This document discusses various treatment options for acne scarring. It begins by describing the types of acne scars and the impact they can have. It then covers techniques like dermarolling, subcision, punch excision, and fillers. It discusses lasers including ablative, nonablative, and fractional lasers. It emphasizes the importance of counseling patients and combining approaches. Safety considerations for isotretinoin are also mentioned. The overall message is that a variety of medical and surgical options exist to improve acne scarring, and treatment should be tailored to each individual patient.
A skin graft is a surgical procedure in which a piece of skin is transplanted from one area to another. Often skin will be taken from unaffected areas on the injured person and used to cover a defect, often a burn.
Acute care of facial burns (7th august 2010)Tauseef Hassan
A brief overview of acute management of facial burns, specific procedures regarding excision and different skin substitutes and dressings used for biological and definitive coverage.
Scar Revision in oral and Maxillofacial SurgeryPunam Nagargoje
A scar can be defined as a fault or blemish resulting from some former condition, wound, sore or burn. Scar formation is an inevitable consequence of wound healing in which the normal skin is replaced by a fibrous tissue.
• Mechanism
– Trauma
– Surgical
• Location & orientation
– Cosmesis
– Function.
Ideal Scar
• Flat
• Narrow
• Good color match
• Parallel to or within skin crease, folds and RSTLs
The ideal scar is level with the surrounding tissues, has a favorable color match, is narrow, parallel to or lying within a RSTL, and sinuous without long straight unbroken lines. Not all scars are able to be improved by revision techniques and those that are already optimal may be made much worse if a poorly thought out attempt at revision is undertaken. Patients should be carefully counseled to assure that their expectations are realistic – if they expect the scar to be completely gone - I.e invisible – they need education or they are likely to be displeased
Strategies
• Prevention
– Incision planning
• Relaxed skin tension lines
• Facial subunits
– Careful surgical technique
Postop Wound care
• Steroid injection
• Antitension taping
• Excision
– Irregularization
– Reorientation
• Camouflage
– Cosmetics
– Dermabrasion
Timing
• Traditionally 6 to 12 months
• Perhaps earlier for those perpendicular to tension lines
• Dermabrasion 6 to 9 weeks
– High fibroblast activity
The timing of scar revision has traditionally been after the scar has had a period of maturation of 6 to 12 months.
This allows time for scar maturation and better defines what needs to be accomplished in the revision.
Many would argue that scars lying outside RSTLs and especially those perpendicular to RSTLs are likely to have a poor cosmetic outcome and early revision and reorientation can be considered.
Dermabrasion is frequently performed at 6-9 weeks post injury utilizing the high fibroblastic activity in the wound at that time to aid in favorable wound healing.
Wound Healing
• Inflammatory phase – hours
• Proliferative phase – days
• Remodeling phase – months
Cellular Activity in Wound
Healing
Wound Healing.
TYPES OF SCARS
Mature scar
Imature scar
Contractures
Linear hypertrophic scar
Widespread hypertrophic scar
Minor keloid
Major keloid
Ice pick scar
Rolling scars
Boxcar scars
Hypertrophic scar
Can regress
Oriented collagen
Confined to wound
Scant mucin No myofibroblasts
Scars to consider revision
Longer than 20 mm
• Wider than 1-2 mm
• Disturbing function
• Poor match to surrounding tissue
– Colour
– Depth
• Against RSTLs
Timing of Scar Revision
Generally, every scar will show improvement without revision for up to 1 – 3 years
Traditionally we wait 6 to 12 months
Allows time for the scar to mature
Perhaps earlier for those poorly positioned (perpendicular to tension lines) or those that are markedly uneven
Relevant anatomy
Hide i
Cervicofacial liposuction in Oral and Maxillofacial SurgeryPunam Nagargoje
Liposuction is surgical aspiration of subcutaneous fat by use of a cannula attached to a vacuum pump.
one of the most commonly performed cosmetic procedures .
also referred to as liposculpture, lipoplasty, and suction-assisted lipectomy.
Not a Substitute for healthy lifestyle.
