Post-acne Scarring

  • Greg J. GoodmanEmail author


Acne is a very common inflammatory disease with superimposed opportunistic infection, which, if left untreated, will often lead to lifelong scarring. The resultant scarring is graded for the purposes of classification and communication, but the scarring is a very individual issue with even minor scarring a great issue for patients.

The treatment of scarring is usually incomplete with surface and volumetric treatments being the mainstay. Hence, grading revolves around these issues. The milder grades 1 and 2 scarring usually require multiple surface treatments with energy-based (fractionated and non-fractionated) and other surface treatments. For more severe grades where volume is a greater issue, fractionated devices appear to be the best form of energy- and nonenergy-based devices, but often, volume restoration (fillers and surgical techniques) or volume depletion (intralesional steroids and cytotoxics) is also required. The choice of the variety of fractional delivery is made on the basis of the scar and patient characteristics. Rarely, botulinum toxin may also be needed especially in hypertrophic scarring.

In all grades, it would appear that combining treatments either concurrently or sequentially is superior to employing a single modality. Combining fractionation and non-fractional therapies may be particularly efficacious (e.g. low-strength peels and needling or fractionated lasers). Otherwise combination therapy may involve fractional devices to be used to allow deeper ingress of agents by transdermal delivery (e.g. steroids, cytotoxics, bimatoprost).


Scar Atrophic scar Keloid Hypertrophic scar Scar grade Scar treatment 


  1. 1.
    Hazarika N, Rajaprabha RK. Assessment of life quality index among patients with acne vulgaris in a suburban population. Indian J Dermatol. 2016;61(2):163–8. Scholar
  2. 2.
    Burton JL, Cunliffe WJ, Stafford I, Shuster S. The prevalence of acne vulgaris in adolescence. Br J Dermatol. 1971;85:119–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Munro-Ashman D. Acne vulgaris in a public school. Trans St Johns Hosp Dermatol Soc. 1963;49:144–8.PubMedGoogle Scholar
  4. 4.
    Rademaker M, Garioch JJ, Simpson NB. Acne in schoolchildren: no longer a concern for dermatologists. Br Med J. 1989;298:1217–9.CrossRefGoogle Scholar
  5. 5.
    Bloch B. Metabolism, endocrine glands and skin disease, with special reference to acne vulgaris and xanthoma. Br J Dermatol. 1931;43:61–87.CrossRefGoogle Scholar
  6. 6.
    Lucky AW, Biro FM, Huster GA, et al. Acne vulgaris in early adolescent boys correlations with pubertal maturation and age. Arch Dermatol. 1991;172:210–6.CrossRefGoogle Scholar
  7. 7.
    Lucky AW, Biro FM, Huster GA, et al. Acne vulgaris in premenarchal girls. Arch Dermatol. 1994;130:308–14.CrossRefPubMedGoogle Scholar
  8. 8.
    Bessone L, Sertoli P. Considerazioni sudi un case de acne infantile. Chronica Dermatologica. 1970;1:3.Google Scholar
  9. 9.
    Bessone L. L’eruzione acneiforme corticotropane e cortisonica nell infanzia. Chronica Dermatologica. 1974;1:77.Google Scholar
  10. 10.
    Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr. 1997;130:30–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J. 1979;1(6171):1109–10.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kligman AM. An overview of acne. J Invest Dermatol. 1974;62:268.CrossRefPubMedGoogle Scholar
  13. 13.
    Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol. 1994;19(4):303–8.CrossRefPubMedGoogle Scholar
  14. 14.
    O’Loughlin M. Acne in the adult female. Aust J Dermatol. 1964;7:218–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Puhvel SM, Barfatani M, Warwick M, Sternberg TH. Study of antibody levels to Corynebacterium acnes. Arch Dermatol. 1964;90:421–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Puhvel SM, Hoffman LK, Sternberg TH. Presence of complement fixing antibodies to Corynebacterium acnes in the sera of acne patients with acne vulgaris. Arch Dermatol. 1966;93:364–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Puhvel SM, Amircan D, Weintraub J, Reissner RM. Lymphocyte transformation in subjects with nodulocystic acne. Br J Dermatol. 1977;97:205–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee WL, Shalita AR. Leukocyte abnormalities in acne conglobata. [Abstract]. J Invest Dermatol. 1980;74:258.Google Scholar
  19. 19.
    Smith MA. The role of comedones in acne vulgaris. Br J Dermatol. 1962;54:337–8.CrossRefGoogle Scholar
  20. 20.
    Strauss JS. Sebaceous glands. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. 4th ed. New York: McGraw-Hill; 1993. p. 709–26.Google Scholar
  21. 21.
