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Objectives: Sharing more than 20 years personal experiences in Subcision , presentations of tips and tricks in dealing with scars in various types including how to evaluate the patients , needle selection and also adjunctive treatment. Nevertheless , the clues to achieve the best result in one visit , what to be aware of and how to manage when coming across the side effects . Discussion about the environmental and emotional factors in affecting the phase of wound healing.

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Objectives: This study aimed to evaluate the effectiveness of the combination of ablative fractional resurfacing laser with other methods, specifically fractional CO2 laser and chemical peel in atrophic scars treatment.

Introduction: Atrophic scars, which were results of losing or contracting collagen fibers below the skin, present a most common but also significant challenge after acne treatment. They greatly affect patient’s appearance, self-esteem, and overall quality of life. Currently, there are various treatments for these scars, such as laser therapy, chemical peels, micro needling, punch techniques, subcision, and even combinations of these methods. However, the poor clinical responses of these methods showing the need for ongoing research and clinical optimization in this situation.

Materials / method: 40 patients presenting with moderate to severe atrophic scars, they received a treatment utilizing a combination of Fractional CO2 Laser and Chemical Peel. The regimen comprised five sessions, every 4 weeks. Each session had two stages: patients firstly received laser treatment with two passes. First pass targeted the entire facial area with energy levels ranging from 25-35mJ. Second pass focused on areas with more depressed scars, utilizing energy levels of 45-65mJ. Continuously by undergoing chemical peel application with 15% TCA on the laser-treated skin until reaching the desired endpoint.

Results: After 5 months, patients were evaluated for atrophic scars severity, skin surface, and satisfaction with treatment outcomes. Every patient saw improvement in atrophic scars and skin texture, as well as a reduction in hyperpigmentation. Though some experienced temporary issues like irritation, prolonged redness, and hyperpigmentation during the treatment, these were effectively managed. At the end of the treatment, all patients were pleased with the treatment outcomes and have higher seft- esteem, better quality of life.

Conclusion: This is a synergistic combination, as the fractional laser helps to bring peeling agents into the skin, enhancing the chemical peel’s effects without requiring high energy and still has its efficiency. The combination is a promising method for skin regeneration and increasing collagen, making it a excellent option for treating atrophic scars. However, this procedure also carries risks, particularly in terms of pigmentation disorders. Therefore, the indication must be carefully selected and requires proper care before, during, and after the procedure.

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Objectives: Treating acne scars in Southeast Asia for skin types 3-5 in sunny areas is challenging. Hyperpigmentation is the topmost concern, and aggressive treatment may not be suitable due to long downtime and side effects. We prepare the patient's skin with a skin conditioning treatment, involving the daily use of SPF 50 sunscreen and topical low-dose tretinoin. Meanwhile, we prepare the patient's mindset and encourage lifestyle changes from outdoor to more indoor activities. We ensure the patients' commitment to following our instructions in order to achieve the expected results.

Introduction: I will share how I treat acne scars in patients with skin phototypes 3-5 in a tropical zone. We use ablative laser and controlled tissue wounding and heating with microneedle radiofrequency. We personalize the parameters according to each patient. We also provide topical treatment between procedures.

Materials / method: Immediately after each treatment, while the skin channels are still open, we apply secretome from umbilical cord Wharton's jelly stem cell culture. The pain level is less than 5 out of 10, and the redness lasts only a few hours.

Results: We achieve good results with low pain levels during treatment and a short downtime. The skin heals in 4-5 days; even 2 days after the procedure, patients can resume normal activities without noticeable effects

Conclusion: Combination of ablative and microneedle radiofrequency treatment is a good choice for acne scars in Southeast Asia.

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Objectives: A review on classification of scar and its management and prognosis. Discuss on how to minimise scars

Introduction: A scar can be defined as a fault or blemish resulting from some former condition, wound, sore or burn. Scar formation is an inevitable consequence of wound healing in which the normal skin is replaced by a fibrous tissue - scar tissue lacks the characteristics of the normal uninjured skin.

Materials / method: A review of literature on scar tissue studied. cars comprised mainly of collagen, secreted by fibroblast. A scar can be a fine line or a pitted hole on the skin, or an abnormal overgrowth of tissue. Following skin injury, the skin naturally repairs the damage – the degree of repairs process depends on the depth of the injury. If only the epidermal layer is damaged complete re-epithelization can occur with not obvious scaring. For deeper injury involving the dermis and subcutaneous fat – obvious scarring due to disorganized repairs occur – leading to obvious scars.

Results: There are three distinct, sequential phases of repair leading to the formation of a fibrotic scar: (1) inflammation, (2) new tissue formation, and (3) remodeling.
Excessive amounts, collagen production and build up can lead to keloid and hypertrophic scar formations - this happens when fibroblasts and keratinocytes in the skin activities go into overdrive to restructure and rebuild damaged tissue – this is an evolutional process in tissue repair.

Conclusion: Early treatment can improve the appearance of scars. Sequelae of scars is disfigurement and restriction of movements, joint mobility, contracture and pain. There are topicals and procedures that can help prevent and improve the appearance of scars.

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