Treatment of Acne Scars With High Intensity Focused Radio Frequency
September 2015 | Volume 14 | Issue 9 | Case Reports | 1065 | Copyright © September 2015
Omar A. Ibrahimi MD PhD,a Robert A. Weiss MD,b Margaret A. Weiss MD,b Christian R. Halvorson MD,b Flor Mayoral MD,c E. Victor Ross MD,d and Joel L. Cohen MDe
aConnecticut Skin Institute, Stamford, CT
bMaryland Laser, Skin & Vein Institute, Hunt Valley, MD
cMayoral Dermatology, Coral Gables, FL
dScripps Clinic, San Diego, CA
eAboutSkin Dermatology & DermSurgery, Englewood, CO
In this multi-site case series, the efficacy of high intensity focused radiofrequency (RF) delivered to the dermis was evaluated for treating
acne scars. A novel delivery system that uses insulated microneedles to deliver a desired thermal effect to multiple depths of the dermis while sparing the epidermis from RF injury was used. Four (4) healthy subjects from four different practices were evaluated and used in this case report. The subjects were treated between 3 or 4 times depending on the severity of the acne scars presented. The depth of thermal delivery was adjusted before each pass and all subjects received at a minimum, three passes to the treated area. Before and after photographs along with adverse effects were recorded. The theory behind the use of insulated needles with the active
RF delivery at the distal tip is to allow for significant thermal injury to several layers of the dermis while avoiding thermal injury to the epidermis. This case report demonstrates significant improvement on acne scars and that all skin types should be safely treatable with minimum downtime realized. J Drugs Dermatol.
Acne is the most common skin disease, having up to a prevalence of 100% in adolescence in the United States.1 If not controlled properly, cystic and inflammatory lesions
have the potential to leave acne scars (ice pick, pitted, box car, and rolling scar variants). The development of fractional laser
resurfacing has revolutionized the treatment of acne scarring and is today considered the gold standard for treating acne scarring. 2-4 Following the development of fractional technology with lasers, other energy sources were also used in fractionated patterns,
such as radiofrequency and ultrasound. One of the limitations
in treating acne scarring with fractional lasers is the risk of hyperpigmentation, particularly in ethnic and darker Fitzpatrick skin phototypes.5 Because radiofrequency energy is not specifically
absorbed by melanin and can be delivered through an array of insulated microneedles at precise depths that spare the epidermis,
it has been explored in the treatment of acne scars. Here we report a small case series of patients treated at four different dermatologic surgery practices.
The Infini (Lutronic Inc.) delivers high intensity focused bipolar radiofrequency energy through an array of insulated 200 micron
thick microneedles that are arranged in a 7 X 7 array (49 microneedles) with a total spot size of 10 X 10mm. Penetration depth can be controlled from 0.5mm to 3.5 mm. Controlling
the depth of the needle penetration allows for the creation of a latticework of focal RF injuries thus customizing the treatment, in this case deeper in the dermis for treating acne scars. The RF energy can be adjusted from power setting 1 (2.5 W) to a maximum of setting 20 (50 W) with an exposure (on) time that ranging from 10 ms to 1 second. Having insulated needles, except for the active tip, also insures maximum thermal injury zones in the target zone while allowing for little to no long-term damage to the epidermis. Patient downtime is usually no more than 4-8 hours.
The patient is a 28-year-old resident physician who had severe
acne in her teenage and young adult life requiring two course of isotretinoin. She presented complaining about the persisting acne scarring she was left with (Figure 1). Treatment
options including ablative and nonablative fractional lasers and high intensity focused fractionated radiofrequency were reviewed. Her occupation would not allow for extended time off that would be required with ablative and nonablative fractional resurfacing. Additionally she was of mixed Northern European and Middle Eastern heritage with the ability to tan with sun exposure. We opted to treat her with the fractionated radiofrequency device for the sake of less downtime and to minimize any risk of pigment changes.