Advertisement

Evaluating resurfacing modalities in aesthetics

      Abstract

      Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of nonsurgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, microneedling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additionally combination treatments and resurfacing in acne scars, melasma, and skin of color.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hassan KM
        • Benedetto AV.
        Facial skin rejuvenation: ablative laser resurfacing, chemical peels, or photodynamic therapy? Facts and controversies.
        Clin Dermatol. 2013; 31: 737-740
        • Li D
        • Lin SB
        • Cheng B.
        Complications and posttreatment care following invasive laser skin resurfacing: a review.
        J Cosmet Laser Ther. 2018; 20: 168-178
        • Hunzeker CM
        • Weiss ET
        • Geronemus RG.
        Fractionated CO2 laser resurfacing: our experience with more than 2000 treatments.
        Aesthetic Surg J. 2009; 29: 317-322
        • Brightman LA
        • Brauer JA
        • Anolik R
        • et al.
        Ablative and fractional ablative lasers.
        Dermatol Clin. 2009; 27: 479-489
        • Bohnert K
        • Dorizas A
        • Sadick N.
        Prospective, pilot evaluation of the performance of nanofractional radiofrequency for improvement of skin texture via skin resurfacing.
        J Cosmet Dermatol. 2018; 17: 61-65
        • Landau M.
        Chemical peels.
        Clin Dermatol. 2008; 26: 200-208
        • Ramaut L
        • Hoeksema H
        • Pirayesh A
        • et al.
        Microneedling: where do we stand now? A systematic review of the literature.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1-14
        • Alster TS
        • Graham PM.
        Microneedling: a review and practical guide.
        Dermatol Surg. 2018; 44: 397-404
        • Maisel-Campbell AL
        • Ismail A
        • Reynolds KA
        • et al.
        A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging.
        Arch Dermatol Res. 2020; 312: 301-315
        • Archer KA
        • Perkins SW.
        Skin resurfacing in combination with facelift surgery.
        Facial Plast Surg. 2017; 33: 299-310
        • Johnson DL
        • Paletta F.
        Skin resurfacing procedures of the upper face.
        Atlas Oral Maxillofac Surg Clin North Am. 2016; 24: 117-124
        • Gentile RD.
        Easy platelet-rich fibrin (injectable/topical) for post-resurfacing and microneedle therapy.
        Facial Plast Surg Clin North Am. 2020; 28: 127-134
        • Chawla S.
        Split face comparative study of microneedling with PRP versus microneedling with vitamin C in treating atrophic post acne scars.
        J Cutan Aesthet Surg. 2014; 7: 209-212
        • Bhargava S
        • Cunha PR
        • Lee J
        • et al.
        Acne scarring management: systematic review and evaluation of the evidence.
        Am J Clin Dermatol. 2018; 19: 459-477
        • Hausauer AK
        • Humphrey S.
        The physician's guide to platelet-rich plasma in dermatologic surgery part II: clinical evidence.
        Dermatol Surg. 2020; 46: 447-456
        • Wang JV
        • Schoenberg E
        • Saedi N
        • Ibrahim O.
        Platelet-rich plasma, collagen peptides, and stem cells for cutaneous rejuvenation.
        J Clin Aesthet Dermatol. 2020; 13: 44-49
        • Schoenberg E
        • Wang JV
        • Zachary CB
        • Saedi N.
        Treatment of acne scars with PRP and laser therapy: an up-to-date appraisal.
        Arch Dermatol Res. 2019; 311: 643-646
        • Schoenberg E
        • O'Connor M
        • Wang JV
        • Yang S
        • Saedi N.
        Microneedling and PRP for acne scars: a new tool in our arsenal.
        J Cosmet Dermatol. 2020; 19: 112-114
        • Schoenberg E
        • Hattier G
        • Wang JV
        • Saedi N.
        Platelet-rich plasma for facial rejuvenation: an early examination.
        Clin Dermatol. 2020; 38: 251-253
        • Badran KW
        • Nabili V.
        Lasers, microneedling, and platelet-rich plasma for skin rejuvenation and repair.
