Medesthetics

JUL-AUG 2019

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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© GETTY IMAGES SPLITTING ENERGY 44 JULY/AUGUST 2019 | Med Esthetics SKIN CONCERN: SCARRING Fractional devices—both ablative and nonablative—have proved effective tools for both acne scarring and burn scars. "Acne scarring is extremely challenging," says Dr. Lee. "Deep pitted, ice-pick and rolling or crater form scars are diffi cult to treat. It helps to combine many different modali- ties along with subcision and fi llers. Combining fractional RF microneedling with PRP and subcision and trichloroacetic acid (TCA) CROSS is a popular approach for patients with severe acne scarring. These patients usually also need noninvasive lasers to address vascular and pigmentary issues along with resurfacing." RF microneedling is an acne scarring treatment of choice for Mitchel P. Goldman, MD, medical director of West Dermatology and volunteer clinical professor of dermatol- ogy at the University of California, San Diego. "For acne scars, we have evolved into using bipolar RF microneedling and presently believe that the INTR Acel (Perigee Medical) system is the best," he says. An additional benefi t of RF microneedling for acne scar patients is that it has shown promise in controlling active acne as well as decreasing scar depth and improving skin texture. "Improvement may be due to the reduction in some sebaceous glands and reduction of perifolliculitis," says Dr. Goldman. Meanwhile, Dr. Kaufman-Janette opts for either a frac- tional CO 2 laser, fractional 1,540nm or 1,550nm nonabla- tive laser, or fractional RF microneedling with the Lutronic Infi ni or Genius to address acne scars. "For darker skin types, I would steer away from fractional CO 2 due to the higher possibility of postoperative pigmentation abnormali- ties, including hypo- and hyperpigmentation," she says. "I do try to do lower energy treatments on darker skin, as opposed to high energy one-session plans." Dr. Morton also prefers nonablative fractional lasers— 1,540nm or 1,550nm—for acne scarring. "Fractional abla- tive devices, such as CO 2 and Er:YAG lasers may provide more marked results with one to two sessions, but the downtime associated with them (weeks) and the risk of side effects, such as infection, scarring and discoloration, make them less appealing options," she says. Treatment regimens with nonablative fractional devices usually include fi ve to six monthly sessions. The downtime is a week or less and mostly limited to redness, swelling and scaling. "There is some risk of hyperpigmentation in darker skin types, but this generally resolves within two to three months," says Dr. Morton. Picosecond lasers with fractional array handpieces are another potential treatment for acne scarring in patients with darker skin. "Picosecond fractional array devices, in- cluding 532nm, 755nm and 1,064nm wavelengths, can also be used at low energies in a majority of skin types," says Dr. Morton. "They have shown effi cacy for acne scarring with minimal down time and, often, minimal discomfort." As with acne scars, treating burn scars can be challeng- ing because they often involve multiple concerns, including hypertrophy, atrophy, contractures and discoloration. Picosecond lasers with fractional array handpieces are another potential treatment for acne scarring in patients with darker skin.

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