The patient underwent three treatments over a course of six months. The treatment protocol was as follows: The patient was anesthetized with topical Lidocaine 23%/Tetracaine 7% for 45 minutes. The topical anesthesia was removed with sterile gauze and then the area was prepped with chlorhexidine and then saline soaked gauze. The settings were: Three passes, 1st pass: 3mm depth/Level 12/300ms, 2nd pass: 2mm depth/Level 10/200ms 3rd pass: 1mm depth/Level 8/160. The patient was able to return to work the same day of treatment with minimal discomfort after each of the three treatments. She noted her swelling was mild and lasted 1-2 days. She did not experience any bruising or epidermal
changes. She also did not notice any flare in her acne during the recovery period. On follow-up three months following her third treatment, she noted high satisfaction and rated her improved to be >95% from baseline (Figure 1).
Case 2
The patient is a 30-year-old Hispanic male who had severe cystic acne as a teenager and into his early 20s, treated with a course of isotretinoin at age 14. He presented complaining
of significant residual acne scarring on the face (Figure 2). He had received no cosmetic treatments in the past and was initially treated with a 1540-nm Erbium:Glass nonablative fractional laser (StarLux-500™, Palomar Medical
Technologies, Inc., Burlington, MA) utilizing an extra deep (XD™) handpiece. After three treatments spaced one month apart, the patient did not appreciate significant improvement in his scarring and treatments with high intensity
focused fractionated radiofrequency were initiated.
He has since undergone four treatments spaced a month apart. The treatment protocol has been as follows: The patient
was anesthetized with topical Lidocaine 15%/prilocaine 5%/phenylephrine for 60 minutes. The topical anesthesia was removed with sterile gauze and then the area was prepped with chlorhexidine. The settings have varied during his treatments.
His first two treatments utilized a two pass technique, 1st pass: Level 10/400ms, with depths of 1.5 mm over the zygoma,
temples, and forehead, and 2.0 mm on the lower cheeks, upper lip, and chin; 2nd pass: 1 mm depth/Level 10/300ms to the entire face. His third and fourth treatments utilized a three pass technique, with similar settings to his prior treatments
but with an additional pass at Level 10/300ms, depth of 1.5 mm to the cheeks. Following each treatment, topical triamcinolone cream and a combination antioxidant serum containing L-ascorbic acid, alpha tocopherol, and ferulic acid solution were applied. The patient reported mild swelling and erythema for 1-2 days after his treatments without bruising or pigmentary changes. The patient did experience significant
discomfort during the treatment itself but this resolved immediately upon completion. At three-month follow-up after
his fourth treatment, he expressed satisfaction with his results and rated his improvement to be 50% from baseline (Figure).
Case 3
The patient is 49 years old and had a history of cystic acne. He presented with significant acne scaring, had been on Accutane several years before and wanted to improve the appearance of his scars.
The patient underwent three treatments over a course of three months. The treatment protocol was as follows: The patient was anesthetized with topical Lidocaine 23%/Tetracaine 7% for 60 minutes. The topical anesthesia was removed with sterile gauze and then the area was prepped with chlorhexidine.