        Facial Plast Surg Clin N Am. 2018; 26: 455-468
        • Clementoni MT
        • Pedrelli V
        • Zaccaria G
        • et al.
        New developments for fractional co2 resurfacing for skin rejuvenation and scar reduction.
        Facial Plast Surg Clin North Am. 2020; 28: 17-28
        • Van Gemert MJC
        • Bloemen PR
        • Wang WY
        • et al.
        Periocular CO2 laser resurfacing: severe ocular complications from multiple unintentional laser impacts on the protective metal eye shields.
        Lasers Surg Med. 2018; 50: 980-986
        • Ramsdell WM.
        Fractional carbon dioxide laser resurfacing.
        Semin Plast Surg. 2012; 26: 125-130
        • Nanni CA
        • Alster TS.
        Complications of carbon dioxide laser resurfacing. an evaluation of 500 patients.
        Dermatol Surg. 1998; 24: 315-320
        • Dijkema SJ
        • van der Lei B.
        Long-term results of upper lips treated for rhytides with carbon dioxide laser.
        Plast Reconstr Surg. 2005; 115: 1731-1735
        • Manstein D
        • Herron GS
        • Sink RK
        • et al.
        Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.
        Lasers Surg Med. 2004; 34: 426-438
        • Neaman KC
        • Baca ME
        • Piazza III RC
        • et al.
        Outcomes of fractional CO2 laser application in aesthetic surgery: a retrospective review.
        Aesthetic Surg J. 2010; 30: 845-852
        • Chang YC
        • Croix J
        • Hernandez S
        • et al.
        A comparative split-face trial of plant-based hypoallergenic ointment vs petroleum-based ointment following fractionated carbon dioxide laser resurfacing of the face.
        J Drugs Dermatol. 2018; 17: 1178-1182
        • Sarnoff D
        • Gotkin H
        • Doerfler B
        • et al.
        The safety of laser skin resurfacing with the microablative carbon dioxide laser and review of the literature.
        J Drugs Dermatol. 2018; 17: 1157-1162
        • Ross EV
        • Miller C
        • Meehan K
        • et al.
        One-pass CO2 versus multiple-pass Er:YAG laser resurfacing in the treatment of rhytides: a comparison side-by-side study of pulsed CO2 and Er:YAG lasers.
        Dermatol Surg. 2001; 27: 709-715
        • Newman JB
        • Lord JL
        • Ash K
        • et al.
        Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser.
        Lasers Surg Med. 2000; 26: 208-214
        • Ciocon DH
        • Doshi D
        • Goldberg DJ.
        Non-ablative lasers.
        Curr Probl Dermatol. 2011; 42: 48-55
        • Wat H
        • Wu DC
        • Chan HH.
        Fractional resurfacing in the Asian patient: current state of the art.
        Lasers Surg Med. 2017; 49: 45-59
        • Hantash BM
        • Gladstone HB.
        Current role of resurfacing lasers.
        G Ital Dermatol Venereol. 2009; 144: 229-241
        • Brauer JA
        • Kazlouskaya V
        • Alabdulrazzaq H
        • et al.
        Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring.
        JAMA Dermatol. 2015; 151: 278-284
        • Bernstein EF
        • Schomacker KT
        • Basilavecchio LD
        • et al.
        Treatment of acne scarring with a novel fractionated, dual-wavelength, picosecond-domain laser incorporating a novel holographic beam-splitter.
        Lasers Surg Med. 2017; 49: 796-802
        • Bernstein EF
        • Schomacker KT
        • Paranjape AS
        • et al.
        Treatment of photoaging with a dual-wavelength, 532 nm and 1,064 nm picosecond-domain laser producing a fractionated treatment beam using a holographic optic.
        J Drugs Dermatol. 2017; 16: 1077-1082
        • Yaghmai D
        • Garden JM
        • Bakus AD
        • et al.
        Comparison of a 1,064 nm laser and a 1,320 nm laser for the nonablative treatment of acne scars.
        Dermatol Surg. 2005; 31: 903-909
        • Bogle MA.
        Fractionated mid-infrared resurfacing.
