“It’s pretty hard to fi nd a device that gives you a better improvement than ProFractional…”
Kent Remington, M.D., FACS., FRCP
Acne Scar Treatment with Profractional Resurfacing
Dr. Kent Remington M.D., F.R.C.P.(P)
Since its launch in 2007, ProFractional has achieved successful results in treating wrinkles, fine lines, post-traumatic and acne scars, while improving skins tone and texture. Recognizing that all of these conditions are equally important in your practice, this article focuses on the successful treatment of scarring secondary to active acne vulgaris, a major challenge to practitioners of aesthetic medicine. To the patient, acne scarring is as physically and emotionally traumatic as active acne. The number of patients requesting cosmetic improvement of acne scars is rising rapidly, and armed with knowledge about emerging technology, so are their expectations. But even with new therapies, the issue is still a complex one. Many available treatment options do not seem to satisfy patients, and as such, 50% improvement is considered a success. Patients come into our clinics daily looking to improve their appearance by reducing acne scarring. Until recently all we had to offer them were ablative modalities such as dermabrasion, chemical peels, or CO2 laser resurfacing, all of which require the patient to accept a significant amount of downtime in one form or another.
ProFractional™ from Sciton, Inc. (Palo Alto, CA) softens and blends scars, and patients can feel the difference. Building up on the Contour™ 2940 Er:YAG laser (used to perform MicroLaserPeel®), Sciton added the ProFractional capability that allows users to adjust a scanned pattern size from 6 x 6 mm to 20 x 20 mm and a precise penetration depth of 25 –1000 μm. This allows the physician to treat different types of scars gently or assertively, as the patient requires. There is still a little downtime—patients look like they have a sunburn for a short time. The economics of the ProFractional are advantageous since there are no consumable components.
Benefits of Profractional
The advent of fractional technology came with the promise of better results with less downtime, even with acne scarring. The ProFractional device ablates narrow, precise channels into the dermis with no collateral thermal necrosis, stimulating neocollagenesis and wound healing in the dermis to create smoother, softer skin that feels better to the touch. The untreated surrounding tissue promotes rapid, uniform healing.
Due to efficient light absorption by 2940nm wavelength, ProFractional allows to precisely select and control treatment depth. ProFractional can be as effective as other fractional devices but offers the physician more treatment flexibility. This leads to positive results that can be seen in fewer treatments and less overall downtime. In addition to that, micro-ablated channels immediately eliminate necrotic debris from the tissue, providing for a more comfortable treatment experience and speeding up healing. In comparison, Er:Glass and CO2 fractional devices leave a large zone of thermal necrosis in the tissue, which accounts for a prolonged redness and swelling after the treatment.
ProFractional users can treat individual scars as minimally or as aggressively as necessary to create an overall evenness to the skin. Deeper scars that require more aggressive treatments can be treated accordingly, while more shallow scars on the same patient can be treated at a different setting. Though ProFractional can spot treat, treating the whole face at varying intensities creates a uniform color, texture, and tone.
Acne scars have always been a treatment challenge, so managing expectations plays a key part in patient satisfaction. Whether for the treatment of acne scars or traumatic scars, 50% improvement in texture, tone, color, depth and size is the accepted standard with any treatment option. Photography is helpful in that both patients and clinicians can see improvement by comparison and happy patients will come back for more treatments. Patient satisfaction after ProFractional treatment has been very high because both visible and tactile improvement is obvious. Acne scars make the skin dull; after ProFractional treatment patients’ skin looks fresh, and they have the glow of a more youthful person. This device really improves the overall quality of the skin.
Much of the focus with ProFractional has been for facial acne scarring, but successful treatment of the neck and chest is also possible and has been done in our clinics. Overall, patients report satisfaction with the improvement in their skin’s texture, tone and color. Dermal fillers are being used after the third treatment by one author to help elevate the scars and bring more dramatic results on the face. Inflexible scars such as depressed pox scars require that the filler not be injected until after the third ProFractional treatment due to the effects of collagen remodeling. But acne is a management project, and such a combination is proving beneficial. Combination treatments, such as with MLP or dermal fillers and others involving laser- and light-based modalities, mean that the future for ProFractional looks bright.