Fractional CO2 Laser Treatment vs Autologous Fat Transfer in the Treatment of Acne Scars: A Comparative Study

January 2013 | Volume 12 | Issue 1 | Original Article | 7 | Copyright © January 2013

Omar A. Azzam MD a, Ahmed T. Atta MDb, Rehab M. Sobhi MD, and Pakinam I.N. Mostafa MSca

aDepartment of Dermatology, Kasr El-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt bDepartment of Surgery, Kasr El-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt

Background: Acne scars present a highly challenging and frustrating clinical problem. Fractional CO2 laser treatment has led to marked improvement in scars, and fat transfer, or fat grafting, has also recently proven very useful in regenerative medicine.
Objective: To compare fractional CO2 laser treatment and fat grafting in the treatment of acne scars.
Materials and methods: Twenty patients were included in this study, 10 received 3 sessions of fractional CO2 laser therapy, and 10 received fat grafting. All patients were then followed up for 3 months, and results were assessed with digital photographs taken by a committee of 3 physicians, by a single-blinded physician, and by reports of patient satisfaction.
Results: In the fractional CO2 laser treatment group, under 20% of patients were graded as having excellent scar improvement, 0 as having marked scar improvement, under 10% as having mild scar improvement, and almost 70% as having moderate scar improvement. In the fat-grafting group, the scar and overall improvement were graded as 30% excellent, 30% marked, 20% moderate, and 20% mild.
Conclusion: Fat grafting proved to be more effective in the treatment of acne scars than ablative fractional CO2 laser treatment. There were many points in its favor, the most significant being the clinical improvement in scars and texture. This supports the stem cell theory of adipose tissue in regenerative medicine.

J Drugs Dermatol. 2013;12(1):e7-e13.


Acne scarring is an unfortunate, permanent complication arising from acne vulgaris, and it can be associated with significant psychological distress. The incidence of acne scarring is not well studied, but it may occur to some degree in 95% of patients with acne vulgaris.1 Goodman recommended a proper assessment of all patients within certain parameters to determine the best mode of treatment for different types of acne scarring, and derived various categories for cutting out of the scars (as in punch techniques), filling of the scars, altering the color of the scars, inducing collagen (as in chemical peeling, laser treatment, dermabrasion, and plasma skin resurfacing), and finally, relaxing the region using botulinum toxin.2 Other authors have also recommended treating acne scars according to the type of scar.1
By using optimized parameter selections, CO2 ablative fractional resurfacing appears to be an effective and well-tolerated treatment modality for individuals with dark skin because it avoids the adverse effects and lengthy recovery time of conventional ablative laser resurfacing, while improving the limited efficacy of nonablative dermal remodeling devices.3,4 The fractional CO2 laser treatment causes tissue tightening and collagen remodeling both initially and for a 3- to 6-month period after treatment.5
Ablative fractional CO2 laser resurfacing was used on 13 patients with moderate to severe acne scars. Two to 3 treatments were performed at 1- to 2-month intervals. In this study, pulse energies ranged from 20 to 100 mJ per pulse, and energy densities per pass were 100 microthermal treatment zones (MTZ)/cm2 to 400 MTZ/cm2. Three months after the final treatment, a 26% to 50% improvement in texture and atrophy was noted in all subjects. Quantitative topographic analysis showed an improvement of 43% to 79.9% in the depth of the acne scars. There were no incidents of scarring or hypopigmentation.6 A similar study on 30 subjects with moderate to severe acne scars reported by Walgrave et al showed that 23 out of 25 subjects had sustained clinical improvement of their scars 3 months after treatment.7
Autologous fat transplantation, or fat grafting, is a well-established technique in surgery. Adipose tissue grafts have been used for soft tissue augmentation in a diverse range of surgical procedures for more than 100 years. The most significant problem of this method is the unpredictable resorption rate of the transplanted tissue, especially when used as a filler. Many studies have been performed, and the technique has evolved to produce the maximum tissue retention at the transplantation site.8 Recent studies report that adipose-derived stem cells promote angiogenesis via various growth factors. This brings us to the core of future studies, angiogenic factors and stem cells aiming at longevity.9 The discovery of preadipocytes, their mesenchymal origin, and their role as pluripotent stem cells have been used in regenerative medicine to maintain the graft tissue. Furthermore, autologous fat transplantation is now being used not just as a filler, but as a new method for rejuvenation due to the preadipocyte's capability to differentiate-