        Semin Cutan Med Surg. 2008; 27: 252-258
        • Chwalek J
        • Goldberg DJ.
        Ablative skin resurfacing.
        Curr Probl Dermatol. 2011; 42: 40-47
        • Karsai S
        • Czarnecka A
        • Jünger M
        • et al.
        Ablative fractional lasers (CO2 and Er:YAG): a randomized controlled double-blind split-face trial of the treatment of peri-orbital rhytides.
        Lasers Surg Med. 2010; 42: 160-167
        • Chen KH
        • Tam KW
        • Chen IF
        • et al.
        A systematic review of comparative studies of CO2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles).
        J Cosmet Laser Ther. 2017; 19: 199-204
        • Manuskiatti W
        • Iamphonrat T
        • Wanitphakdeedecha R
        • et al.
        Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians.
        Dermatol Surg. 2013; 39: 111-120
        • Worley B
        • Cohen JL.
        Combination ablative approach to laser therapy in advanced aging of the face.
        J Drugs Dermatol. 2018; 17: 796-799
        • Kauvar AN.
        Fractional nonablative laser resurfacing: is there a skin tightening effect?.
        Dermatol Surg. 2014; 40: S157-S163
        • Weiner SF.
        Radiofrequency microneedling: overview of technology, advantages, differences in devices, studies, and indications.
        Facial Plast Surg Clin North Am. 2019; 27: 291-303
        • Alessa D
        • Bloom JD.
        Microneedling options for skin rejuvenation, including non-temperature-controlled fractional microneedle radiofrequency treatments.
        Facial Plast Surg Clin North Am. 2020; 28: 1-7
        • Roh NK
        • Yoon YM
        • Lee YW
        • et al.
        Treatment of periorbital wrinkles using multipolar fractional radiofrequency in Korean patients.
        Lasers Med Sci. 2017; 32: 61-66
        • Battle F
        • Battle S.
        Clinical evaluation of safety and efficacy of fractional radiofrequency facial treatment of skin type VI patients.
        J Drugs Dermatol. 2018; 17: 1169-1172
        • Kleidona IA
        • Karypidis D
        • Lowe N
        • et al.
        Fractional radiofrequency in the treatment of skin aging: an evidence-based treatment protocol.
        J Cosmet Laser Ther. 2020; 22: 9-25
        • Serdar ZA
        • Tatlıparmak A.
        Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: six-year experience with 333 patients.
        Dermatol Ther. 2019; 32: e13054
        • Gold M
        • Taylor M
        • Rothaus K
        • et al.
        Non-insulated smooth motion, micro-needles RF fractional treatment for wrinkle reduction and lifting of the lower face: international study.
        Lasers Surg Med. 2016; 48: 727-733
        • Liu TM
        • Sun YM
        • Tang ZY
        • et al.
        Microneedle fractional radiofrequency treatment of facial photoageing as assessed in a split-face model.
        Clin Exp Dermatol. 2019; 44 (e96-e102)
        • Zhang M
        • Fang J
        • Wu Q
        • et al.
        A prospective study of the safety and efficacy of a microneedle fractional radiofrequency system for global facial photoaging in Chinese patients.
        Dermatol Surg. 2018; 44: 964-970
        • Kim JK
        • Roh MR
        • Park GH
        • et al.
        Fractionated microneedle radiofrequency for the treatment of periorbital wrinkles.
        J Dermatol. 2013; 40: 172-176
        • Lee SJ
        • Kim JI
        • Yang YJ
        • et al.
        Treatment of periorbital wrinkles with a novel fractional radiofrequency microneedle system in dark-skinned patients.
        Dermatol Surg. 2015; 41: 615-622
        • Tanaka Y.
        Long-term nasal and peri-oral tightening by a single fractional noninsulated microneedle radiofrequency treatment.
        J Clin Aesthet Dermatol. 2017; 10: 45-51
        • Gentile RD
        • Kinney BM
        • Sadick NS.
        Radiofrequency technology in face and neck rejuvenation.
        Facial Plast Surg Clin North Am. 2018; 26: 123-134
        • Wambier CG
        • Lee KC
        • Soon SL
        • et al.
