Treatment of Acne Scars With Hyaluronic Acid: An Improved Approach

July 2013 | Volume 12 | Issue 7 | Original Article | 121 | Copyright © July 2013

Shlomit Halachmi, MD PhD,a Dan Ben Amitai MD,b,d and Moshe Lapidoth MD MPHc,d

aHerzelia Skin and Laser Center, Herzelia Pituach, Israel bPediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Israel cLaser Unit, Department of Dermatology, Rabin Medical Center, Petach Tikva, Israel dSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

resurfacing.12 Larger and deeper acne scars, of any class, may require a combination of surgical intervention (punch excision or punch elevation) and resurfacing.13-15 In more recent years, the approach to acne scars has been focused on non-invasive or minimally invasive approaches. Primary treatment is often provided by ablative or non-ablative laser resurfacing or fractional resurfacing, which have provided good results.16-20 Radiofrequency has also demonstrated efficacy in a number of studies, presumably by causing a mild degree of dermal contraction and by stimulating fibroblasts activity.21,22
An additional approach to treating discrete acne scars is the injection of dermal fillers. Prior reports have described the treatment of acne scars with injections, and showed good levels of efficacy and reasonable tolerability.23-27 A recently published study examined the treatment of acne scars with HA using a needle-less pneumatic device, which distributes a dilute solution of HA over 1 cm2 per injection site.28 While this approach has merits, particularly in the treatment of large surfaces and in its induction of collagen by focal controlled dermal injury, the treatment of discrete scars is very easily amenable to standard injection without devices, and the use of a more concentrated HA gel provides immediate results.
Most of the side effects of non-animal stabilized hyaluronic acid (NASHA) are transient and mild and include pain and intermittent swelling, edema, and erythema at the injection site. Pain is more prominent with higher viscosity and larger-bore needles, and as such Restylane Vital is a relatively less painful injection. The erythema is transient, and swelling can be reduced by application of ice for 5 to 10 minutes post-injection.


Given the high degree of tolerability, the proven safety record, the effectiveness in clinical improvement, and the known durability of NASHA, it is a highly preferred dermal filler for the correction of acne scars. When combined with the Restylane Vital formulation and the microdosage delivery technique, the approach is an excellent option for the treatment of discrete depressed acne scars. It is recommended that Restylane Vital injections be performed after a course of laser resurfacing procedures has been completed, both to avoid heating effects on the injected material (a topic that remains subject to debate) and to reduce the overall “burden” of acne scarring prior to initiating point-by-point injections.


The authors have no conflicts of interest to report.


  1. Fisher GJ, Varani J, Voorhees JJ. Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol. 2008;144(5):666-672.
  2. Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;143(2):155-163.
  3. Carruthers A, Carruthers J. Non-animal-based hyaluronic acid fillers: scientific and technical considerations. Plast Reconstr Surg. 2007;120(suppl 6):s33-s40.
  4. Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol. 1994;19(4):303-308.
  5. Knutson DD. Ultrastructural observations in acne vulgaris: the normal sebaceous follicle and acne lesions. J Invest Dermatol. 1974;62(3):288-307.
  6. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109-117.
  7. Wilson BB, Dent CH, Cooper PH. Papular acne scars. A common cutaneous finding. Arch Dermatol. 1990;126(6):797-800.
  8. Solotoff SA. Treatment for pitted acne scarring--postauricular punch grafts followed by dermabrasion. J Dermatol Surg Oncol. 1986;12(10):1079-1084.
  9. Aalami Harandi S, Balighi K, Lajevardi V, Akbari E. Subcision-suction method: a new successful combination therapy in treatment of atrophic acne scars and other depressed scars. J Eur Acad Dermatol Venereol. 2011;25(1):92-99.
  10. Vaishnani JB. Subcision in rolling acne scars with 24G needle. Indian J Dermatol Venereol Leprol.2008;74(6):677-679.
  11. Alam M, Omura N, Kaminer MS. Subcision for acne scarring: technique and outcomes in 40 patients. Dermatol Surg. 2005;31(3):310-317.
  12. Basta-Juzbašić A. Current therapeutic approach to acne scars. Acta Dermatovenerol Croat. 2010;18(3):171-175.
  13. Khunger N; IADVL Task Force. Standard guidelines of care for acne surgery. Indian J Dermatol Venereol Leprol. 2008;(suppl 74):s28-s36.
  14. Grevelink JM, White VR. Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring. Dermatol Surg. 1998;24(5):527-530.
  15. Dzubow LM. Scar revision by punch-graft transplants. J Dermatol Surg Oncol. 1985;11(12):1200-1202.
  16. Hedelund L, Moreau KE, Beyer DM, Nymann P, Haedersdal M. Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation. Lasers Med Sci. 2010;25(5):749-754.
  17. Kim S, Cho KH. Clinical trial of dual treatment with an ablative fractional laser and a nonablative laser for the treatment of acne scars in Asian patients. Dermatol Surg. 2009;35(7):1089-1098.
  18. Woo SH, Park JH, Kye YC. Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dual-mode Er:YAG laser. DermatolSurg. 2004;30(4 Pt 1):488-493.
  19. Tanzi EL, Alster TS. Comparison of a 1450-nm diode laser and a 1320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study. Dermatol Surg. 2004;30(2 Pt 1):152-157.
  20. Alster TS, West TB. Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. DermatolSurg. 1996;22(2):151-154.
  21. Halachmi S, Orenstein A, Meneghel T, Lapidoth M. A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: a pilot study. J Cosmet Laser Ther. 2010;12(5):208-212.
  22. Montesi G, Calvieri S, Balzani A, Gold MH. Bipolar radiofrequency in the treatment of dermatologic imperfections: clinicopathological and immunohistochemical aspects. J Drugs Dermatol. 2007;6(9):890-896.
  23. Barnett JG, Barnett CR. Treatment of acne scars with liquid silicone injections: 30-year perspective. Dermatol Surg. 2005;31(11 Pt 2):1542-1549.
  24. Cooper JS, Lee BT. Treatment of facial scarring: lasers, filler, and nonoperative techniques. Facial Plast Surg. 2009;25(5):311-315.
  25. Epstein RE, Spencer JM. Correction of atrophic scars with artefill: an open-label pilot study. J Drugs Dermatol. 2010;9(9):1062-1064.
  26. Goldberg DJ, Amin S, Hussain M. Acne scar correction using calcium hydroxylapatite in a carrier-based gel. J Cosmet Laser Ther. 2006;8(3):134-136.
  27. Smith KC. Repair of acne scars with Dermicol-P35. Aesthet Surg J. 2009;29(suppl):s16-s18.
  28. Lee JW, Kim BJ, Kim MN, Lee CK. Treatment of acne scars using subdermal minimal surgery technology. Dermatol Surg. 2010;36(8):1281-1287.


Moshe Lapidoth MD