{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:07:45Z","timestamp":1784776065780,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"China National Natural Science Foundation","doi-asserted-by":"publisher","award":["82073472"],"award-info":[{"award-number":["82073472"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institutions","award":["82073472"],"award-info":[{"award-number":["82073472"]}]},{"name":"Outstanding Young and Middle-Aged Talents Support Program of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)","award":["82073472"],"award-info":[{"award-number":["82073472"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and aim: Fractional CO2 laser is therapeutic for acne atrophic scar, but its effect usually is limited after multiple sessions, with occasional adverse reactions. This study aimed to evaluate the efficacy and safety of a new modality combining ultra-pulse CO2 laser and fractional CO2 laser (multiple mode procedures [MMP]) in the treatment of acne atrophic scars. Method: From December 2017 to January 2023, a total of 103 patients with facial acne atrophic scars treated with MMP technique were retrospectively analyzed. MMP was performed for 1\u20134 sessions with an interval of approximately three months. Based on photographs taken before and after treatment, overall atrophic scar improvement was assessed according to the ECCA grading scale, the modified Manchester Scar Scale and the 4-point Global Assessment Scale (GAS). The safety was evaluated by the degree of pain during treatment and postoperative adverse reactions. Results: All the 103 patients received treatment and completed follow-up, with an average of two sessions. The mean ECCA score decreased from 162.7 to 93.1 with statistically significant difference (p &lt; 0.001). The mean GAS score increased by an average of 2.3 \u00b1 0.9. The GAS improvement more evident for \u201cboxcar\u201d atrophic scars (2.7 \u00b1 0.8) than for \u201crolling\u201d (2.3 \u00b1 0.8) and \u201cicepick\u201d scars (1.7 \u00b1 0.8) (p &lt; 0.001). The average improvement scores for color, distortion and texture were 2.0 \u00b1 0.9, 2.2 \u00b1 0.9 and 2.3 \u00b1 0.8, respectively. The mean pain score during treatment was 3.9 \u00b1 0.8, and the mean duration of erythema was 30.7 \u00b1 3.5 days. Only three patients developed hyperpigmentation at the treated site within a few months. Discussion: Ultra-pulse CO2 fractional laser MMP technique can effectively improve the condition of facial atrophic acne scars with limited adverse reactions.<\/jats:p>","DOI":"10.3390\/jcm12134388","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T01:02:41Z","timestamp":1688086961000},"page":"4388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["\u201cMultiple Mode Procedures\u201d of Ultra-Pulse Fractional CO2 Laser: A Novel Treatment Modality of Facial Atrophic Acne Scars"],"prefix":"10.3390","volume":"12","author":[{"given":"Zhonglan","family":"Pan","sequence":"first","affiliation":[{"name":"Nanjing Yijia Medical Aesthetic Clinic, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqiu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Nantong Third People\u2019s Hospital Affiliated to Nantong University, Nantong 226000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuoqiong","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7965-7624","authenticated-orcid":false,"given":"Bingrong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"ref_1","first-page":"13","article-title":"The epidemiology of acne vulgaris in late adolescence","volume":"7","author":"Lynn","year":"2016","journal-title":"Adolesc. Health Med. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.jaad.2017.09.078","article-title":"Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne","volume":"78","author":"Thiboutot","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1111\/1346-8138.13263","article-title":"Frequency and characteristics of acne-related post-inflammatory hyperpigmentation","volume":"43","author":"Chow","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_4","first-page":"12","article-title":"Acne Scarring-Pathogenesis, Evaluation, and Treatment Options","volume":"10","author":"Connolly","year":"2017","journal-title":"J. Clin. Aesthetic Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s40257-017-0321-x","article-title":"Acne Scars: How Do We Grade Them?","volume":"19","author":"Clark","year":"2018","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.jaad.2020.02.040","article-title":"Acne vulgaris and risk of depression and anxiety: A meta-analytic review","volume":"83","author":"Samuels","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1108\/RPJ-03-2021-0055","article-title":"Laser subtractive and laser powder bed fusion of metals: Review of process and production features","volume":"29","author":"Khorasani","year":"2023","journal-title":"Rapid Prototyp. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1002\/lsm.20048","article-title":"Fractional photothermolysis: A new concept for cutaneous remodeling using microscopic patterns of thermal injury","volume":"34","author":"Manstein","year":"2004","journal-title":"Lasers Surg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2165\/11598910-000000000-00000","article-title":"Management of acne scarring, part I: A comparative review of laser surgical approaches","volume":"13","author":"Sobanko","year":"2012","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1111\/j.1529-8019.2009.01265.x","article-title":"Fractional CO2 laser: A novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair","volume":"22","author":"Prignano","year":"2009","journal-title":"Dermatol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1097\/01.prs.0000299380.83221.a8","article-title":"Full-face carbon dioxide laser resurfacing: A 10-year follow-up descriptive study","volume":"121","author":"Prado","year":"2008","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","first-page":"6803988","article-title":"Effect and Safety Analysis of PRP and Yifu Combined with Ultrapulsed CO2 Lattice Laser in Patients with Sunken Acne Scar","volume":"2022","author":"Wang","year":"2022","journal-title":"J. Healthc. Eng."