Helps to change body proportions.
History
Maliniak- described submental fat removal and neck contouring in early 1930s.
Davis- Curettes.
Schrudde- lipexeresis in 1972.
Illouz- lipolysis with saline & hyaluronidase.
Klein- Tumescent technique.
Procedure
Liposuction is devided in three steps;
1) Infusion
2)Evacuation
3)Post examination.
INFUSION
To achieve even removal of fat – accurate infusion of wetting solution.
Dilute lidocaine with epinephrine solution into fat is performed with infiltration cannulas and pumps.
Cannulas dimentions –
Diameter- from 1 – 3 mm.
Length – from 10- 30 cm.
Blunt tip
EVACUATION
Through Small access incisions fat is removed.
Efficiency of a cannula determined by three features:
Configuration
Diameter
Length.
Configuration of cannula
Shape of distal tip of the cannula and
the number , configuration and
position of apertures
affect the efficacy and speed of liposuction
Multiple openings;
Area from which fat can be removed.
shearing of fat.
speed of evacuation.
Result in less trauma.
Diameter of cannula
Commonly used cannulas range from 1.8 to 5 mm.
Small diameter;
1) minimal tissue resistance
2) slower fat evacuation.
- Useful for fine , precise fat removal .
Large diameter;
1) increased efficiency of evacuation
2)increased tissue resistance.
- Useful for deeper and larger fatty deposits.
Cannula length
Most commonly used cannulas are 18 to 23 cm.
Shorter cannulas;
1)10 to 14 cm in length
- are generally used in the face , neck , calves & ankles.
Longer cannula;
- provide access to distant areas with fewer incisions.
SUCTION DEVICES
Syringe system.
Power assisted liposuction.
Ultrasonic assisted liposuction.
Laser assisted liposuction.
Hand held syringe:-
1)good for use in head and neck surgery owing to their low cost, portability, & ease of handling.
2) provide an efficient technique for precise contouring of irregularities secondary to cervicofacial adiposity.
Suction unit:-
-Are useful for closed and open liposuction techniques.
-Provide continuous vaccum & are most useful for removing large amounts of fat or defating a flap
Patient Evaulation
history is explored in detail mainly
- body weight history
- exercise patterens
- eating disorders
Medication intake; medication allergies.
The patient's goals should be understood.
Explanation of the procedure, its risks, alternatives, benefits, and convalescence should be explained.
Consent is obtained.
he treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas
A skin graft is a surgical procedure in which a piece of skin is transplanted from one area to another. Often skin will be taken from unaffected areas on the injured person and used to cover a defect, often a burn.
Acute care of facial burns (7th august 2010)Tauseef Hassan
A brief overview of acute management of facial burns, specific procedures regarding excision and different skin substitutes and dressings used for biological and definitive coverage.
Scar Revision in oral and Maxillofacial SurgeryPunam Nagargoje
A scar can be defined as a fault or blemish resulting from some former condition, wound, sore or burn. Scar formation is an inevitable consequence of wound healing in which the normal skin is replaced by a fibrous tissue.
• Mechanism
– Trauma
– Surgical
• Location & orientation
– Cosmesis
– Function.
Ideal Scar
• Flat
• Narrow
• Good color match
• Parallel to or within skin crease, folds and RSTLs
The ideal scar is level with the surrounding tissues, has a favorable color match, is narrow, parallel to or lying within a RSTL, and sinuous without long straight unbroken lines. Not all scars are able to be improved by revision techniques and those that are already optimal may be made much worse if a poorly thought out attempt at revision is undertaken. Patients should be carefully counseled to assure that their expectations are realistic – if they expect the scar to be completely gone - I.e invisible – they need education or they are likely to be displeased
Strategies
• Prevention
– Incision planning
• Relaxed skin tension lines
• Facial subunits
– Careful surgical technique
Postop Wound care
• Steroid injection
• Antitension taping
• Excision
– Irregularization
– Reorientation
• Camouflage
– Cosmetics
– Dermabrasion
Timing
• Traditionally 6 to 12 months
• Perhaps earlier for those perpendicular to tension lines
• Dermabrasion 6 to 9 weeks
– High fibroblast activity
The timing of scar revision has traditionally been after the scar has had a period of maturation of 6 to 12 months.
