Acne Scars: Multimodal Treatment with Surgical Subdermal Plane Dissection, Microfragmented Adipose Tissue Infiltration and Deep CO2 Laser Resurfacing. Our Clinical Experience in 15 Clinical Cases Treated - Lipogems

Abstract

Background: Acne vulgaris is a common dermatological condition with an estimated prevalence of 70 to 87% in the general population; post-acne scars are equally common conditions with an estimated prevalence of 11 to 14% in the general population and cause a major impact on patients’ quality of life with an important negative psychological impact. Currently, there is no single treatment that can guarantee satisfactory results in the treatment of permanent scars, but the use of multiple therapeutic modalities in combination and with a synergistic effect allows to obtain a better outcome. From this assumption of combining different treatments but with a synergistic effect in the remodeling of acne scars, our study was born. We decided to evaluate the results obtained with 3 techniques that have proven to be complementary in our experience: surgical plane dermoabrasion and their surgical preparation with a cannula and/or 18G needle, infiltration of microfragmented autologous adipose tissue and treatment with fractionated CO2 laser in deep resurfacing mode. Surgical dermoabrasion of the subcutaneous plane from the dermal plane using a cannula needle allows to free the tissue from the adhesions responsible for the scarring retraction and to prepare the correct plane for infiltration with microfragmented adipose tissue. Treatment with microfragmented adipose tissue allows, through the action of stem cells and derived secretion factors, to stimulate collagen synthesis, neoangiogenesis and fibroblast migration. Finally, treatment with fractionated CO2 laser with deep resurfacing induces the synthesis of new collagen through the activation of cutaneous fibroblasts or growth factors. Materials and methods: We recruited 15 patients who we treated at our center (12 women and 3 men, age range between 19 and 54 years, 8 with Fitzpatrick phototype II and 7 with Fitzpatrick phototype III) with atrophic acne scars (boxcar, rolling and icepeack). Patients with active acne, active medical treatment, or patients who had undergone other treatments such as chemical, mechanical or laser resurfacing in the 12 months prior to the study were excluded. All patients were reassessed in the postoperative period at 3, 6, 9 and 12 months and were photographed using a standardized digital camera with the same lighting. The efficacy of the improvement of the scar was evaluated with the ECCA score (échelle d’évaluation clinique des cicatrices d’acné,), to which the patients were subjected to every medical check-up. We also analyzed the subjective perception of patients and their satisfaction through the IGA scale (Investigator’s Global Assessment). All treated patients expressed their feedback during the final follow-up visit using a 5-point scale corresponding to different degrees of improvement (grade 0=no improvement, 1=1–25% improvement, 2=26–50% improvement, standard scale for 75% improvement and 4=76–100% improvement). We recorded the overall duration of patient downtime, defined as a period that significantly affected their quality of relationships and work activity. Results: A significant reduction in the ECCA score was observed from the first postoperative visit in 12 treated cases and subsequently in all cases at the final follow-up visit. According to the IGA scale at the final follow-up visit, 12 patients achieved grade 3 improvements and three patients achieved grade 2. At the final follow-up visit, all patients had a reduction in the volume of the atrophic scar, the average pore volume and the skin roughness. The mean duration of patient downtime was 4.5 days. 11 patients experienced treatment-related side effects such as post-treatment pain, erythema, edema and dryness that resolved within 4 days. No patient healed with the appearance of new scars or other permanent events. Conclusion: The use of adipose tissue in regenerative medicine associated with plane dermoabrasion and ablative CO2 laser represents a valid strategy not only in terms of clinical efficacy, but also of safety in the treatment of acne scars. Furthermore, the use of microfragmented adipose tissue allows for the reduction of post-procedural side effects (edema, inflammation, pain, dryness) with a much faster return to regular daily activities and consequently greater patient satisfaction.