Rejuvenation of the Acne-Scarred Face

Since the 1950s, dermaplaning has been used to improve acne scars. However, global improvement is often limited and remains about 50%. By combining the techniques of subcision, subcutaneous filling, laser shrinkage of collagen, dermabrasion, and excision of acne scars, we hoped to achieve a more pleasing aesthetic result. After preconditioning the skin of 62 patients (ages 17—47, mean age 32; 22 men and 40 women) with vitamin A/glycolic conditioning lotions, a Jessner/TCA peel was performed on the neck and décolletage area. The periorbital areas were also peeled if they were not photoaged. The acne valleys were subcised with a semiblunt needle, and the developed pockets were filled with adipose tissue. Then, the surface skin was vaporized with three passes of a CO 2 laser, and the deeper acne scars in the midface region were sanded with a diamond fraise abrasion. Remaining scars were relasered, excised, or both, and sutured or grafted. To facilitate healing, a semiocclusive dressing was used for 5 days, then replaced with an ointment-based moisturizer for another 5 days. After 10 days, a moisturizer–sunscreen was used, followed by a bleaching cream at 15 days, if necessary. Patients were usually back to work in 2 weeks. By combining these multiple modalities of dermal subcision and augmentation, collagen shrinkage, and dermal sanding, dramatic improvement of the acne-scarred face was possible.