Although the conventional, short-pulsed
erbium:
yttrium-aluminum-garnet (
Er:YAG) laser provides substantial clinical improvement for pitted, facial
acne scars, it shows less effective hemostasis and limited residual thermal effect in the dermis. Recently, dual-mode
Er:YAG laser systems with both ablation and coagulation modes have been developed. The purpose of this study was to evaluate the clinical and histologic effects of resurfacing pitted, facial
acne scars with a dual-mode
Er:YAG laser. Twenty patients with pitted facial
acne scars underwent
laser resurfacing using a computerized-scanning, dual-mode
Er:YAG laser. All patients had Fitzpatrick skin types ranging III-V. Initially, the epidermis was removed in two passes using the ablative settings. This step was followed by two passes in a mixed ablation and coagulation mode, to produce further ablation and controlled, residual thermal damage. A final pass in a ablation mode was used to remove necrotic tissue.
Laser overlapping was approximately 30%. The results of
laser treatment were evaluated for the degree of clinical improvement, duration of
erythema, pigmentary change, and any adverse events at two weeks, one month, and three months. In two patients, skin biopsies were obtained at the following intervals: immediately and two weeks postoperatively for histologic examination. There was a 75% average clinical improvement observed in pitted, facial
acne scars after
laser treatment. Complete wound healing occurred between six and eight days. On histologic examination, complete re-epithelialization was observed at two weeks.
Erythema occurred in all patients after
laser treatment and lasted longer than three months in 10 patients (50%). Postinflammatory
hyperpigmentation occurred in 12 patients (60%) two to four weeks after
laser treatment and lasted longer than three months in one patient (5%). One patient (5%) experienced mild hypopigmention. Mild to moderate, postoperative
acne flare-up occurred in seven patients (35%). No other adverse effects were observed. In conclusion, resurfacing with a dual-mode
Er:YAG laser is a safe and effective treatment modality for pitted, facial
acne scars.