A Combination Approach to Treating Acne Scars in All Skin Types: Carbolic Chemical Reconstruction of Skin Scars, Blunt Bi-level Cannula Subcision, and Microneedling-A Case Series.

Acne is a common condition that often results in scarring. Current treatment options, such as chemical peels, laser therapy, radiofrequency, subcision, and microneedling, all have some efficacy in the treatment of acne scars. Results can vary based on the type of scarring and the treatment modality used. We propose a novel treatment of acne scarring using a multimodal approach comprising chemical reconstruction of skin scars, subcision, and microneedling. A retrospective chart review was conducted from January 2017 to December 2018 of all patients with acne scars treated with a triple combination approach in an outpatient cosmetic dermatology practice. Patients presenting with acne scarring who were 18 years of age or older and treated with the triple combination technique were eligible for inclusion. Each patient was treated with a combination of three procedures: 1) chemical reconstruction of skin scars (CROSS), mainly with carbolic acid; 2) blunt bi-level cannula subcision; and 3) microneedling. A total of 139 patients were treated, of whom 89 (64%) had Fitzpatrick Skin Types IV to VI. Shadow-lit before and after photos and patient feedback on side effects and satisfaction level were used to assess changes. On average, patients received a total of two treatments each (range: 1-4 treatments). This triple approach to treating acne scars resulted in consistently high satisfaction among patients and photographic evidence of improvements. The triple combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) appears to be effective for the treatment of acne scars. Randomized, controlled clinical trials with larger patient numbers are needed to support these observations.