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"212","DOI":"10.3109\/14764170903134326","article-title":"Atrophic acne scar treatment using triple combination therapy: Dot peeling, subcision and fractional laser","volume":"11","author":"Kang","year":"2009","journal-title":"J. Cosmet. Laser Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1111\/jocd.13335","article-title":"A novel technique for treating atrophic facial scars in Asians using ultra-pulse CO2 laser","volume":"19","author":"Jin","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1111\/jocd.14868","article-title":"Efficacy and adverse reactions of fractional CO2 laser for atrophic acne scars and related clinical factors: A retrospective study on 121 patients","volume":"21","author":"Li","year":"2022","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2623","DOI":"10.1007\/s10103-022-03528-w","article-title":"Treatment of acne scars with fractional carbon dioxide laser in Asians: A retrospective study to search for predicting factors associated with efficacy","volume":"37","author":"Fang","year":"2022","journal-title":"Lasers Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0032-1329413","article-title":"Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface","volume":"26","author":"Preissig","year":"2012","journal-title":"Semin. Plast. Surg."},{"key":"ref_18","first-page":"881","article-title":"The efficacy and adverse reactions of fractional CO2 laser for treatment of atrophic acne scars","volume":"48","author":"Hongjin","year":"2015","journal-title":"Chin. J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/14764172.2018.1516886","article-title":"The effects of Antimicrobial Peptides and Hyaluronic Acid compound mask on wound healing after ablative fractional Carbon Dioxide laser resurfacing","volume":"21","author":"Zhang","year":"2019","journal-title":"J. Cosmet. Laser Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/jocd.12334","article-title":"Clinical efficacy of utilizing Ultrapulse CO2 combined with fractional CO2 laser for the treatment of hypertrophic scars in Asians-A prospective clinical evaluation","volume":"16","author":"Lei","year":"2017","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1159\/000096912","article-title":"ECCA grading scale: An original validated acne scar grading scale for clinical practice in dermatology","volume":"214","author":"Dreno","year":"2007","journal-title":"Dermatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1097\/00006534-199811000-00022","article-title":"A new quantitative scale for clinical scar assessment","volume":"102","author":"Beausang","year":"1998","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","first-page":"e088","article-title":"Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults","volume":"2","author":"Delgado","year":"2018","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e14539","DOI":"10.1111\/dth.14539","article-title":"The efficacy of fractional CO2 laser in acne scar treatment: A meta-analysis","volume":"34","author":"Zhang","year":"2021","journal-title":"Dermatol. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1111\/j.1529-8019.2008.00239.x","article-title":"CROSS technique: Chemical reconstruction of skin scars method","volume":"21","author":"Fabbrocini","year":"2008","journal-title":"Dermatol. Ther."},{"key":"ref_26","first-page":"1163","article-title":"Focal Acne Scar Treatment (FAST), a new approach to atrophic acne scars: A case series","volume":"12","author":"Schweiger","year":"2013","journal-title":"J. Drugs Dermatol."},{"key":"ref_27","first-page":"71","article-title":"The efficacy and security of focal fractional laser in treatment of atrophic acne scars","volume":"25","author":"Qin","year":"2019","journal-title":"Chin. J. Med. Aesthet. Cosmetol."},{"key":"ref_28","first-page":"1189","article-title":"Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar","volume":"16","author":"Asilian","year":"2011","journal-title":"J. Res. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1097\/01.DSS.0000452623.24760.9c","article-title":"A comparison of the scar prevention effect between carbon dioxide fractional laser and pulsed dye laser in surgical scars","volume":"40","author":"Kim","year":"2014","journal-title":"Dermatol. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.asj.2006.12.002","article-title":"Growth factor expression with different wound treatments after laser resurfacing","volume":"27","author":"Lee","year":"2007","journal-title":"Aesthetic Surg. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4388\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:03:43Z","timestamp":1760126623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,29]]},"references-count":30,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12134388"],"URL":"https:\/\/doi.org\/10.3390\/jcm12134388","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,29]]}}}