Hunzeker CM, Weiss ET, Geronemus RG. Fractionated CO2 laser resurfacing: our experience with more than 2000 treat-ments. Aesthet Surg J 2009;29:317-22.
    Pubmed CrossRef
  29. Deng H, Yuan D, Yan C, Lin X, Ding X. A 2940 nm fractional photothermolysis laser in the treatment of acne scarring: a pilot study in China. J Drugs Dermatol 2009;8:978-80.
  30. Kim S. Treatment of acne scars in Asian patients using a 2,790-nm fractional yttrium scandium gallium garnet laser. Dermatol Surg 2011;37:1464-9.
    Pubmed CrossRef
  31. Cho SI, Kim YC. Treatment of atrophic facial scars with com-bined use of high-energy pulsed CO2 laser and Er:YAG laser: a practical guide of the laser techniques for the Er:YAG laser. Dermatol Surg 1999;25:959-64.
    Pubmed CrossRef
  32. Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, et al. Energy-based devices for the treatment of acne scars: 2022 international consensus recommendations. La-sers Surg Med 2022;54:10-26.
    Pubmed CrossRef

Article

Review Article

J Cosmet Med 2022; 6(1): 1-7

Published online June 30, 2022 https://doi.org/10.25056/JCM.2022.6.1.1

Copyright © Korean Society of Korean Cosmetic Surgery.

Laser resurfacing in acne scarring: a review

Cheuk Hung Lee, MBBS (HK), FHKAM (MED), FHKCP, MScPD (Cardiff), MRCP (UK), DPD (Wales), DipDerm (Glasgow)1 , Kar Wai Alvin Lee, MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), MScClinDerm (Cardiff), MScPD (Cardiff), DipMed (CUHK), DCH (Sydney)1 , Kwin Wah Chan, MBChB (CUHK), MScPD (Cardiff), PgDipPD (Cardiff), PGDipClinDerm (Lond), DipMed (CUHK), DCH (Sydney)1 , Kar Wai Phoebe Lam, MBCHB (OTAGO), MRCS (EDIN), MSCPD (CARDIFF)2 , Tin Hau Wong, MBBS, MRCS (EDIN), MSCPD (CARDIFF)3

1Ever Keen Medical Centre, Hong Kong
2Perfect Skin Solution, Hong Kong
3Medaes Medical Centre, Hong Kong

Correspondence to:Kar Wai Alvin Lee
E-mail: alvin429@yahoo.com

Received: May 30, 2022; Revised: June 5, 2022; Accepted: June 8, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Scarring can complicate acne vulgaris and lead to considerable psychosocial implications. Resurfacing and collagen regeneration treatments for acne scars include cryotherapy, chemical peeling, lasers and lights, and radiofrequency. Lasers have become popular among these options. A range of lasers with varying designs, wavelengths, and fractional technologies have become available as treatment choices for acne scars. This review compares the efficacy and adverse effects of these treatments. This is a literature review to determine whether the use of a combination of laser treatments yields superior outcomes compared to a single-device method in the management of acne scars. Our literature review revealed that patient factors, including Fitzpatrick skin phenotype and acne scar subtype, are essential determinants of outcome success in acne treatment with laser. Evidence suggests that ablative CO2 and Er:YAG lasers provide the best curative effects on acne scars in all skin types. Both non-fractional and fractional techniques can effectively treat atrophic acne scars. However, when using a pulse-dye laser to treat hypertrophic scars, the outcomes are variable. Potential complications of ablative lasers include acne flares, infections, and scarring.

Keywords: acne, CO2 laser, Er:YAG laser, laser, scarring

Fig 1.

Figure 1.The laser-induced optical breakdown leads to the formation of vacuoles that promote neocollagenesis and remodeling while the fractional plasma ablation effect leads to the resurfacing effect. LIOB, laser-induced optical breakdown.
Journal of Cosmetic Medicine 2022; 6: 1-7https://doi.org/10.25056/JCM.2022.6.1.1

