Effective Treatment of Acne Scars Using Pneumatic Injection of Hyaluronic Acid

January 2015 | Volume 14 | Issue 1 | Case Reports | 74 | Copyright © January 2015

Tapan Patel MBBS MRCP,a Oren Tevet MScb

aPHI Clinic, London, UK
bPerfAction, Inc., Israel

Acne scars remain a challenging condition to treat despite multiple currently available technologies.
This study evaluated the clinical efficacy and safety of pneumatic injections of Hyaluronic Acid in the treatment of acne scars.
Two patients (Fitzpatrick skin type IV-V) with acne scars received two sessions of pneumatic, needleless injections of crosslinked hyaluronic acid (HA) at 4-week intervals. The treatment response was assessed by comparing pre‐ and 3‐month posttreatment clinical photography.
The patients’ acne scar grade improved from 2 to 1 in the first case, and 3 to 2 in the second case, based on independent physician assessment. Patient degree of satisfaction was similar to the physicians' assessment. No significant adverse events were noted. We conclude that pneumatic injection technology to deliver HA to the tissue is an effective and safe method for improving acne scars, even in patients with dark complexion.

J Drugs Dermatol. 2015;14(1):74-76.


Acne scars may result from damage to the skin during the healing of active acne. The two causes of acne scar formation can be categorized as either a result of increased tissue formation (hypertrophic scar) or, the more common cause, loss or damage of tissue (atrophic scar). 1 Additionally, acne scars can be divided into 3 basic subtypes: icepick scars, rolling scars, and boxcar scars based on their width, depth, and 3-dimensional composition.2
Patients with acne scars may experience severe psychological effects as a result of the cosmetic blemishes. These effects may include emotional debilitation, embarrassment, poor self-esteem, preoccupation, low confidence, anxiety, or depression.3 Current treatment options include dermal fillers, chemical peels, microdermabrasion, laser skin resurfacing, subcision, and needling. The limitations of these treatments are that they may be invasive, and may not provide a complete scar resolution since they do not treat deeper scars. Furthermore, they may cause hyperpigmentation in darker skin types. Another limitation of laser treatments is the need to incorporate needle subcision of scars to release the deep attachments of the scars to underlying structures. There is therefore a need for a treatment modality that will enable treating all scar subtypes, year-round, applicable to darker skin types, and will achieve results with minimal downtime.
This report describes the use of jet volumetric remodeling (JVR) technology to treat acne scars in two patients. It performs by pneumatically accelerating a carrier fluid jet containing highmass molecules of hyaluronic acid (HA) into the tissue.


Jet volumetric remodeling technology (Enerjet, PerfAction, Inc., Rehovot, Israel) was used to deliver cross-linked Hyaluronic Acid (Belotero Basic, Merz Aesthetics, Inc., San Mateo, CA). Two patients were treated with the Enerjet system.
Case 1: Female, age 41, Fitzpatrick skin type IV. Acne scars are mainly boxcar type.
Case 2: Male, age 30, Fitzpatrick skin type V. Acne scars are a mix of boxcar and ice pick.

Treatment Protocol

Prior to the treatment, high-resolution photography was documented for each area (Profect Technologies, USA). A treatment session included treatment of the patients’ face, as follows:
Case 1: Approximately 20 shots were applied to each side, at a setting of 45% pressure and filling level 5.
Case 2: Approximately 45 shots were applied to each side, at a setting of 40% pressure and filling level 4.
After the treatment, treated areas were visually examined for skin responses. The patients underwent a series of 2 treatment sessions at 4-week intervals. A follow-up evaluation 3