Comparison of a Single Treatment of Needleless Microsubcision With Hyaluronic Acid and Carbon Dioxide Pinhole Method for Atrophic Acne Scars

BACKGROUND Scarring, particularly the atrophic type, is one of the most distressing consequences of acne. Despite the availability of various treatment options, no single best treatment option has been recognized. OBJECTIVE To compare the efficacy of carbon dioxide (CO 2 ) pinhole method and needleless microsubcision with hyaluronic acid (HA) to identify a more effective treatment option for acne atrophic scars. MATERIALS AND METHODS A 4-week prospective, single-center, evaluator-blinded, randomized, split-face study was conducted. Clinical evaluation using the VISIA imaging tool, reflectance confocal microscopy (RCM), and histopathologic analysis was performed a month after a single-treatment session. RESULTS Microsubcision with HA improved scarring depth and postacne erythema more than CO 2 pinhole method, although the differences were not statistically significant. Histopathologic analysis revealed that microsubcision with HA induced diffuse soft tissue remodeling and evenly distributed fine collagen fibers. In addition, RCM analysis revealed evenly distributed hyper-reflective collagen fibers in the dermis and regular honeycomb patterns in the epidermis. No serious adverse effects were observed. CONCLUSION This study demonstrated that needleless microsubcision with HA shows a nonsignificant trend toward superiority than CO 2 pinhole method in treating atrophic acne scars.