Acne often results in scarring. Current treatment options, like chemical peels, laser therapy, radiofrequency, subcision and microneedling, have shown some efficacy in treating acne scars. However, the results can greatly depend on scarring type and the treatment modality used. 

A study has proposed a novel treatment of acne scarring using a multimodal approach comprising chemical reconstruction of skin scars, subcision and microneedling. This retrospective chart review from January 2017 to December 2018 included all patients (aged 18 years or older) with acne scars treated with a triple combination approach. Each patient received 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. 

The study included 139 patients, among which 64% had Fitzpatrick Skin Types IV to VI. It used shadow-lit before and after photos and patient feedback on side effects and satisfaction levels to assess changes. On average, each patient received two treatments (range: 1-4 treatments). A triple approach to treating acne scars caused high satisfaction among patients and photographic evidence of improvements. 

This study suggests that a triple combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering) and microneedling (to stimulate neocollagenesis) is an effective treatment for acne scars. Further studies are warranted to support these observations.

Source: Rullan PP, Olson R, Lee KC. 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. J Clin Aesthet Dermatol. 2020;13(5):19-23.