Fractional Carbon Dioxide Laser and its Combination with Subcision in Improving Atrophic Acne Scars

Background: Acne is a very common skin disease in which scars are seen in 95% of the patients. Although numerous treatments have been recommended, researchers are still searching for a single modality to treat the complication due to its variety in shape and depth. We compared the effects of fractional carbon dioxide (CO₂) laser alone and in combination with subcision in the treatment of atrophic acne scars. Materials and Methods: This clinical trial study was performed in Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran) during 2011–2012. Eligible patients with atrophic acne scars were treated with fractional CO₂laser alone (five sessions with 3-week interval) on the right side of the face and fractional CO₂laser plus subcision (one session using both with four sessions of fractional CO₂laser, with 3-week interval) on the left side. The subjects were visited 1, 2, and 6 months after the treatment. Patient satisfaction rate was analyzed using SPSS 20 software. Results: The average of recovery rate was 54.7% using the combination method and 43.0% using laser alone (P < 0.001). The mean patient satisfaction was significantly higher with the combination method than laser alone (6.6 ± 1.2 vs. 5.2 ± 1.8; P < 0.001). Bruising was only seen with the combination method and lasted for 1 week in 57.0% and for 2 weeks in 43.0%. Erythema was seen in both methods. Postinflammatory pigmentation and hyperpigmentation were associated with combination method. No persistent side effects were seen after 6 months. Conclusion: Using a combination of subcision and laser had suitable results regarding scar recovery and satisfaction rate.