CO2 Laser a Good Option for Acne Scar Treatment

Acne scars remains one of the most challenging condition to treat. In short, there is no one single treatment that is best for everyone. That being said, I see many patients whom are extremely frustrated after trying treatments that are not effective for their type of acne.

The carbon dioxide (CO2) laser is an effective treatment for atrophic (slightly depressed) scars. In the recent years, it has been used less as others are trying “simpler” procedures with little or no downtime, although with far less benefit. In this study over 77% of participants reported at least mild improvement, while 40% of the participants noted moderate to significant improvement.

That being said, this is not the only treatment for this type of scarring. Dermabrasion and medium depth chemical peels (i.e. TCA – trichloroacetic acid) are good options as well. Short term options include fillers, such as Restylane.

Citation: Elcin G, Yalici-Armagan B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: Prospective clinical trial with short and long-term evaluation. 2017;32(9):2047-2054. doi:10.1007/s10103-017-2322-7.

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“Better than Botox?”

Revance Therapeutics Inc. said that an experimental drug RT002 [injectable daxibotulinumtoxinA] can smooth wrinkles for longer than Allergan’s Botox, according to the results of late-stage studies. We will have to wait for the published data to see, but at least early reports look promising.

Botox Cosmetic is now FDA approved for the treatment of the forehead

Botox and Dysport have been  used to treat the forehead for nearly 2 decades as an “off label indication”.  This has no impact on the treatment of the forehead furrows, but it does have the FDA’s stamp of approval.

To celebrate this we are offering treatment of the forehead for $199. This does not include the treatment of any other area (frown lines or crow’s feet). You must present this article to receive this special offer.

Restrictions apply–inquire to find out more. This offer expires November 1, 2017.

PRP: is it worth all the hype?

Celebreties are raving about it, doctors are promoting it for many things, but is it really worth the hype?

In short, PRP is not FDA approved for anu Dermatologic or Cosmetic indication. There are several small studies that concluded that there is benefit when treating androgenic alopecia. That being said, larger, well-designed studies are needed. For other indications, such as photo-rejuvenation, studies are even more poorly designed.

There is a good scientific basis for why PRP may help a variety of conditions. Unfortunately, due to a lack of good clinical studies further research is needed. So the answer to the question of whether is is worth the hype is maybe. 

Often, PRP is combined with another procedure–laser resurfacing+PRP, or Restylane+PRP. When doing so, it is difficult to know if the PRP is adding any benefit.

Scar Treatments using “Lasers”

It’s funny today. No matter what the condition, everyone thinks that a “laser” is available and is best. In most cases, this is not so, but in many cases, laser treatments are available.

There are many different types and causes of scars: traumatic, post-surgical, and acne scars to name a few. Well, there is not one treatment that is best for all types of scars. So, when it comes to scars, you need to have a lot of tools at your disposal in order to get the best result. For example, here is a list of treatments that I perform regularly for scars:

  • CO2 laser ablation
  • Dermabrasion (not to be confused with microdermabrasion)
  • TCA peels
  • IPL (intensed pulsed light)
  • Topical treatments (i.e. silicone gel sheets, 5-FU), which can be combined with other treatment modalities
  • Surgical scar revision
  • Electrodesiccation
  • Dermal and/or subdermal fillers
  • Subcision

What is not on the list:

  • Microdermabrasion – studies have shown that there is virtually no benefit unless one reaches the dermis( pinpoint bleeding), at which point it is a dermabrasion and not microdermabrasion. This modality can be combined with chemical peels, which does offer benefit.
  • Microneedling – although there may be some benefit, the cost-benefit ratio is poor (high cost for minimal, if any, benefit). This is frequently recommended as there is minimal risk.

In short, the treatment of scars requires experience and skill. More and more frequently, I perform post-operative treatments to reduce the appearance of scars before they fully form (i.e. 10-14 days after facial surgery). But, most scars that are treated are from acne and/or trauma.

Hair loss treatments – for men and women

According to a recent article, all treatments that were evaluated were effective in treating hair loss.

For men, 2% minoxidil, 5% minoxidil, low light therapy, and finasteride were all effective.

For women, 2% minoxidil was effective. Unfortunately, other treatments were not evaluated for women.

Recommendations from Dr. Bader: In my experience finasteride is most effective in men with a high compliance rate.  The original 1mg dose was actually pulled out of thin air–no studies to find the most effective dose with the least amount of side effects was used to come up with this dose. I have found that 1mg may not be enough for some patients. 1.25mg (a quarter of a 5mg tablet) works well and some require a 2.5mg dose once or twice a week. I have found that this higher dosing has a greater effect on those who do not get the desired result with a minimal increase in side effects.

For women, I recommend that 5% minoxidil used once daily. This dosing schedule was recently FDA approved, not that this matters. One can buy the 5% minoxidil for men or women, whichever is cheaper. The product is the same. The only difference is the instructions that come with the product. Men are instructed to use the product twice daily. Studies have shown that 5% minoxidil twice a day is no more effective than 2% minoxidil twice a day. For this reason, once a day dosing is recommended for women, not that there is substantially greater risk of using the product twice a day. Side effects from this product include low blood pressure and increased facial hair growth in some. I recommend using the product at night, when one is less affected by lower blood pressure. One should get out of bed slowly to ensure they do not get lightheaded.

New scar treatment for thick scars

Tranilast 8% liposomal gel was shown to be effective in treating scars from cesarean sections. Patients were asked to treat half of their scars with this gel and the other half with placebo. Patients were much more satisfied with the Tranilast side.

Unfortunately, this treatment has not been compared to other treatments, including steroid injections and silicone gel sheets, but at least gives another option for patients with thick scars