        Advanced chemical peels: phenol-croton oil peel.
        J Am Acad Dermatol. 2019; 81: 327-336
        • Fulton JE
        • Porumb S.
        Chemical peels: their place within the range of resurfacing techniques.
        Am J Clin Dermatol. 2004; 5: 179-187
        • Hetter GP.
        An examination of the phenol-croton oil peel: part IV. Face peel results with different concentrations of phenol and croton oil.
        Plast Reconstr Surg. 2000; 105: 1061-1087
        • Hetter GP.
        An examination of the phenol-croton oil peel: Part I. Dissecting the formula.
        Plast Reconstr Surg. 2000; 105: 227-251
        • Chew J
        • Gin I
        • Rau KA
        • et al.
        Treatment of upper lip wrinkles: a comparison of 950 microsec dwell time carbon dioxide laser with unoccluded Baker's phenol chemical peel.
        Dermatol Surg. 1999; 25: 262-266
        • Langsdon PR
        • Milburn M
        • Yarber R.
        Comparison of the laser and phenol chemical peel in facial skin resurfacing.
        Arch Otolaryngol Head Neck Surg. 2000; 126: 1195-1199
        • Bensimon RH.
        Croton oil peels [published correction appears in Aesthet Surg J. 2008;28:221].
        Aesthet Surg J. 2008; 28: 33-45
        • Wambier CG
        • Beltrame FL.
        Air safety and personal protective equipment for phenol-croton oil peels.
        Dermatol Surg. 2018; 44: 1035-1037
        • El-Domyati M
        • Barakat M
        • Awad S.
        Multiple microneedling sessions for minimally invasive facial rejuvenation: an objective assessment.
        Int J Dermatol. 2015; 54: 1361-1369
        • Hou A
        • Cohen B
        • Haimovic A
        • et al.
        Microneedling: a comprehensive review.
        Dermatol Surg. 2017; 43: 321-339
        • Alam M
        • Han S
        • Pongprutthipan M
        • et al.
        Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial.
        JAMA Dermatol. 2014; 150: 844-849
        • Varma K
        • Bhargava S
        • Kumar U
        Microneedling for atrophic post acne scars: is it effective? A prospective study of 36 patients at tertiary care centre.
        Hong Kong J Dermatol Venereol. 2018; 26: 52-57
        • Afzal FF
        • Ahmad S
        • Mehrose MY
        • et al.
        Efficacy of micro-needling on post acne scars.
        J Ayub Med Coll Abbottabad. 2019; 31: 336-339
        • Bandral MR
        • Padgavankar PH
        • Japatti SR
        • et al.
        Clinical evaluation of microneedling therapy in the management of facial scar: a prospective randomized study.
        J Maxillofac Oral Surg. 2019; 18: 572-578
        • Fabbrocini G
        • Fardella N
        • Monfrecola A
        • et al.
        Acne scarring treatment using skin needling.
        Clin Exp Dermatol. 2009; 34: 874-879
        • Alster TS
        • Li MKY.
        Microneedling of scars: a large prospective study with long-term follow-up.
        Plast Reconstr Surg. 2020; 145: 358-364
        • Park KY
        • Kim HK
        • Kim SE
        • et al.
        Treatment of striae distensae using needling therapy: a pilot study.
        Dermatol Surg. 2012; 38: 1823-1828
        • Alster TS
        • Li MK.
        Microneedling treatment of striae distensae in light and dark skin with long-term follow-up.
        Dermatol Surg. 2020; 46: 459-464
        • Khater MH
        • Khattab FM
        • Abdelhaleem MR.
        Treatment of striae distensae with needling therapy versus CO2 fractional laser.
        J Cosmet Laser Ther. 2016; 18: 75-79
        • Soliman M
        • Mohsen Soliman M
        • El-Tawdy A
        • et al.
        Efficacy of fractional carbon dioxide laser versus microneedling in the treatment of striae distensae.
        J Cosmet Laser Ther. 2019; 21: 270-277
        • Naspolini AP
        • Boza JC
        • da Silva VD
        • et al.