    Holland DB, Jeremy AH, Roberts SG, Seukeran DC, Layton AM, Cunliffe WJ. Inflammation in acne scarring: a comparison of the responses in lesions from patients prone and not prone to scar. Br J Dermatol. 2004;150:72–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Gillard JA, Reed MW, Buttle D, Cross SS, Brown NJ. Matrix metalloproteinase activity and immunohistochemical profile of matrix metalloproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 during human dermal wound healing. Wound Repair Regen. 2004;12(3):295–304.CrossRefPubMedGoogle Scholar
  23. 23.
    Dang CM, Beanes SR, Lee H, Zhang X, Soo C, Ting K. Scarless fetal wounds are associated with an increased matrix metalloproteinase-to-tissue-derived inhibitor of metalloproteinase ratio. Plast Reconstr Surg. 2003;111:2273–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim J, Ochoa MT, Krutzik SR, Takeuchi O, Uematsu S, Legaspi AJ, Brightbill HD, Holland D, Cunliffe WJ, Akira S, Sieling PA, Godowski PJ, Modlin RL. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002;169:1535–41.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Zaleski-Larsen LA, Fabi SG, McGraw T, Taylor M. Acne scar treatment: a multimodality approach tailored to scar type. Dermatol Surg. 2016;42(Suppl 2):S139–49. Scholar
  26. 26.
    Panchaprateep R, Munavalli G. Low-fluence 585 nm Q-switched Nd:YAG laser: a novel laser treatment for post-acne erythema. Lasers Surg Med. 2015;47:148–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345:1198–2000.CrossRefPubMedGoogle Scholar
  28. 28.
    Manuskiatti W, Fitzpatrick RE, Goldman MP. Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser. J Am Acad Dermatol. 2001;45:557–65.CrossRefPubMedGoogle Scholar
  29. 29.
    Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol. 2002;138:1149–55.CrossRefPubMedGoogle Scholar
  30. 30.
    Sawcer D, Lee HR, Lowe NJ. Lasers and adjunctive treatments for facial scars: a review. J Cutan Laser Ther. 1999;1:77–85.CrossRefPubMedGoogle Scholar
  31. 31.
    Lee DH, Choi YS, Min SU, Yoon MY, et al. Comparison of a 585-nm pulsed dye laser and a 1,064-nm Nd:YAG laser for the treatment of acne scars: a randomized split-face clinical study. J Am Acad Dermatol. 2009;60:801–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Dreno B, Khammari A, Orain N, Noray C, et al. ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology. 2007;214:46–51.CrossRefPubMedGoogle Scholar
  33. 33.
    Patel N, Clement M. Selective nonablative treatment of acne scarring with 585 nm flashlamp pulsed dye laser. Dermatol Surg. 2002;28:942–5.PubMedGoogle Scholar
  34. 34.
    Glaich AS, Rahman Z, Goldberg LH, Friedman PM. Fractional resurfacing for the treatment of hypopigmented scars: a pilot study. Dermatol Surg. 2007;33:289–94; discussion 293–4.PubMedGoogle Scholar
  35. 35.
    Cohen BE, Brauer JA, Geronemus RG. Acne scarring: a review of available therapeutic lasers. Lasers Surg Med. 2016;48:95–115.CrossRefPubMedGoogle Scholar
  36. 36.
    Wang B, Wu Y, Luo YJ, Xu XG, Xu TH, Chen JZ, Gao XH, Chen HD, Li YH. Combination of intense pulsed light and fractional CO2 laser treatments for patients with acne with inflammatory and scarring lesions. Clin Exp Dermatol. 2013;38:344–51.CrossRefPubMedGoogle Scholar
  37. 37.
    Wat H, Wu DC, Rao J, Goldman MP. Application of intense pulsed light in the treatment of dermatologic disease: a systematic review. Dermatol Surg. 2014;40:359–77.CrossRefPubMedGoogle Scholar
  38. 38.
    Tanzi EL, Manitphakdeedecha R, Alster TS. Fraxel laser indications and long-term follow-up. Aesthet Surg J. 2008;28:679–80.CrossRefGoogle Scholar
  39. 39.
    Lee HM, Haw S, Kim JK, Chang SE, Lee MW. Split-face study using a 1,927-nm thulium fiber fractional laser to treat photoaging and melasma in Asian skin. Dermatol Surg. 2013;39:879–88.CrossRefPubMedGoogle Scholar
  40. 40.
    Massaki AB, Fabi SG, Fitzpatrick R. Repigmentation of hypopigmented scars using an erbium-doped 1,550-nm fractionated laser and topical bimatoprost. Dermatol Surg. 2012;38:995–1001.CrossRefPubMedGoogle Scholar
  41. 41.
