Minimally Invasive Percutaneous Collagen Induction Improves Aesthetic Outcomes in Postsurgical Scars
Post surgical scars are an unavoidable outcome of aesthetic procedures and many patients seek options to soften their appearance. Various modalities exist to treat scars, including topicals, intralesional, surgical, and energy-based devices. Microneedling, or minimally invasive percutaneous collagen induction, causes mechanical injury to the skin down to the reticular dermis. Specifically, this “subincision” releases the fibrous strands responsible for scarring and builds up connective tissue beneath the scar. Treatment with thousands of microneedles causes disruption of the epidermis and micro-wounds in the papillary dermis, stimulating growth factors and fibroblasts that induce neocollagenesis and initiate the scarless healing cascade.
The effectiveness of microneedling in chronic acne scars has been well studied, however, there is a lack of investigation into the effects on postsurgical scars. Following incisions, fibroblasts in the papillary dermis synthesize poorly organized collagen fibers, leading to scar formation. Thus, treatment of scars with microneedling in the early postoperative period can reduce formation of disorganized collagen production, softening the appearance of postsurgical scars. The purpose of this study is to highlight the safety and efficacy of treatment with minimally invasive percutaneous collagen induction on postsurgical scars.
Methods/Technique
:Twenty-five patients who had absorbable sutures placed in the deep dermis during wound closure were enrolled in the study. In the postoperative period, all patients had scars treated with 3 rounds of minimally invasive percutaneous collagen induction with the SkinPen Precision microneedling device. Depth of invasion was determined based on location of the treatment area (1 mm –2.5 mm). Scores from the Vancour Scar Scale, Patient and Observer Scar Scales, and Global Aesthetic Improvement Scale were recorded and used to analyze scars after each of the three treatments and at the 2-month follow-up visit.
Results/Complications
:Patients had a statistically significant improvement in Vancour Scar Scale, Patient and Observer Scar Scales, and Global Aesthetic Improvement Scale scores at 16-week posttreatment when compared to pretreatment scores (p <0.001). There was no statistically significant difference in patient age, location of scar, or Fitzpatrick skin type. A statistically significant difference was noted when comparing patients who began treatment 6-7 weeks postoperatively with patients who began treatment 13-16 weeks postoperatively (p <0.04).
Conclusion
:Scars are an inevitable outcome of surgery in which many modalities of treatment exist. One promising method that has proven to be effective in the treatment of chronic acne scars is microneedling, also known as minimally invasive percutaneous collagen induction. This study, however, illustrates the positive effect of microneedling on early postsurgical scars. The data shows treatment with minimally invasive percutaneous collagen induction during the early maturation phase (6-7 weeks postoperatively) demonstrated improved aesthetic outcomes when compared to initiation during the late maturation phase (13-16 weeks postoperatively).