Subdermal Minimal Surgery for Acne Scars

Lee JW et al. Treatment of acne scars using subdermal minimal surgery technology. Dermatol Surg 2010 Aug; 36:1281.

Method:

Subdermal minimal surgery technology makes use of an industrial-strength, needleless hypodermic inoculator that delivers medication into the skin through a high-pressure jet.

One shot covers a 1-cm2 area in the dermal and subdermal planes. In a pilot study from South Korea, investigators evaluated the efficacy of this technology for treating acne scars.

Ten patients with facial acne scars underwent a series of three subdermal minimal surgery treatments, 4 weeks apart, under topical EMLA anesthesia (lidocaine, prilocaine topical cream). Hyaluronic acid (HA) was infiltrated into the area of the scar, at 0.15 mL/scar. The HA used in this trial was 90% cross-linked with butanediol diglycidyl ether; according to the authors, it remains active for 6 to 8 weeks.

Result:

At follow-up 3 months after the last treatment, two independent observers found mean scar improvement of 51% to 75%; in patient assessments, the mean rating was 25% to 50% improvement.

Conclusion:

The authors note that the benefit seemed to last for at least 6 months and that ice pick scars improved more than rolling or boxcar-type scars. Pain was described as none to mild, and no complications were noted.

Comment:

Subdermal minimal surgery technology has interesting potential for delivering filler materials and medications into the skin.

It is not clear whether the observed benefit was related to the fleeting presence of HA or to the trauma of infiltration and resulting wound healing and collagen remodeling.

The authors state that the HA is dispersed within the dermis, but given the density of the dermis, it is much more likely that the material is dispersed in the subdermal plane.