    Siadat AH, Rezaei R, Asilian A, Abtahi-Naeini B, Rakhshanpour M, Raei M, Hosseini SM. Repigmentation of hypopigmented scars using combination of fractionated carbon dioxide laser with topical latanoprost vs. fractionated carbon dioxide laser alone. Indian J Dermatol. 2015;60:364–8.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Roxo RF, Sarmento DF, Kawalek AZ, Spencer JM, et al. Successful treatment of a hypochromic scar with manual dermabrasion: case report. Dermatol Surg. 2003;29:189–91.PubMedGoogle Scholar
  43. 43.
    Camirand A, Doucet J. Needle dermabrasion. Aesthet Plast Surg. 1997;21:48–51.CrossRefGoogle Scholar
  44. 44.
    Olsson MJ, Juhlin L. Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension. Br J Dermatol. 2002;147:893–904.CrossRefPubMedGoogle Scholar
  45. 45.
    Goodman GJ. An automated autologous cell transplantation method for the treatment of hypopigmented scarring. Dermatol Surg. 2008;34:578–81.PubMedGoogle Scholar
  46. 46.
    Stoner ML, Wood FM. The treatment of hypopigmented lesions with cultured epithelial autograft. J Burn Care Rehabil. 2000;21(1 Pt 1):50–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: a comprehensive review. Dermatol Surg. 2016. [Epub ahead of print].Google Scholar
  48. 48.
    Abdel Hay R, Shalaby K, Zaher H, Hafez V, Chi CC, Dimitri S, Nabhan AF, Layton AM. Interventions for acne scars. Cochrane Database Syst Rev. 2016;4:CD011946. Scholar
  49. 49.
    Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D. Acne scarring treatment using skin needling. Clin Exp Dermatol. 2009;34(8):874–9. Epub 2009 May 22.CrossRefPubMedGoogle Scholar
  50. 50.
    Chan HH, Lam LK, Wong DS, Kono T, Trendell-Smith N. Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians. Lasers Surg Med. 2004;34(2):98–103.CrossRefPubMedGoogle Scholar
  51. 51.
    Min S, Park SY, Moon J, Kwon HH, Yoon JY, Suh DH. Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment. Lasers Surg Med. 2016. [Epub ahead of print].
  52. 52.
    Bhatia AC, Dover JS, Arndt KA, Stewart B, Alam M. Patient satisfaction and reported long-term therapeutic efficacy associated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging. Dermatol Surg. 2006;32:346–52.PubMedGoogle Scholar
  53. 53.
    Tsai RY, Wang CN, Chan HL. Aluminum oxide crystal microdermabrasion. A new technique for treating facial scarring. Dermatol Surg. 1995;21:539–42.CrossRefPubMedGoogle Scholar
  54. 54.
    Fabbrocini G, Annunziata MC, D’Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Bhalla M, Thami GP. Microdermabrasion: reappraisal and brief review of literature. Dermatol Surg. 2006;32(6):809–14.PubMedGoogle Scholar
  56. 56.
    Spencer JM. Microdermabrasion. Am J Clin Dermatol. 2005;6:89–92.CrossRefPubMedGoogle Scholar
  57. 57.
    Rajan P, Grimes PE. Skin barrier changes induced by aluminum oxide and sodium chloride microdermabrasion. Dermatol Surg. 2002;28:390–3.PubMedGoogle Scholar
  58. 58.
    Freeman MS. Microdermabrasion. Facial Plast Surg Clin North Am. 2001;9:257–66.PubMedGoogle Scholar
  59. 59.
    Sapra S, Stewart JA, Mraud K, Schupp R. A Canadian study of the use of poly-L-lactic acid dermal implant for the treatment of hill and valley acne scarring. Dermatol Surg. 2015;41(5):587–94. Scholar
  60. 60.
    Fife DJ. Commentary on a Canadian study of the use of poly-L-lactic Acid dermal implant for the treatment of hill and valley acne scarring. Dermatol Surg. 2015;41:595–6.CrossRefPubMedGoogle Scholar
  61. 61.
    Joseph JH, Eaton LL, Cohen SR. Current concepts in the use of Bellafill. Plast Reconstr Surg. 2015;136(5 Suppl):171S–9S.CrossRefPubMedGoogle Scholar
  62. 62.
    Kerscher M, Bayrhamme J. Rejuvenating influence of a stabilized hyaluronic acid-based gel of nonanimal origin on facial skin aging. Dermatol Surg. 2008;34:720–6.PubMedGoogle Scholar
  63. 63.
