Atrophic acne scar treatment using triple combination therapy: dot peeling, subcision and fractional laser

J Cosmet Laser Ther. 2009 Dec;11(4):212-5. doi: 10.3109/14764170903134326.


Atrophic scars are a common complication of acne. Many modalities are proposed but each does not yield satisfactory clinical outcomes. Thus, a new combination therapy is suggested that incorporates (i) dot peeling, the focal application and tattooing of higher trichloroacetic acid concentrations; (ii) subcision, the process by which there is separation of the acne scar from the underlying skin; and (iii) fractional laser irradiation. In this pilot study, the efficacy and safety of this method was investigated for the treatment of acne scars. Ten patients received this therapy for a year. Dot peeling and subcision were performed twice 2-3 months apart and fractional laser irradiation was performed every 3-4 weeks. Outcomes were assessed using scar severity scores and patients' subjective ratings. Acne scarring improved in all of the patients completing this study. Acne scar severity scores decreased by a mean of 55.3%. Eighty percent of the patients felt significant or marked improvement. There were no significant complications at the treatment sites. It would appear that triple combination therapy is a safe and very effective combination treatment modality for a variety of atrophic acne scars.

MeSH terms

  • Acne Vulgaris / complications*
  • Adult
  • Cicatrix / etiology
  • Cicatrix / therapy*
  • Cosmetic Techniques / instrumentation*
  • Female
  • Humans
  • Low-Level Light Therapy / instrumentation
  • Low-Level Light Therapy / methods*
  • Male
  • Patient Satisfaction
  • Pilot Projects
  • Skin / radiation effects
  • Trichloroacetic Acid / therapeutic use


  • Trichloroacetic Acid