        Efficacy of microneedling versus fractional non-ablative laser to treat striae alba: a randomized study.
        Am J Clin Dermatol. 2019; 20: 277-287
        • Ibrahim ZA
        • El-Ashmawy AA
        • Shora OA.
        Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: a randomized study.
        J Cosmet Dermatol. 2017; 16: 388-399
        • Asif M
        • Kanodia S
        • Singh K.
        Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study.
        J Cosmet Dermatol. 2016; 15: 434-443
        • Ibrahim MK
        • Ibrahim SM
        • Salem AM.
        Skin microneedling plus platelet-rich plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study.
        J Dermatolog Treat. 2018; 29: 281-286
        • Porwal S
        • Chahar YS
        • Singh PK.
        A comparative study of combined dermaroller and platelet-rich plasma versus dermaroller alone in acne scars and assessment of quality of life before and after treatment.
        Indian J Dermatol. 2018; 63: 403-408
        • Bhargava S
        • Kroumpouzos G
        • Varma K
        • Kumar U.
        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; 18: 1092-1097
        • Deshmukh NS
        • Belgaumkar VA.
        Platelet-rich plasma augments subcision in atrophic acne scars: a split-face comparative study.
        Dermatol Surg. 2019; 45: 90-98
        • Chang HC
        • Sung CW
        • Lin MH.
        Combination therapy with microneedling and platelet-rich plasma for acne scarring: a systematic review and meta-analysis.
        Dermatol Surg. 2020; 46: 1118-1122
        • Hesseler MJ
        • Shyam N.
        Platelet-rich plasma and its utility in the treatment of acne scars: a systematic review.
        J Am Acad Dermatol. 2019; 80: 1730-1745
        • Alser OH
        • Goutos I.
        The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review.
        Scars Burn Heal. 2018; 42059513118808773
        • Hsieh TS
        • Chiu WK
        • Yang TF
        • et al.
        A meta-analysis of the evidence for assisted therapy with platelet-rich plasma for atrophic acne scars.
        Aesthetic Plast Surg. 2019; 43: 1615-1623
        • Chang HC
        • Sung CW
        • Lin MH.
        Efficacy of autologous platelet-rich plasma combined with ablative fractional carbon dioxide laser for acne scars: a systematic review and meta-analysis.
        Aesthet Surg J. 2019; 39 (NP279-NP287)
        • Galal O
        • Tawfik AA
        • Abdalla N
        • et al.
        Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: image analysis system evaluation.
        J Cosmet Dermatol. 2019; 18: 1665-1671
        • Gawdat HI
        • Hegazy RA
        • Fawzy MM
        • et al.
        Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars.
        Dermatol Surg. 2014; 40: 152-161
        • Zhu JT
        • Xuan M
        • Zhang YN
        • et al.
        The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne.
        Mol Med Rep. 2013; 8: 233-237
        • Kar BR
        • Raj C.
        Fractional CO2 laser vs fractional CO2 with topical platelet-rich plasma in the treatment of acnescars: a split-face comparison trial.
        J Cutan Aesthet Surg. 2017; 10: 136-144
        • Faghihi G
        • Keyvan S
        • Asilian A
        • et al.
        Efficacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: a split-face randomized clinical trial.
        Indian J Dermatol Venereol Leprol. 2016; 82: 162-168
        • Garg S
        • Khillan K
        • Bharija SC.
        Platelet-rich plasma therapy in the treatment of recalcitrant melasma.
        Dermatol Surg. 2019; 45: 482-484
        • Jha AK
        • Sonthalia S
        • Jakhar D.
        Platelet-rich plasma with microneedling and trichloroacetic acid peel for treatment of striae distensae.
        J Am Acad Dermatol. 2018; 79: e107-e108
        • Gamil HD
        • Ibrahim SA
        • Ebrahim HM
        • et al.
        Platelet-rich plasma versus tretinoin in treatment of striae distensae: a comparative study.
        Dermatol Surg. 2018; 44: 697-704
        • Hersant B
        • Niddam J
        • Meningaud JP.