This allows time for scar maturation and better defines what needs to be accomplished in the revision.
Many would argue that scars lying outside RSTLs and especially those perpendicular to RSTLs are likely to have a poor cosmetic outcome and early revision and reorientation can be considered.
Dermabrasion is frequently performed at 6-9 weeks post injury utilizing the high fibroblastic activity in the wound at that time to aid in favorable wound healing.
Wound Healing
• Inflammatory phase – hours
• Proliferative phase – days
• Remodeling phase – months
Cellular Activity in Wound
Healing
Wound Healing.
TYPES OF SCARS
Mature scar
Imature scar
Contractures
Linear hypertrophic scar
Widespread hypertrophic scar
Minor keloid
Major keloid
Ice pick scar
Rolling scars
Boxcar scars
Hypertrophic scar
Can regress
Oriented collagen
Confined to wound
Scant mucin No myofibroblasts
Scars to consider revision
Longer than 20 mm
• Wider than 1-2 mm
• Disturbing function
• Poor match to surrounding tissue
– Colour
– Depth
• Against RSTLs
Timing of Scar Revision
Generally, every scar will show improvement without revision for up to 1 – 3 years
Traditionally we wait 6 to 12 months
Allows time for the scar to mature
Perhaps earlier for those poorly positioned (perpendicular to tension lines) or those that are markedly uneven
Relevant anatomy
Hide i
Cervicofacial liposuction in Oral and Maxillofacial SurgeryPunam Nagargoje
Liposuction is surgical aspiration of subcutaneous fat by use of a cannula attached to a vacuum pump.
one of the most commonly performed cosmetic procedures .
also referred to as liposculpture, lipoplasty, and suction-assisted lipectomy.
Not a Substitute for healthy lifestyle.
Helps to change body proportions.
History
Maliniak- described submental fat removal and neck contouring in early 1930s.
Davis- Curettes.
Schrudde- lipexeresis in 1972.
Illouz- lipolysis with saline & hyaluronidase.
Klein- Tumescent technique.
Procedure
Liposuction is devided in three steps;
1) Infusion
2)Evacuation
3)Post examination.
INFUSION
To achieve even removal of fat – accurate infusion of wetting solution.
Dilute lidocaine with epinephrine solution into fat is performed with infiltration cannulas and pumps.
Cannulas dimentions –
Diameter- from 1 – 3 mm.
Length – from 10- 30 cm.
Blunt tip
EVACUATION
Through Small access incisions fat is removed.
Efficiency of a cannula determined by three features:
Configuration
Diameter
Length.
Configuration of cannula
Shape of distal tip of the cannula and
the number , configuration and
position of apertures
affect the efficacy and speed of liposuction
Multiple openings;
Area from which fat can be removed.
shearing of fat.
speed of evacuation.
Result in less trauma.
Diameter of cannula
Commonly used cannulas range from 1.8 to 5 mm.
Small diameter;
1) minimal tissue resistance
2) slower fat evacuation.
- Useful for fine , precise fat removal .
Large diameter;
1) increased efficiency of evacuation
2)increased tissue resistance.
- Useful for deeper and larger fatty deposits.
Cannula length
Most commonly used cannulas are 18 to 23 cm.
Shorter cannulas;
1)10 to 14 cm in length
- are generally used in the face , neck , calves & ankles.
Longer cannula;
- provide access to distant areas with fewer incisions.
SUCTION DEVICES
Syringe system.
Power assisted liposuction.
Ultrasonic assisted liposuction.
Laser assisted liposuction.
Hand held syringe:-
1)good for use in head and neck surgery owing to their low cost, portability, & ease of handling.
2) provide an efficient technique for precise contouring of irregularities secondary to cervicofacial adiposity.
Suction unit:-
-Are useful for closed and open liposuction techniques.
