Subcision Followed by Diluted Calcium Hydroxylapatite Injection Versus Subcision Followed by Painting CROSS TCA Technique for the Treatment of Atrophic Acne Scars

Atrophic scars present as depressions secondary to fibrous contractions. Subcision is a technique in which a needle is inserted under the acne scar to sever the fibrous tissue (tethers) that bind down the scar. This releases the fibrous tissue.

The original chemical reconstruction of skin scars (CROSS) technique using trichloroacetic acid (TCA) entails focal application of highly concentrated TCA (70% to 100%) with firm pressure applied to the entire atrophic area using a sharpened wooden applicator until frosting occurs.

Fillers containing hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid are increasingly used to correct atrophic acne scarring as they augment soft tissue in variable degree and are most effective in soft rolling or boxcar scars.

Inclusion criteria

• Age from 20 to 50 years.
• Both sexes.
• Patients with atrophic acne scars.

Exclusion criteria

• Patients with Fitzpatrick skin phototypes V and VI.
• Receiving systemic isotretinoin medication at the time of the study.
• Active bacterial, viral or fungal infections in the treatment area.
• Hypertrophic scarring or keloidal tendency.
• Photosensitivity or photodermatitis.
• Unrealistic expectation, bleeding, coagulation disorders, and any other related skin disease.
• Pregnant or lactating females.
• Chronic debilitating diseases such as diabetes mellitus, cardiovascular diseases, renal failure, hepatic diseases, chronic respiratory diseases or any endocrine diseases.
• History of immunosuppressive drug intake or chemotherapy within 6 months before treatment.