        Comparison between the efficacy and safety of platelet-rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study.
        J Cosmet Dermatol. 2016; 15: 565
        • Abdel Hay R
        • Shalaby K
        • Zaher H
        • et al.
        Interventions for acne scars.
        Cochrane Database of Syst Rev. 2016; 4 (CD011946)
        • Khunger N
        • Bhardwaj D
        • Khunger M.
        Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types.
        J Cosmet Dermatol. 2011; 10: 51-57
        • Lee JW
        • Kim BJ
        • Kim MN.
        Treatment of acne scars using subdermal minimal surgery technology.
        Dermatol Surg. 2010; 36: 1281-1287
        • Taylor MB
        • Zaleski-Larsen L
        • McGraw TA.
        Single session treatment of rolling acne scars using tumescent anesthesia, 20% trichloroacetic acid extensive subcision, and fractional CO2 laser.
        Dermatol Surg. 2017; 43: 70-74
        • Faghihi G
        • Nouraei S
        • Asilian A
        • et al.
        Efficacy of punch elevation combined with fractional carbon dioxide laser resurfacing in facial atrophic acne scarring: a randomized split-face clinical study.
        Indian J Dermatol. 2015; 60: 473-478
        • Patel L
        • McGrouther D
        • Chakrabarty K.
        Evaluating evidence for atrophic scarring treatment modalities.
        JRSM Open. 2014; 5: 1-13
        • Anupama YG
        • Wahab AJ.
        Effectiveness of CO2 laser with subcision in patients with acne scars.
        J Cosmet Laser Ther. 2016; 18: 367-371
        • Chandrashekar BS
        • Sriram R
        • Mysore R
        • et al.
        Evaluation of microneedling fractional radiofrequency device for treatment of acne scars.
        J Cutan Aesthet Surg. 2014; 7: 93-97
        • Tatlıparmak A
        • Aksoy B
        • Shishehgarkhaneh LR
        • et al.
        Use of combined fractional carbon dioxide laser and fractional microneedle radiofrequency for the treatment of acne scars: a retrospective analysis of 1-month treatment outcome on scar severity and patient satisfaction.
        J Cosmet Dermatol. 2020; 19: 115-121
        • Biesman BS
        • Cohen JL
        • DiBernardo BE
        • et al.
        Treatment of atrophic facial acne scars with microneedling followed by polymethylmethacrylate-collagen gel dermal filler.
        Dermatol Surg. 2019; 45: 1570-1579
        • Bhargava S
        • Kumar U
        • Varma K.
        Subcision and microneedling–cheap and safe combination to treat atrophic acne scars in dark skin. A prospective study of 45 patients at tertiary care centre.
        J Clin Aesthet Dermatol. 2019; 12: 18-22
        • Garg S
        • Baveja S.
        Combination therapy in the management of atrophic acne scars.
        J Cutan Aesthet Surg. 2014; 7: 18-23
        • Ali B
        • El Mahdy N
        • Elfar NN.
        Microneedling (Dermapen) and Jessner's solution peeling in treatment of atrophic acne scars: a comparative randomized clinical study.
        J Cosmet Laser Ther. 2019; 21: 357-363
        • Long T
        • Gupta A
        • Ma S
        • et al.
        Platelet-rich plasma in noninvasive procedures for atrophic acne scars: a systematic review and meta-analysis.
        J Cosmet Dermatol. 2020; 19: 836-844
        • Nilforoushzadeh MA
        • Faghihi G
        • Jaffary F
        • et al.
        Fractional carbon dioxide laser and its combination with subcision in improving atrophic acne scars.
        Adv Biomed Res. 2017; 6: 20
        • Faghihi G
        • Poostiyan N
        • Asilian A
        • et al.
        Efficacy of fractionated microneedle radiofrequency with and without adding subcision for the treatment of atrophic facial acne scars: a randomized split-face clinical study.
        J Cosmet Dermatol. 2017; 16: 223-229
        • Mu YZ
        • Jiang L
        • Yang H.
        The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars.
        Dermatol Ther. 2019; 32: e13084
        • Cunha PR
        • Kroumpouzos G.