-Provide continuous vaccum & are most useful for removing large amounts of fat or defating a flap
Patient Evaulation
history is explored in detail mainly
- body weight history
- exercise patterens
- eating disorders
Medication intake; medication allergies.
The patient's goals should be understood.
Explanation of the procedure, its risks, alternatives, benefits, and convalescence should be explained.
Consent is obtained.
he treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas
2. Scars are an indelible reminder of acne
can play havoc with the social functioning of
the patient leading to stress and anxiety
reduce QOL as great as that with epilepsy,
asthma, diabetes or arthritis.
Limited treatment options for acne scars
leave prevention as the best remedy for
scar prone patients.
3. Atrophic and Hypertrophic (3 : 1).
Atrophic Acne Scars: 3 types;
Icepick- 60–70% of total scars, the boxcar 20–30% and rolling scars 15–25%.
4. INFLAMMATION
Of pilosebaceous follicles.
Dermal inflammation greater potential for
scarring.
GRANULATION TISSUE FORMATION
Normal wound- type III collagen
Mature scars - type I collagen.
MATRIX REMODELING
Scar prone patients- prolonged cycles of MMPs
procollagen synthesis
5. Goodman and Baron devised a qualitative scarring grading system that is simple and universally
applicable except in severe cases where different patterns are simultaneously present in a
patient
6.
7. Combination of medical and surgical approaches
Communication with patients- gain trust and confidence
Counseling
Understanding patients’ expectations
Informed consent
Pre and post-treatment photographs.
Examination of skin- scar type, extent, tendency for pigmentation and keloid formation.
9. Skin Needling Therapy, Dermaroller Therapy Or Collagen Induction Therapy (CIT)
Dermaroller- drum shaped roller, studded with 192 microneedles in eight rows.
Needle length ranging from 0.5 to 2 mm.
1.5 mm- mc used. 2 mm- deeper atrophic scar.
Motorized dermastamps- needle cartridges attached to a motor device having a to-
and-fro movement inducing pricks.
Home care dermastamps.
Indications
Grade 3 and 4 scars-- rolling and boxcar scars.
C/I
Active herpes labialis
Keloidal tendency
Patients on isotretinoin therapy within 6m
Bleeding disorders.
10. Procedure
Disinfection and anesthetization with EMLA
Rolled four times in four different directions:
horizontally, vertically, and diagonally right and left.
To ensure even pricking pattern, resulting in about
250–300 pricks/cm2.
Endpoint- uniform bleeding points.
Skin stretched perpendicular to direction of
dermaroller movement to reach the base of the scars.
11. Postprocedure Care
Mild swelling and superficial bruising.
Oral analgesics for needle size is >2 mm.
A total of 3-4 treatment sessions, repeated at 4–8
weeks interval.
Outcome
Full result in 8–12 months
Improvement in acne scar continues even after 6
months after the last dermaroller therapy.
Combine with other techniques for better results.
Studies
G Fabbrocini et al. confirms that dermaroller therapy was highly effective in treatment of rolling acne scars.
A recent Indian study by Majid I, found that, in 21 patients with Grade 3 scarring treated with microneedling, an excellent response was noted in 16 patients (reduction to
Grade 1 or less). Overall, 26 out of the total of 36 patients (72.2%) showed an excellent response to dermaroller treatment while 6 others achieved a good response (16.7%).
12.
13. Release subcutaneous fibrotic strands in a rolling scar that improve with stretching the skin
The mechanisms of scar improvement in subcision are:
Releasing fibrotic strands underlying scars
Organization of blood in the induced dermal pocket
Connective tissue formation in the area.
14. Treatment Procedure
Area is marked and subcutaneous anesthesia given.
Best needle- 1.5 inch Nokor Admix needle.
16 to 23G inj needles can be used.
Done in 2 directions, larger scars- multiple puncture sites.
The needle can be fixed on a 2cc syringe so that the syringe works as a
handle.
Firm pressure applied postop for 5 min to achieve hemostasis.
Repeated at 6 weeks for up to 2- 3 successive treatments.
