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Background: Basal cell carcinomas (BCCs) have previously been treated off‐label with ingenol mebutate (IM). Ablative fractional laser (AFL) may improve efficacy of IM by increasing drug uptake in the tumour. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) detect BCC non‐invasively. Our aim was to investigate BCC response and tolerability after combined AFL and IM treatment of low‐risk BCCs. Methods: Twenty patients with histologically verified superficial (n = 7) and nodular (n = 13) BCCs were treated with combined fractional CO2‐laser (10 600 nm) and IM 0.015% or 0.05%, the concentration depending on anatomical location. BCC response was evaluated clinically, by OCT and RCM at day 29 and 90 after first treatment, and histologically at day 90. Treatment was repeated at day 29 if BCC persisted. Local skin reactions (LSRs) were assessed using LSR scale at all visits. Results: At day 29, 18/20 patients received a second treatment due to residual BCC detected clinically, by OCT or RCM. OCT and RCM presented subclinical BCCs in five of 20 cases (25%). At day 90, overall histological cure rate was 70%, corresponding to clinical (65%) and OCT/RCM (60%) cure rates, and agreement between evaluation methods was substantial (kappa ≥ 0.796, P < 0.0001). Clearance rates were similar for sBCCs and nBCCs (P = 0.354) and for lesions treated with IM 0.015% and 0.05% (P = 0.141). LSRs were tolerable, but scarring was observed in the majority of cleared patients. Conclusion: Two treatments of combined AFL and IM show potential to treat low‐risk BCCs with acceptable tolerability. OCT and RCM show promise to detect subclinical BCCs at short‐term follow‐up. [ABSTRACT FROM AUTHOR]

Summary: Background: Physical pretreatments can potentiate the efficacy of daylight photodynamic therapy (dPDT), but clinical comparative studies remain limited. Objectives: Performed in large skin areas with actinic keratoses (AKs) and photodamage, this blinded, randomized clinical trial compared the efficacy and safety of dPDT after tailored skin pretreatment using ablative fractional laser (AFL) or microdermabrasion (MD). Methods: Two ≥ 50‐cm2 side‐by‐side skin areas were randomized to receive a single treatment with AFL‐dPDT or MD‐dPDT. Pretreatment parameters were tailored according to AK grade and skin constitution to ensure standardized immediate end points. Subsequently, methyl aminolaevulinate was applied, followed by 2‐h daylight exposure. The primary outcome comprised blinded assessment of AK clearance at the 3‐month follow‐up. Results: In 18 patients with 832 AKs, AFL‐dPDT provided significantly higher AK clearance (81% vs. 60%, P < 0·001), led to fewer new AKs (P < 0·001) and showed superior improvement in dyspigmentation (P = 0·003) and skin texture (P = 0·001) vs. MD‐dPDT. Peaking at days 3–6, AFL‐PDT induced more intensified local skin responses (P = 0·004), including instances of Staphylococcus aureus infection (n = 3). Patients nonetheless preferred AFL‐dPDT (P = 0·077), due to lower pretreatment‐related pain (P = 0·002) and superior cosmesis (P = 0·035) and efficacy compared with MD‐dPDT. Conclusions: AFL‐dPDT is an effective treatment for patients with AK with extensive field cancerization, although AFL pretreatment is associated with intensified local skin reactions. What's already known about this topic? Different physical skin pretreatments have been shown to potentiate the efficacy of daylight photodynamic therapy (dPDT), but comparison studies are lacking. What does this study add? Using tailored pretreatment parameters to obtain standardized immediate end points prior to dPDT, ablative fractional laser provided superior lesional clearance and enhanced rejuvenating effects, but increased local skin reactions compared with pretreatment with microdermabrasion.Ablative fractional laser‐assisted dPDT represents a viable, intensified treatment strategy for patients with multiple actinic keratoses and large areas of photodamaged skin. Linked Editorial:Wolf. Br J Dermatol 2019; 180:697–698. Respond to this article [ABSTRACT FROM AUTHOR]

Recently, design thinking has become recognized as a necessity for every student, especially when they engage in design-based learning, as a pedagogical approach to science, technology, engineering, and mathematics education. However, design-based learning is mostly based on forward engineering, in which students' design thinking can be nurtured by designing unknown solutions. Little is known about whether design thinking can be facilitated in the context of reverse engineering, when students learn from already designed products. This study therefore seeks to explore the perceptions of 38 ninth-grade students on the characteristics of design thinking before and after a four-week reverse engineering project, using Likert scales to measure six aspects of design thinking, namely (a) being comfortable with uncertainty and risks, (b) human-centeredness, (c) mindfulness to the process and impacts on others, (d) collaboratively working with diversity, (e) orientation to learning by making and testing, and (f) being confident and optimistic to use creativity. The data were analyzed using descriptive and inferential statistics, including means, standard deviations, paired-samples t-tests, and Wilcoxon signed-rank tests. The results indicate that two aspects, human-centeredness and being confident and optimistic to use creativity, were significant ( p  = 0.008 and p  = 0.043, respectively), with size effects of 0.43 and 0.34, respectively. Based on this potential, reverse engineering can be a design-based learning approach to facilitate students' design thinking. It is recommended that instructional activities involving reverse engineering maintain some degree of ambiguity and risk to prevent design fixation among students., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

