Acne scarring remains a very difficult facial problem that defies any single method of improvement. Fundamentally, acne scars are treated by either outer skin resurfacing, complete excision, or injectable filling for pushing out the depressed scar. Each approach has its own utility based on the type of acne scar size and shape.
The simplest and easiest treatment to apply for acne scars are injectable fillers. And for the right type of acne scar (broader based saucer shape scars or atrophic acne scars), the push of a filler can be very effective. But not all fillers push out scars equally and all have variable time periods of persistence.
In the July 2014 issue of the American Academy of Dermatology, a study was published entitled ‘A Double-Blind, Randomized, Multicenter, Controlled Trial Of Suspended Polymethylmethacrylate Microspheres For The Correction Of Atrophic Facial Acne Scars’. In this study, nearly 150 patients that had multiple rolling, atrophic acne scars randomly received PMMA-collagen (Artefill) or saline injections.. They usually received two injections session and were followed for up to six months after treatment. Success was obtained in two-thirds (64%) of the Artefill injected patients compared to one-third of those that had received saline injections.. Adverse reactions to Artefill were mild and reversible. No differences were seen between ages, race or skin types.
It is not surprising that a particulated filler would produce better results in depressed scars than water (saline) or even a non-particulated filler. (not studied) The viscosity and push of an injectable filler like Artefill is simply more robust which is exactly what scarred and atrophic skin needs to be sufficiently elevated. The observation that almost all acne scars were not improved by Artefill is somewhat surprising but that is probably reflective of the tough adherence of many acne scars and injector technique. What is not shown in the study is how long the Artefill effect lasts but this was really a pilot study to evaluate safety and effectiveness.
One very interesting aspect of this study was that saline injections produced any effectiveness at all, not that Artefill was more effective. This effect is hard to explain particularly at the six month follow-up period. Does saline alone by lifting the scar produce some degree of collagen formation?
Dr. Barry Eppley
Indianapolis, Indiana