Comparison of Fractional Carbon Dioxide Laser Alone and in Combination with Subcision in Improving Atrophic Acne Scars

Acne is a very common skin disease. Scar are seen in 95% of patients with acne. Although numerous treatments have been recommended to cure acne scars, researchers are still searching for a single modality to treat the complication due to its variety in shape and depth. In other words, a combination of available methods is required to reach satisfactory results. We compared the effects of fractional carbon dioxide (CO2) laser alone and in combination with subcision. This clinical trial study was performed in Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran) during 2011-12. Eligible patients with atrophic acne scars were treated with fractional CO2 laser alone (five sessions with three-week interval) on right side of the face and fractional CO2 laser plus subcision (one session using both followed by four sessions of fractional CO2 laser, all with three-week intervals) on the left side. The subjects were visited one, two, and six months after the treatment. Patient satisfaction rate was analyzed by SPSS20. 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 rate according to visual analogue scale (VAS) score was significantly higher with the combination method than with laser alone (6.6 vs. 5.2; P < 0.001). Bruising was only seen with the combination method and lasted for one week in 57.0% of patients and for two weeks in 43.0%. Erythema was a side effect of both methods. Post-inflammatory pigmentation and hyperpigmentation were only caused by the combination method. None of the patients had persistent side effects after six months. Using a combination of subcision and laser had suitable results regarding scar recovery and satisfaction rate. However, bruising, post-inflammatory pigmentation, and hyperpigmentation were the side effects of this method. In general, subcision plus laser can be beneficial in the treatment of atrophic acne scars.