الفهرس 
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Abstract
Acne vulgaris is one of the most commonly encountered skin conditions, and is frequently seen in both adolescent and adult populations. Scarring is a common result of acne and may take the form of atrophic or hypertrophic scars, thus resulting not only in an un-desirable cosmetic appearance but also potential impairment of the overall well-being. Atrophic acne scars can be classified into three scar types: icepick, boxcar, and rolling. Different classifications and grading scores are present in order to assess the severity of acne scars and to standardize the discussions about the treatments of scars.
The management of acne scarring includes various types of resurfacing (chemical peels, lasers, lights, and cryotherapy), use of dermal fillers, and surgical methods such as dermabrasion, subcision or punch excision. Individual scar characteristics, including color, texture and morphology determine the treatment choice. Combining treatment methods may provide additional improvement compared with one method alone. It should be noted that none of the currently available treatments can achieve complete resolution of the scar. The best method of preventing or limiting scarring is to treat acne early enough to minimize the extent and duration of inflammation.
Fractional carbon dioxide laser is a well-known effective modality for treatment of acne scars. It depends on the idea of creating microscopic thermal wounds referred to as the microscopic thermal zone (MTZ), and specifically spares tissues surrounding each wound providing rapid reepithelialization from surrounding undamaged tissues, and thus resulting in a faster recovery, reduced downtime, and greatly improved side effects for patients.
Scar subcision is a minor in-office procedure for treating depressed scars and wrinkles using a tri-beveled hypodermic needle inserted through a puncture in the skin surface, and its sharp edges maneuvered under the defect to make subcuticular cuts. The principle of this procedure is to break the fibrotic strands, which tether the scar to the underlying subcutaneous tissue leading to lifting of the scar.
Polydioxanone (PDO) is a synthetic absorbable surgical suture that has been used in surgery for many years. The suture material is reabsorbed completely by the body in 4 to 6 months. This reabsorption is done by hydrolysis, triggering fibroblast production, which in turn produces more collagen in the targeted area. In recent years, polydioxanone threads have been used in the field of cosmetology for facial rejuvenation especially in lifting procedures. The main types of PDO threads include smooth monofilament plain threads, monofilament spiral or screw, multiple monofilament threads, and cogged sutures.
The current split face pilot study aimed to compare between the efficacy and safety of PDO monofilament threads versus well standard method as the fractional CO2 laser technique for treatment of atrophic post acne scars. Both procedures were preceded by scar subcision. Two sessions were done one month apart. We found that combination therapy of subcision/fractional CO2 laser in only two treatment sessions could statistically significantly reduce the scar severity. Dropping of the scar severity was documented by Goodman and Baron grading system, and the scar color density and texture according to Antera Camera.
Evaluation of the effect of scar subcision/PDO threads revealed an absence of any statistically significant difference between the baseline, after one month, and three months after the last treatment session according to according to Goodman and Baron grading scale, and Antera Camera assessment. Also, scar subcision/PDO threads was inferior to subcision/fractional CO2 laser treatment modality for correction of atrophic acne scars.
To summarize, the current work emphasized on the effectiveness of fractional CO2 laser to as a leading modality for treatment of atrophic post acne scars. PDO threads are being used widely in aesthetic dermatology for face lifting, contouring and mild wrinkles treatment. However, the current work did not find any benefit from the use of PDO monofilaments in treatment of acne scarring.