Comparison of Non-insulated Microneedle Fractional Radiofrequency and Ablative Fractional Carbon Dioxide Laser for the Treatment of Facial Atrophic Acne Scarring: A Pilot Randomized Split-face Clinical Study

Abstract

A study was undertaken to compare the effectiveness and adverse effects of non-insulated microneedle fractional radiofrequency (NIMFRF) and ablative fractional carbon dioxide (AFCO2) laser on facial atrophic acne scarring in a randomized split-face model. Thirty subjects with facial atrophic acne scarring were enrolled. Each side of the face randomly received 1 session of NIMFRF or AFCO2 laser. Photographs were taken by VISIA Complexion Analysis System at baseline, 1 month, 2 months, and 6 months after treatments. Subjective evaluations included Échelle d'Évaluation Clinique des Cicatrices d'Acné (ECCA) score, global improve-ment, and self-satisfaction. Potential adverse effects were also recorded. Skin melanin index and ery-thema index were measured. NIMFRF and AFCO2 laser show-ed comparable efficacies on atrophic acne scarring (p > 0.05). ECCA scores decreased significantly at each follow-up visit, compared with baseline (p < 0.05). Approximate 95% of subjects achieved "satisfied" or "very satisfied" improvement. Pain was more obvious on the AFCO2 laser side. Significantly increased red area value, melanin index and erythema index levels were seen on the AFCO2 laser side at one month or 2 month, compared with the NIMFRF side (p < 0.05). NIMFRF has milder adverse effects with shorter recovery period than AFCO2 laser. NIMFRF may be preferable for some patients due to its favourable adverse effect profile.

Fig. 1

Mean ECCA scores and mean decreases in ECCA scores on the NIMFRF and AFCO₂ laser sides. (A) Both on the NIMFRF side and AFCO₂ laser side, the mean ECCA scores were significantly decreased compared with the baselines. (B) For the mean decreases in ECCA scores, there was no difference between the NIMFRF side and the AFCO₂ laser side either at baseline or at each follow-up visit. **p < 0.01; NS, p > 0.05.

Fig. 2

Representative clinical photographs of (A) a 25-year-old man and (B) a 32-year-old woman before and after treatment with NIMFRF and AFCO₂ laser. After NIMFRF and AFCO₂ laser treatment, facial atrophic acne scarring was significantly improved. Both modalities achieved similar therapeutic effect.

Fig. 3

Changes in red area under VISIA Complexion Analysis System on the NIMFRF and AFCO₂ laser sides. The erythema of the AFCO₂ laser side was more severe than the NIMFRF side at M1, and comparable at other follow-up visits.

Fig. 4

Measure indexes using VISIA Complexion Analysis System: changes in MI and EI values and skin sebum content on the NIMFRF and AFCO₂ laser sides. (A) The values of red areas on the AFCO₂ laser side were significantly higher than that of the NIMFRF side at M1, and no differences were seen at other time points. (B) The values of pores significantly decreased after NIMFRF and AFCO₂ laser treatments and the difference in the 2 devices was not statistically significant. Significant increases in MI and EI values were seen on the AFCO₂ laser side at M1 follow-up visit. (C) The increases in MI value were much higher on the AFCO₂ laser side than the NIMFRF side at M1 and M2. (D) The increase of EI value was much higher on the AFCO₂ laser side than the NIMFRF side at M1. No significant difference was seen at other time points. Significant decreases in skin sebum content were seen on both the NIMFRF and AFCO₂ laser sides at M1. (E) The changes of skin sebum content were not significant between the 2 sides at any other time point. ***p < 0.001, **p < 0.01, *p < 0.05; NS, p > 0.05.