Mohammed Saleh Al‐Dhubaibi

Background Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, associated with significant psychological distress. Objective A new complementary treatment of atrophic acne scars using subcision and injection of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H‐HA/L‐HA). Methods This study included eighty‐two patients divided into two groups with predominantly atrophic acne scarring. Group 1 received subcision with saline injection, while group 2 received triple steps acne scar revision technique (TSASRT). After topical anesthesia, the procedure of combining subcision and hybrid H‐HA/L‐HA technique was done in which the first step started using subcision technique done to release fibrous cords at the dermal or deep dermal, subcutaneous plane using Nokor needles‐18 g. The second step is to inject the scar's atrophic dermal component with a 29 g needle, applying an average amount of hybrid H‐HA/L‐HA (0.02–0.1 mL) to the dermal component. The third step was to fill the subcisied space with hybrid H‐HA/L‐HA (0.02–0.1 mL) using a 25 g cannula. Results Clinical improvement was achieved in both groups. There were statistically significant improvements in the TSASRT versus subcision ( p ≤ 0.05) in acne scar severity index and qualitative scarring grading system. Conclusion The triple step acne scar revision technique appears to be a safe and effective way to treat atrophic acne scars on the face.