    Jordan RE, Cummins CL, Burls AJ, Seukeran DC. Laser resurfacing for facial acne scars. Cochrane Database Syst Rev. 2001;(1):CD001866.Google Scholar
  64. 64.
    Jordan R, Cummins CC, Burls A, Seukeran DD. WITHDRAWN: laser resurfacing for facial acne scars. Cochrane Database Syst Rev. 2016;4:CD001866. Scholar
  65. 65.
    Stulhofer Buzina D, Lipozenčić J, Bukvić Mokos Z, Ceović R, et al. Ablative laser resurfacing: is it still the gold standard for facial rejuvenation? Acta Dermatovenerol Croat. 2010;18:190–4.PubMedGoogle Scholar
  66. 66.
    Hantash BM, Gladstone HG. Current role of resurfacing lasers. Ital Dermatol Venereol. 2009;144:229–41.Google Scholar
  67. 67.
    Goodman GJ. Dermabrasion using tumescent anaesthesia. J Dermatol Surg Oncol. 1994;20:802–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Al-Waiz MM, Al-Sharqi AI. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg. 2002;28:383–7.PubMedGoogle Scholar
  69. 69.
    Smith KC. Repair of acne scars with Dermicol-P35. Aesthet Surg J. 2009;29(3 Suppl):S16–8.CrossRefPubMedGoogle Scholar
  70. 70.
    Goodman GJ, Van Den Broek A. The modified tower vertical filler technique for the treatment of post-acne scarring. Australas J Dermatol. 2016;57:19–23.CrossRefPubMedGoogle Scholar
  71. 71.
    Karnik J, Baumann L, Bruce S, Callender V, Cohen S, Grimes P, Joseph J, Shamban A, Spencer J, Tedaldi R, Werschler WP, Smith SR. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol. 2014;71:77–83.CrossRefPubMedGoogle Scholar
  72. 72.
    Goodman GJ. The use of botulinum toxin as primary or adjunctive treatment for post acne and traumatic scarring. J Cutan Aesthet Surg. 2010;3:90–2.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol. 2015;14:161–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Wilson AM. Eradication of keloids: surgical excision followed by a single injection of intralesional 5-fluorouracil and botulinum toxin. Can J Plast Surg. 2013;21:87–91.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Orentreich DS. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg. 1995;21:543–9.PubMedGoogle Scholar
  76. 76.
    Goodman GJ. Therapeutic undermining of scars (Subcision). Australas J Dermatol. 2001;42:114–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Ramadan SA, El-Komy MH, Bassiouny DA, El-Tobshy SA. Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars. Dermatol Surg. 2011;37:626–33.CrossRefPubMedGoogle Scholar
  78. 78.
    Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Dermatol Surg. 2002;28:1017–21.PubMedGoogle Scholar
  79. 79.
    Garg S, Baveja S. Combination therapy in the management of atrophic acne scars. J Cutan Aesthet Surg. 2014;7:18–23.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Goodman GJ, Baron JA. Postacne scarring: a qualitative global scarring grading system. Dermatol Surg. 2006;32:1458–66.PubMedGoogle Scholar
  81. 81.
    Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg. 1999;25:224–32.CrossRefPubMedGoogle Scholar
  82. 82.
    Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27:23–7.PubMedGoogle Scholar
  83. 83.
    Stewart CE, Kim JY. Application of mitomycin-C for head and neck keloids. Otolaryngol Head Neck Surg. 2006;135:946–50.CrossRefPubMedGoogle Scholar
  84. 84.
    Ren Y, Zhou X, Wei Z, Lin W, Fan B, Feng S. Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J. 2016. [Epub ahead of print].
  85. 85.
    Grevelink JM, White VR. Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring. Dermatol Surg. 1998;24:527–30.PubMedGoogle Scholar
  86. 86.
    Solotoff S. Treatment for pitted acne scarring–postauricular punch grafts followed by dermabrasion. J Dermatol Surg Oncol. 1986;12:1079.CrossRefPubMedGoogle Scholar
  87. 87.
    Faghihi G, Nouraei S, Asilian A, Keyvan S, Abtahi-Naeini B, Rakhshanpour M, Nilforoushzadeh MA, Hosseini SM. Efficacy of punch elevation combined with fractional carbon dioxide laser resurfacing in facial atrophic acne scarring: a randomized split-face clinical study. Indian J Dermatol. 2015;60:473–8.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    James IB, Coleman SR, Rubin JP. Fat, stem cells, and platelet-rich plasma. Clin Plast Surg. 2016;43:473–88.CrossRefPubMedGoogle Scholar
  89. 89.
