Combination therapy using subcision, needling, and platelet-rich plasma in the management of grade 4 atrophic acne scars: A pilot study

J Cosmet Dermatol. 2019 Aug;18(4):1092-1097. doi: 10.1111/jocd.12935. Epub 2019 Mar 28.


Background: Multimodality therapies including minimally invasive modalities are increasingly used in atrophic scarring.

Objective: To evaluate the role of platelet-rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring.

Methods: A total of 30 patients with grade 4 acne scars were randomly divided into two groups, 15 patients each: Group A underwent three sequential treatments of subcision and needling while Group B, three sequential treatments of subcision, needling, and topical application of PRP that were performed at 3-week intervals. Scar grading was assessed 3 months following the final session. Participant's assessment of treatment response was registered.

Results: Scar improvement ≥50% was reported significantly more often by Group B than Group A patients (P = 0.025). Regarding physician-based assessment of scar grading post-therapy (number of patients with two grades improvement vs one grade or no improvement), there was a trend toward more improvement in Group B (P = 0.195). Physician's evaluation of acne scar improvement correlated with the patient's assessment of improvement: 60% of Group A and 66.6% of Group B patients appreciated an improvement of 25%-49% and 50%-74%, respectively. Mean duration of postprocedure erythema/edema was shorter among Group B than Group A patients (16.1 vs 32.9 hours, respectively). Overall, substantial improvement was noticed in rolling and boxcar scars with only a mild change in icepick scars.

Conclusion: Platelet-rich plasma appears to add to the improvement of grade 4 atrophic acne scars when combined with needling and subcision. These findings require further evaluation by future studies.

Keywords: acne scarring; management; needling; platelet-rich plasma; subcision; therapy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acne Vulgaris / complications*
  • Acupuncture Therapy
  • Adult
  • Atrophy / etiology
  • Atrophy / pathology
  • Atrophy / therapy
  • Cicatrix / etiology
  • Cicatrix / pathology
  • Cicatrix / therapy*
  • Combined Modality Therapy / methods
  • Cosmetic Techniques*
  • Dermatologic Surgical Procedures
  • Face
  • Female
  • Humans
  • Male
  • Needles
  • Pilot Projects
  • Platelet-Rich Plasma
  • Skin / pathology*
  • Treatment Outcome
  • Young Adult