Treatment of Acne Scars of Skin Types II to V by Sublative Fractional Bipolar Radiofrequency and Bipolar Radiofrequency Combined with Diode Laser

Abstract

Objective: This study evaluated the safety and efficacy of sublative fractional bipolar radiofrequency and bipolar radio frequency combined with diode laser for the treatment of both superficial and deep acne scars in patients with skin types II to V.

Design: Prospective, single-center study. Subjects received up to five treatments with sublative fractional bipolar radiofrequency and bipolar radiofrequency combined with diode laser. Treatments were directed to at least two facial (forehead, perioral, cheeks) and/or neck areas with acne scars at four-week intervals. Treatment parameters on each subject were based on skin type and on skin responses to test spots on the target area just before treatment.

Setting: Physician office.

Participants: Subjects (n=20, aged 40.7±10.5 years [mean ± SD], skin types II-V) with acne scars and without acne lesions enrolled in this prospective study.

Measurements: RESULTS were evaluated just before each treatment and at four and 12 weeks after the final treatment using the Goodman Scar Scale, a quantitative method of evaluating scars that attempts to reduce grading subjectivity, as well as by patient satisfaction.

Results: Acne scars improved significantly one month after three treatments and improvement persisted for at least 12 weeks after the fifth treatment. Improvement was not affected by skin type. Adverse effects were limited to transient erythema and edema.

Conclusion: The combination of diode laser and bipolar radiofrequency energy device in addition to fractionated sublative radiofrequency is a safe and statistically significantly effective combined modality for the treatment of both superficial and deep acne scars in patients with skin types II to V with minimal downtime and no significant side effects.

Figure 1

Schematic of Combination Bipolar Matrix Array and Bi-Polar RF (DLRF). The intersection of the two modalities creates thermal bands at 1.5mm into the dermis causing collagen contraction. Figure courtesy of Syneron Medical LTD.

Figure 2

Sublative Rejuvenation Disposable Tips and Schematic. Radiofrequency current flows between the positive and negative mini-electrodes. Control of this current allows varying degrees of tissue impact. In the space of no current flow a healing reservoir is obtained. Image courtesy of Syneron Medical LTD.

Figure 3

Photomicrograph of skin wound taken immediately after sublative rejuvenation pulse. Note clean ablation of epidermis and upper dermis with slight coagulation of the upper dermis. Photomicrograph courtesy of Syneron Medical LTD.

Figure 4

Thirty-six hours after treatment, note crust formation and deep dermal coagulation and remodeling. Reprinted with permission from: Hruza G, et al. Skin rejuvenation and wrinkle reduction using a fractional radiofrequency system.

Figure 5

Average Goodman Scar Score Over Time. Patients with at least three treatments versus patients with five treatments. *=statistical significance.

Figure 6

The mean acne score for each ethnicity at baseline is compared to the mean acne scar for each ethnicity one month after completing three treatments. The number of patients in each ethnicity group was Caucasian=10, Hispanic/Latino=4, Asian/Pacific Islander=3, Indian/Middle Eastern=2, and Caucasian and Middle Eastern (she is Fitzgerald skin type III)=1.

Figure 7

Hispanic study patient before and one month after three treatments of SR and DLRF

Figure 8

Same patient as Figure 7, opposite cheek view. Hispanic patient before and one month after three treatments

Figure 9

East Indian study patient before and one month after five treatments of SR and DLRF

Figure 10

Thermal profile at different energies Sublative 64 (.86W/electrode). As the energy is increased, both the depth and diameter of affected tissue increases.