        Melasma and vitiligo: novel and experimental therapies.
        J Clin Exp Dermatol Res. 2016; 7: 2
        • Cassiano DP
        • Espósito ACC
        • Hassun KM
        • et al.
        Early clinical and histological changes induced by microneedling in facial melasma: a pilot study.
        Indian J Dermatol Venereol Leprol. 2019; 85: 638-641
        • Lima EDA.
        Microneedling in facial recalcitrant melasma: report of a series of 22 cases.
        An Bras Dermatol. 2015; 90: 919-921
        • Lima EVA
        • Lima MMDA
        • Paixão MP
        • et al.
        Assessment of the effects of skin microneedling as adjuvant therapy for facial melasma: a pilot study.
        BMC Dermatol. 2017; 17: 14
        • Fabbrocini G
        • De Vita V
        • Fardella N
        • et al.
        Skin needling to enhance depigmenting serum penetration in the treatment of melasma.
        Plast Surg Int. 2011; 2011158241
        • Ismail ESA
        • Patsatsi A
        • Abd El-Maged WM
        • et al.
        Efficacy of microneedling with topical vitamin C in the treatment of melasma.
        J Cosmet Dermatol. 2019; 18: 1342-1347
        • Budamakuntla L
        • Loganathan E
        • Suresh DH
        • et al.
        A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma.
        Cutan Aesthet Surg. 2013; 6: 139-143
        • Sirithanabadeekul P
        • Dannarongchai A
        • Suwanchinda A.
        Platelet-rich plasma treatment for melasma: a pilot study.
        J Cosmet Dermatol. 2020; 19: 1321-1327
        • Yue B
        • Yang Q
        • Xu J
        • et al.
        Efficacy and safety of fractional q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients.
        Lasers Med Sci. 2016; 31: 1657-1663
        • Kauvar AN.
        Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers.
        Lasers Surg Med. 2012; 44: 117-124
        • Lee YJ
        • Shin HJ
        • Noh TK
        • et al.
        Treatment of melasma and post-inflammatory hyperpigmentation by a picosecond 755-nm alexandrite laser in Asian patients.
        Ann Dermatol. 2017; 29: 779-781
        • Trivedi MK
        • Yang FC
        • Cho BK.
        A review of laser and light therapy in melasma.
        Int J Womens Dermatol. 2017; 3: 11-20
        • Morais OO
        • Lemos EF
        • Sousa MC
        • et al.
        The use of ablative lasers in the treatment of facial melasma.
        An Bras Dermatol. 2013; 88: 238-242
        • Cohen BE
        • Elbuluk N.
        Microneedling in skin of color: a review of uses and efficacy.
        J Am Acad Dermatol. 2016; 74: 348-355
        • Peng GL.
        Platelet-rich plasma for skin rejuvenation: facts, fiction, and pearls for practice.
        Facial Plast Surg Clin North Am. 2019; 27: 405-411
        • Shin MK
        • Lee JH
        • Lee SJ
        • et al.
        Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation.
        Dermatol Surg. 2012; 38: 623-630
        • Knight JM
        • Kautz G.
        Sequential facial skin rejuvenation with intense pulsed light and non-ablative fractionated laser resurfacing in Fitzpatrick skin type II-IV patients: A prospective multicenter analysis.
        Lasers Surg Med. 2019; 51: 141-149
        • Wat H
        • Yee-Nam Shek S
        • Yeung CK
        • et al.
        Efficacy and safety of picosecond 755-nm alexandrite laser with diffractive lens array for non-ablative rejuvenation in Chinese skin.
        Lasers Surg Med. 2019; 51: 8-13
        • Kaushik SB
        • Alexis AF.
        Nonablative fractional laser resurfacing in skin of color: evidence-based review.
        J Clin Aesthet Dermatol. 2017; 10: 51-67
        • Mei XL
        • Wang L.
        Ablative fractional carbon dioxide laser combined with intense pulsed light for the treatment of photoaging skin in Chinese population: a split-face study.
        Medicine (Baltimore). 2018; 97: e9494