References

  1. Kilkenny M, Merlin K, Plunkett A, Marks R. The prevalence of common skin conditions in Australian school students: 3. Acne vulgaris. Br J Dermatol 1998;139:840-5.
    Pubmed CrossRef
  2. Yeung CK, Teo LH, Xiang LH, Chan HH. A community-based epidemiological study of acne vulgaris in Hong Kong adoles-cents. Acta Derm Venereol 2002;82:104-7.
    Pubmed CrossRef
  3. Well D. Acne vulgaris: a review of causes and treatment op-tions. Nurse Pract 2013;38:22-31; quiz 32.
    Pubmed CrossRef
  4. Layton AM, Henderson CA, Cunliffe WJ. A clinical evalua-tion of acne scarring and its incidence. Clin Exp Dermatol 1994;19:303-8.
    Pubmed CrossRef
  5. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classifica-tion system and review of treatment options. J Am Acad Der-matol 2001;45:109-17.
    Pubmed CrossRef
  6. Wilmink GJ, Opalenik SR, Beckham JT, Abraham AA, Nanney LB, Mahadevan-Jansen A, et al. Molecular imaging-assisted optimization of hsp70 expression during laser-induced ther-mal preconditioning for wound repair enhancement. J Invest Dermatol 2009;129:205-16.
    Pubmed KoreaMed CrossRef
  7. Leclère FM, Mordon SR. Twenty-five years of active laser pre-vention of scars: what have we learned? J Cosmet Laser Ther
  8. Shah M, Foreman DM, Ferguson MW. Neutralising antibody to TGF-beta 1,2 reduces cutaneous scarring in adult rodents. J Cell Sci 1994;107(Pt 5):1137-57.
    Pubmed CrossRef
  9. Ross EV, Sajben FP, Hsia J, Barnette D, Miller CH, McKinlay JR. Nonablative skin remodeling: selective dermal heating with a mid-infrared laser and contact cooling combination. Lasers Surg Med 2000;26:186-95.
    CrossRef
  10. Keller R, Belda Júnior W, Valente NY, Rodrigues CJ. Nonab-lative 1,064-nm Nd:YAG laser for treating atrophic facial acne scars: histologic and clinical analysis. Dermatol Surg 2007;33:1470-6.
    Pubmed CrossRef
  11. Lipper GM, Perez M. Nonablative acne scar reduction af-ter a series of treatments with a short-pulsed 1,064-nm neodymium:YAG laser. Dermatol Surg 2006;32:998-1006.
    Pubmed CrossRef
  12. Maluki AH, Mohammad FH. Treatment of atrophic facial scars of acne vulgaris by Q-Switched Nd:YAG (neodymium: yttrium-aluminum-garnet) laser 1064 nm wavelength. J Cos-met Laser Ther 2012;14:224-33.
    Pubmed CrossRef
  13. Friedman PM, Jih MH, Skover GR, Payonk GS, Kimyai-Asadi A, Geronemus RG. Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month fol-low-up study. Arch Dermatol 2004;140:1337-41.
    Pubmed CrossRef
  14. Yaghmai D, Garden JM, Bakus AD, Massa MC. Comparison of a 1,064 nm laser and a 1,320 nm laser for the nonablative treatment of acne scars. Dermatol Surg 2005;31(8 Pt 1):903-9.
    Pubmed CrossRef
  15. Cohen BE, Brauer JA, Geronemus RG. Acne scarring: a review of available therapeutic lasers. Lasers Surg Med 2016;48:95-115.
    Pubmed CrossRef
  16. Alster TS, McMeekin TO. Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol 1996;35:79-81.
    CrossRef
  17. Patel N, Clement M. Selective nonablative treatment of acne scarring with 585 nm flashlamp pulsed dye laser. Dermatol Surg 2002;28:942-5; discussion 945.
    Pubmed CrossRef
  18. Yoon HJ, Lee DH, Kim SO, Park KC, Youn SW. Acne erythema improvement by long-pulsed 595-nm pulsed-dye laser treat-ment: a pilot study. J Dermatolog Treat 2008;19:38-44.
    Pubmed CrossRef
  19. Brauer JA, Kazlouskaya V, Alabdulrazzaq H, Bae YS, Bernstein LJ, Anolik R, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol 2015;151:278-84.
    Pubmed CrossRef
  20. Chua SH, Ang P, Khoo LS, Goh CL. Nonablative 1450-nm di-ode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study. Dermatol Surg 2004;30:1287-91.
    Pubmed CrossRef
  21. Bellew SG, Lee C, Weiss MA, Weiss RA. Improvement of atro-phic acne scars with a 1,320 nm Nd:YAG laser: retrospective study. Dermatol Surg 2005;31(9 Pt 2):1218-21; discussion 1222.
    Pubmed CrossRef
  22. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm Nd:YAG laser. Dermatol Surg 2003;29:904-8.
    Pubmed CrossRef
  23. Bhatia AC, Dover JS, Arndt KA, Stewart B, Alam M. Patient satisfaction and reported long-term therapeutic efficacy asso-ciated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging. Dermatol Surg 2006;32:346-52.
    Pubmed CrossRef
  24. Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Derma-tol Surg 2007;33:295-9.
    Pubmed CrossRef
  25. Ong M, Bashir S. A systematic review of laser resurfacing for acne scars. JAAD 2012;66(4 Suppl 1):AB213.
    CrossRef
  26. Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, Oh SH. The ef-ficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 2009;35:1955-61.
    Pubmed CrossRef
  27. 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;46:89-93.
    Pubmed CrossRef
  28. Hunzeker CM, Weiss ET, Geronemus RG. Fractionated CO2 laser resurfacing: our experience with more than 2000 treat-ments. Aesthet Surg J 2009;29:317-22.
    Pubmed CrossRef
  29. Deng H, Yuan D, Yan C, Lin X, Ding X. A 2940 nm fractional photothermolysis laser in the treatment of acne scarring: a pilot study in China. J Drugs Dermatol 2009;8:978-80.
  30. Kim S. Treatment of acne scars in Asian patients using a 2,790-nm fractional yttrium scandium gallium garnet laser. Dermatol Surg 2011;37:1464-9.
    Pubmed CrossRef
  31. Cho SI, Kim YC. Treatment of atrophic facial scars with com-bined use of high-energy pulsed CO2 laser and Er:YAG laser: a practical guide of the laser techniques for the Er:YAG laser. Dermatol Surg 1999;25:959-64.
    Pubmed CrossRef
  32. Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, et al. Energy-based devices for the treatment of acne scars: 2022 international consensus recommendations. La-sers Surg Med 2022;54:10-26.
    Pubmed CrossRef

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