    Sasaki GH. The safety and efficacy of cell-assisted fat grafting to traditional fat grafting in the anterior mid-face: an indirect assessment by 3D imaging. Aesthet Plast Surg. 2015;39:833–46.CrossRefGoogle Scholar
  90. 90.
    Azzam OA, Atta AT, Sobhi RM, Mostafa PI. Fractional CO2 laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study. J Drugs Dermatol. 2013;12:e7–e13.PubMedGoogle Scholar
  91. 91.
    Tanzi EL, Alster TS. Comparison of a 1,450-nm diode laser and a 1,320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study. Dermatol Surg. 2004;30(2 Pt 1):152–7.PubMedGoogle Scholar
  92. 92.
    Bernstein EF, Ferreira M, Anderson D. A pilot investigation to subjectively measure treatment effect and side-effect profile of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration laser. J Cosmet Laser Ther. 2001;3:137–41.CrossRefPubMedGoogle Scholar
  93. 93.
    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(9):1189–95.PubMedPubMedCentralGoogle Scholar
  94. 94.
    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;44:447–52.CrossRefPubMedGoogle Scholar
  95. 95.
    Yang Q, Huang W, Qian H, Chen S, Ma L, Lu Z. Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: a split-face comparative study. J Cosmet Laser Ther. 2016;18:312–6.CrossRefPubMedGoogle Scholar
  96. 96.
    Alexis AF, Coley MK, Nijhawan RI, Luke JD, Shah SK, Argobi YA, Nodzenski M, Veledar E, Alam M. Nonablative fractional laser resurfacing for acne scarring in patients with Fitzpatrick skin Phototypes IV–VI. Dermatol Surg. 2016;42:392–402.CrossRefPubMedGoogle Scholar
  97. 97.
    Mahmoud BH, Srivastava D, Janiga JJ, Yang JJ, Lim HW, Ozog DM. Safety and efficacy of erbium-doped yttrium aluminum garnet fractionated laser for treatment of acne scars in type IV to VI skin. Dermatol Surg. 2010;36:602–9.CrossRefPubMedGoogle Scholar
  98. 98.
    Chae WS, Seong JY, Jung HN, Kong SH, Kim MH, Suh HS, Choi YS. Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar. J Cosmet Dermatol. 2015;14:100–6.CrossRefPubMedGoogle Scholar
  99. 99.
    Rongsaard N, Rummaneethorn P. Comparison of a fractional bipolar radiofrequency device and a fractional erbium-doped glass 1,550-nm device for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg. 2014;40:14–21.CrossRefPubMedGoogle Scholar
  100. 100.
    Cachafeiro T, Escobar G, Maldonado G, Cestari T, Corleta O. Comparison of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of atrophic acne scars: a randomized clinical trial. Dermatol Surg. 2016;42:232–41.CrossRefPubMedGoogle Scholar
  101. 101.
    Erbağci Z, Akçali C. Biweekly serial glycolic acid peels vs. long-term daily use of topical low-strength glycolic acid in the treatment of atrophic acne scars. Int J Dermatol. 2000;39:789–94.CrossRefPubMedGoogle Scholar
  102. 102.
    Leheta TM, Abdel Hay RM, El Garem YF. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatolog Treat. 2014;25:130–6.CrossRefPubMedGoogle Scholar
  103. 103.
    Leheta TM, Abdel Hay RM, Hegazy RA, El Garem YF. Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial. J Dermatolog Treat. 2014;25:137–41.CrossRefPubMedGoogle Scholar
  104. 104.
    Alam M, Han S, Pongprutthipan M, Disphanurat W, Kakar R, Nodzenski M, Pace N, Kim N, Yoo S, Veledar E, Poon E, West DP. Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial. JAMA Dermatol. 2014;150(8):844–9. Scholar
  105. 105.
    Goodman GJ, Baron JA. Postacne scarring – a quantitative global scarring grading system. J Cosmet Dermatol. 2006;5:48–52.CrossRefPubMedGoogle Scholar
  106. 106.
    Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: a retrospective review. J Am Acad Dermatol. 2016;74:931–6.CrossRefPubMedGoogle Scholar
  107. 107.
    Brauer JA, Kazlouskaya V, Alabdulrazzaq H, Bae YS, Bernstein LJ, Anolik R, Heller PA, Geronemus RG. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol. 2015;151:278–84.CrossRefPubMedGoogle Scholar
  108. 108.
    Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg. 2014;40:624–31.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Primary PracticeMonash UniversityClaytonAustralia
  2. 2.Skin and Cancer Foundation Inc.CarltonAustralia

Personalised recommendations