NOKOR
NEEDLE
Needle inserted
from periphery
with blade
facing upward
Tip turned
parallel to skin
surface
Sweep gently at
dermal
subdermal jxn
snapping sound
heard as the
bands break
15. Complications
Bleeding
Hematoma
hypertrophic scaring
scar recurrence
Bluish discoloration and swelling persists for 5–7 days.
Practical Tips
For multiple scars, start with the most dependent area and work upward
Mild bleeding is expected and beneficial.
large hematoma allow blood to flow out
combined with subdermal implants Autologous fat or dermal tissue
Superior results can be achieved by combination therapy.
16. Includes:
1. punch excision
2. punch flotation or punch elevation
3. punch replacement grafting
Punch Excision
For ice pick scars and deep boxcar scars less than 3.5 mm diameter
Scar excised with 1.5- 3 mm biopsy punch as per size of the scar
Traction applied perpendicular to the skin lines changes circular wound
into an ellipse parallel to the relaxed skin tension lines.
Scar tissue is removed and wound sutured with interrupted sutures
17. Punch Flotation
Best for wide (> 3 mm) boxcar scars
Punch equal to scar size is selected
Bound-down scar is released and freed from the underlying tissue
positioned to lie slightly higher than the surrounding skin.
Secured in position by cyanoacrylate tissue adhesive
Punch Replacement Grafting
For deep, irregular pits and tethered boxcar scars with altered skin texture.
similar to that of a punch flotation,
Plug replaced with donor plug obtained from the postauricular area or inner arm
Donor punch graft should be 0.5 mm larger than the punch used to excise the scar.
18. Punch replacement and flotation techniques are successful for scars on less mobile
regions such as the malar and forehead area
less successful in perioral sites
Complications
poor graft take, graft extrusion and graft visibility.
Poor color and textural mismatch
Dermabrasion after excision, but before closure, improves the subsequent scar
appearance
Recently, simultaneous resurfacing with a CO2 laser and punch excision has been
advocated.
19. Uses high strength TCA focally on the atrophic acne scars to induce collagenization and
cosmetic improvement.
MOA
Best t/t for ICE PICK scars
TCA precipitates proteins and cause coagulative necrosis
Induction of collagen production and reorganization of
dermal collagen.
Remodelling of type III collagen by type I collagen
Improvement of scars
20. Complications
Transient PIH and hypopigmentation
Practical Tips
Priming the skin with hydroquinone and tretinoin cream for 2 weeks
Strict Photoprotection
Avoid accidental spillage of TCA
Application limited to scar base and not to rim of the opening of the pit.
21. Advantages
1. Not susceptible to infection
2. Can be tailored for a variety of defects
3. Creates a permanent spacer between skin and underlying fibrous band
4. Readily available
5. Easy to perform
Two different techniques- conventional and enzymatic separation.
Conventional Technique
Subcision done
Donor tissue is harvested using biopsy punches/ dermatomes from the
post auricular site.
Epidermal part and excess fat is trimmed and tissue transferred to saline.
Scar area is tunneled to create a space for the graft.
Graft is inserted using a forceps through small slit
slit is sutured with proline
22. Enzymatic Technique
FTSG harvested transferred 0.25% of trypsin in
EDTA solution Incubated at 37º C for 75 minutes.
Tissue is transferred to phosphate buffered saline and
the epidermis is manually separated.
Soft, flexible and easily moldable dermal tissue
Filled into the defect as in case of conventional
technique.
Or it can be transferred into 1 cc syringe and pushed
into the defect.
Area molded by external manipulation.
23. Chemical Peeling
Peeling agents used-
1. salicylic acid 20–30%
2. TCA 10%
3. 15% and 25%
4. glycolic acid 25–35%
5. Jessner’s peel
TCA 35%- used for deeper scars
Salicylic acid 20–30%- peeling agent of choice in active acne
Microdermabrasion
Easy technique, safe in darker skin and low cost.
Indicated for superficial scars and is ineffective for deeper scars.
Repeated weekly until the desired result is obtained.
