Successful Treatment of Atrophic Postoperative and Traumatic Scarring With Carbon Dioxide Ablative Fractional Resurfacing Quantitative Volumetric Scar Improvement
AUTHORS: Elliot T. Weiss, MD; Anne Chapas, MD; Lori Brightman, MD; Christopher Hunzeker, MD; Elizabeth K. Hale, MD; Julie K. Karen, MD; Leonard Bernstein, MD; Roy G. Geronemus, MD
RESEARCH SITES: Laser & Skin Surgery Center of New York, New York, New York.
PUBLICATION: Arch Dermatol. 2010;146(2):133- 140
YEAR: 2010
OBJECTIVE: To assess the safety and efficacy of ablative fractional resurfacing (AFR) for nonacne atrophic scarring.
DESIGN: In this before-and-after trial, each scar received 3 AFR treatments and 6 months of follow-up.
SETTING: Private academic practice.
PATIENTS: Fifteen women with Fitzpatrick skin types I to IV, aged 21 to 66 years, presented with 22 nonacne atrophic scars between June 1 and November 30, 2007. Three patients (3 scars) were excluded from the study after receiving 1 AFR treatment and not returning for follow-up visits. The remaining 12 patients (19 scars) completed all 3 treatments and 6 months of follow-up.
INTERVENTIONS: Each scar received 3 AFR treatments at 1- to 4-month intervals.
MAIN OUTCOME MEASURES: Erythema, edema, petechiae, scarring, crusting, and dyschromia were graded after treatment and through 6 months of follow-up. Skin texture, pigmentation, atrophy, and overall appearance were evaluated after treatment and through 6 months of follow-up by the patient and a nonblinded investigator. A 3-dimensional optical profiling system generated high-resolution topographic representations of atrophic scars for objective measurement of changes in scar volume and depth.
RESULTS: Adverse effects of treatment were mild to moderate, and no scarring or delayed-onset hypopigmentation was observed. At the 6-month follow-up visit, patient and investigator scores demonstrated improvements in skin texture for all scars (patient range, 1-4 [mean, 2.79]; investigator range, 2-4 [mean, 2.95]), pigmentation for all scars (patient range, 1-4 [mean, 2.32]; investigator range, 1-4 [mean, 2.21]), atrophy for all scars (patient range, 1-4 [mean, 2.26]; investigator range, 2-4 [mean, 2.95]), and overall scar appearance for all scars (patient range, 2-4 [mean, 2.89]; investigator range, 2-4 [mean, 3.05]). Image analysis revealed a 38.0% mean reduction of volume and 35.6% mean reduction of maximum scar depth.
CONCLUSION: The AFR treatments represent a safe, effective treatment modality for improving atrophic scarring due to surgery or trauma.