INTRODUCTION
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-