24. Soft Tissue Augmentation (Fillers)
T/t of scars with loss of dermal tissue elevate them and bring the surface of the scars in level
with the surface of surrounding skin
Preparations used- hyaluronic acid fillers, autologous fat, PLLA (Sculptra), calcium hydroxyapatite
(CaHA, Radiesse) and Liquid injectable silicon.
High cost and temporary duration of result is a disadvantage.
Scar Revisions
Scar revision techniques such as Z, M and Y plasty
Performed by a dermatosurgeon properly trained in performing these procedures.
25. Cryotherapy
Cryoslush and cryopeel nodulocystic acne, inflammatory papule and pustule.
Cryoslush method, solid CO2 is crushed and a few drops of acetone are added
to make a paste applied to the lesions with a gauze ball for 2–10 seconds.
Superficial peeling is achieved due to epidermal necrosis, which causes
desquamation of comedones, resolution of inflammatory papules, pustules, nodules
and cysts.
Cryopeel method, spray of liquid N2 used for 2–3 sec.
Pigmentary changes are common, esp in darker-skinned patients
Persistent erythema and scarring may also occur
26. Grade 2 and Grade 3 scars are ideal candidates for
laser treatment.
Rolling and superficial boxcar scars respond the
best
Lasers Used for Acne Scars
1. Ablative lasers
2. Nonablative lasers
27. Ablative lasers cause injury or ablation of epidermis and dermis with resultant
collagen deposition.
The two main ablative lasers used are;
CO2 laser
emits light at 10,600-nm wavelength.
causes vaporization of epidermis and papillary dermis to a depth of about 20–60
µm.
Additionally, there is thermal injury up to another 20– 40 µm zone around the
vaporization zone.
Erbium Yttrium Aluminum Garnet (Er:YAG) laser
Emits light in the 2,940-nm wavelength and the depth of ablation with this laser is
only 10–20 µm.
surrounding thermal damage does not exceed 15 µm.
Thus total depth of achieved is about 30–40 µm with single pass.
28. S/E-
1. prolonged erythema
2. exfoliation of the skin
3. posttreatment hyper- and hypopigmentation
4. risk of scarring
5. secondary infections
6. prolonged downtime
Ablative lasers are most effective in treatment of post-acne scars
CO2 laser is thought to be a more effective laser as it can achieve a greater depth of
ablation.
Erbium YAG laser has less risk of side effects.
29. MOA- controlled injury to the dermal collagen without any damage to the epidermis
Healing response with dermal collagen remodeling tightening effect on the skin with
resultant improvement in the appearance of the scars
Require less downtime, less efficacious as compared to ablative lasers.
Divided into two groups:
a. Infrared lasers:
1450-nm diode laser- advantage of treating active acne
1064-nm Qs Nd: YAG laser
1320-nm Nd: YAG laser
1540-nm Er: glass laser
b. Visible light lasers:
IPL
pulsed dye lasers
light emitting diodes
broadband light sources
• Nonablative lasers provide modest
improvement.
• T/t comprises of multiple sessions
at 3–4 week
30. Minimizes adverse effects and shortens the downtime
Skipped noninjured
part of the skin
provides the source
of keratinocytes that
migrate into the
laser-treated injured
areas.
31. Divided into;
NONABLATIVE FRACTIONAL LASERS
use wavelength of 1410– 1550 nm.
Cause nonablative columns of dermal and
epidermal injury with skip areas.
Eg; 1550-nm erbium doped fiber laser known as
Fraxel laser
ABLATIVE FRACTIONAL LASERS
Delivers the best of both worlds by providing
efficacy of ablative laser treatment but
minimizes the side effects.
Eg; fractional CO2 laser.
32. Isotretinoin reduces acne vulgaris and prevents further scarring.
Care should be exercised in patients with recent history of isotretinoin as it
delays in healing and atypical scar formation.
Earlier studies suggest 6–12 m waiting period before performing resurfacing
procedures.
However, recent publications demonstrate considerable safety of different
procedures in patients recently treated with isotretinoin
Abrasion of a small test area is a useful predictor of wound healing, enabling
earlier acne scar treatment using this procedure.