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Post-acne scar removal with a CO2 laser: a clinical case

The article discusses the clinical case of a patient who underwent successful treatment of post-acne scars with laser exposure to DOT and DROT therapy.
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Atrophic acne scars are not only one of the most common reasons for visiting cosmetologists, but also one of the most difficult therapeutic tasks.

The pathogenesis of their formation is complicated.

It is believed that it is associated with inflammatory mediators and enzymatic degradation of collagen fibers of the dermis, as well as hypodermis. Today, research is continuing on why some patients with acne develop scars, while others do not, since the severity of acne does not always correlate with the frequency or degree of scarring. A hereditary or genetic predisposition to their formation is assumed 1. In any case, post-acne scars often lead to psycho-emotional discomfort of patients and a significant decrease in the quality of life.

The clinical picture of atrophic scars is quite typical – thin, reminiscent of tissue paper and have a transparent surface through which the vessels are visible. As a result of fibrosis, all skin appendages disappear, the relief is completely smoothed. Flat atrophic small scars occur mainly on the face. Large scars up to several centimeters are noted in the shoulder girdle.

Histological examination shows a flat thin epidermis with voids. Within the dermis, a large number of dilated lymphatic and venous vessels are found. Thin, horizontally located collagen fibers in the form of nodes and loops are clearly visible, lymphohistiocytic cells are located between these fibers. Elastic fibers are almost completely destroyed, stored only on the periphery of the scar. The appendages of the skin are also completely destroyed, only sometimes the remains of hair follicles are found.

Post-Acne Correction Techniques
Prior to the era of the development of laser technology, an effective and safe treatment for acne scars was absent. In order to correct them, deep peelings were used, which often resulted in burns, continuous scarring of the treated area and dubious aesthetic result 2, 3.

Currently, the most effective, fast and safe method of treating post-acne atrophic scars is the use of DOT and DROT therapy using the CO2 laser system SmartXide2 from DEKA (Italy).

DOT-therapy SmartXide2 Deka, post-acne
The advantages of this technique include not only the combination of a CO2 laser with RF radiation, but also the possibility of modulating the shape of the pulses and the presence of five stack levels (DEKA’s patented technology).

There is a point fractional vaporization of microscopic skin areas at a strictly specified depth, which leads to a reduction in the area of ​​the treated area, the formation of tissue heating zones (in undamaged skin areas) and, as a result, active stimulation of new collagen.
When using DROT therapy, the primary effect on the tissue is exerted by a CO2 laser pulse, preparing the skin for the subsequent exposure to RF radiation due to increased blood flow in the dermis, as a result of which its conductivity for thermal energy is significantly increased. Subsequent RF radiation, penetrating deep into the dermis, is able to provide intensive and long-term stimulation of fibroblasts without damaging the skin. It is noted that even when choosing higher laser energy parameters when using combination (DROT) therapy, an increase in the recovery period is not characteristic.
For laser therapy of acne scars, the penetration depth of the laser beam and the possibility of flexible changes in this parameter are fundamentally important. Due to the stack mode from 1 to 5 levels, SmartXide2 allows you to adjust the exposure depth without pronounced lateral thermal damage, which made it possible to conduct highly effective and differentiated laser scar therapy with a minimal risk of side effects, even when using high laser energy parameters.
An indisputable advantage in working with scars is the ability to modulate the shape of the pulse. In particular, when working with deep atrophic scars, thick porous skin, the D-Pulse pulse shape is preferred. This pulse shape has a high peak power, which does not depend on the subsequent thermal part, which allows for pronounced tissue shrinkage and alignment of its relief.
It must be emphasized that the basis of the effectiveness of this laser is a combination of parameters: modulation of the pulse shape, adjustable exposure depth (stacks) and adjustable distance between points, which provides doctors with effective opportunities to control the nature of the impact, individualize therapy and avoid the occurrence of excessive thermal damage to the lateral zones, which directly reduces the risk of post-inflammatory hyperpigmentation.

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