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    Top 5 dermatology controversies


    #4: Ablative versus Nonablative

    “Although dermatologists have used ablative methods for smoothing acne scars for well over one hundred years, some now say non-ablative approaches may produce similar results with less downtime and fewer side effects. Dermabrasion, deep chemical peeling, and laser resurfacing have been the go-to approaches for acne scars, removing skin to the mid to lower dermis and allowing re-epithelialization to produce smoother skin. Now a number of non-ablative technologies may produce equal results,” Dr. Coleman says. “[Among those, the] 1,540‐nm erbium-doped diode fractional lasers used in a maximum dose of 100 mJ in six serial sessions have been shown to produce significant improvement in all but deep atrophic acne scars. Fractional radiofrequency microneedle devices have also been shown to produce demonstrable improvement. Recently, the 755-nm alexandrite picosecond laser has been used successfully in acne scars with the added benefit of improvement in post inflammatory hyperpigmentation.”

    Derms speak up

    Jennifer Chwalek, M.D.Dermatologist Jennifer Chwalek, M.D., clinical instructor at Mount Sinai Medical Center, says she agrees that nonablative technologies can produce very good results. In many cases, she says, those results may be similar to or even approach ablative technology (but requiring more treatments).

    RECOMMENDED: Tips for treating acne scars

    “All of the technologies [Dr. Coleman noted] may be used successfully to treat acne scars, but when it comes to deciding the right modality for a patient, the type of scar, severity of scars and patient's lifestyle (specifically the possible downtime associated with some treatments) need to be considered,” Dr. Chwalek says.

    Roy G. Geronemus, M.D.There’s room and need for all options, according to Roy G. Geronemus, M.D., director of the Laser & Skin Surgery of New York and clinical professor of dermatology, New York University Medical Center.

    ALSO READ: FDA oks Bellafill for acne-scar therapy

    “The dermatologist’s toolbox for the treatment of acne scars has grown over the past decade. Many lasers and radiofrequency devices (nonablative and ablative) can effectively improve acne scars with certain advantages provided by the various devices,” Dr. Geronemus says. “The optimal outcome for each individual patient varies based upon matching the benefits and downtime of each device with many clinical variables. These variables include the benefit of each device for certain types of acne scars, the ability to treat darker skin phototypes and the tolerance for downtime and multiple treatments, if needed.”

    NEXT: Comparing neurotoxins

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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