Background and Objectives: Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy-based devices (EBD) for this condition are limited, with a short duration of follow-up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark-skinned patients., Study Design/materials and Methods: Nineteen subjects (aged 26-47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1-month after each treatment and at 1, 3, and 6 months after the final treatment., Results: The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1-month after the third treatment and continued until 3 months after the fourth (final) treatment (P < 0.001). However, the improvement dropped significantly at 6 months after the final treatment. Objective measurements of the improvements in skin surface smoothness and wrinkles corresponded with the physician raters' clinical evaluation., Conclusions: Erbium:YAG laser is a safe and effective treatment for enlarged pores in dark-skinned individuals. Maintenance treatments are recommended to achieve a longer-lasting outcome. Lasers Surg. Med. © 2020 Wiley Periodicals LLC., (© 2020 Wiley Periodicals LLC.)

Visualization and quantification of the skin microvasculature are important for studying the health of the human microcirculation. We correlated structural and pathophysiological changes of the dermal capillary-level microvasculature with age and blood pressure by using the reactive hyperemia optical coherence tomography angiography (RH-OCT-A) technique and evaluated both conventional OCT-A and the RH-OCT-A method as non-invasive imaging alternatives to histopathology. This observational pilot study acquired OCT-A and RH-OCT-A images of the dermal microvasculature of 13 young and 12 old healthy Caucasian female subjects. Two skin biopsies were collected per subject for histological analysis. The dermal microvasculature in OCT-A, RH-OCT-A, and histological images were automatically quantified and significant indications of vessel rarefaction in both old subjects and subjects with high blood pressure were observed by RH-OCT-A and histopathology. We showed that an increase in dermal microvasculature perfusion in response to reactive hyperemia was significantly lower in high blood pressure subjects compared to normal blood pressure subjects (117% vs. 229%). These results demonstrate that RH-OCT-A imaging holds functional information of the microvasculature with respect to physiological factors such as age and blood pressure that may help to monitor early disease progression and assess overall vascular health. Additionally, our results suggest that RH-OCT-A images may serve as a non-invasive alternative to histopathology for vascular analysis.

Intradermal injections of botulinum toxin type A (BTX-A) have been used successfully to treat patients with primary palmoplantar hyperhidrosis (PPH). However, problems with local injections of BTX-A for palmar hyperhidrosis include injection pain and reduced palmar muscle strength. This case series describes three patients with PPH. Patients were followed up for 3 months and assessed using the minor iodine starch test and the visual analog scale (VAS). Over two sessions within a 2-week interval, all patients received treatment on one palm, while the other palm served as the untreated control. Treated palms received fractional CO 2 laser therapy and immediate post-operative topical application of BTX-A solution for a total of 50 units. Sweat production was assessed based on the size of the sweat-producing area (measured by the minor iodine starch test) and subjective assessment of sweat production using the visual analog scale (VAS) at baseline, 2 weeks after the first treatment, and 1, 2, and 3 months after the second treatment. In the BTX-A-treated palm, the decrease in the mean sweat production was 51.6% at 2 weeks after the first treatment, and 88.5%, 67.8%, and 52.9%, at 1, 2, and 3 months after the final treatment when compared to the baseline. In the untreated palms, the decrease in the mean sweat production was 2% on all follow-ups when compared to the baseline. No adverse effect was observed in any patient. Fractional CO 2 laser is a safe technique for BTX-A delivery on the palm area and is demonstrated to be safe and effective in decreasing sweat secretion of hyperhidrosis palm.

Intradermal injection of botulinumtoxinA (BoNT/A) has been used off-label by many clinicians for the purpose of face-lifting effect. Some studies on AbobotulinumtoxinA (AboA) demonstrated clinical efficacy on face-lifting effect when comparing to normal saline solution (NSS). So far, there is no split-face comparison study on face-lifting effect of IncobotulinumtoxinA (IncoA). The objective of this study was to compare the face-lifting effect of IncoA intradermal injection and NSS. Twenty-two subjects were enrolled and randomly injected with IncoA at 1:6 cc dilution (100 unit or 1 vial in 6 cc of NSS) on one side, and NSS on the other side by using intradermal injection technique. Standardized photographic documentation with 2-, and 3-dimentional imaging system (Vectra H1, Canfield Scientific, Inc., Fairfield, NJ) were obtained at baseline, and at 2 weeks after treatment. The face-lifting effect was graded by the subjects and two blinded dermatologists, using photographic comparison. Side effects were also recorded at the end of the study. Immediate face-lifting was identified on the side that was treated with IncoA by blinded injectors in 63.6% of patients. Of all subjects, 17 (77.3%) have noticed the improvement of skin laxity on the side that was treated with IncoA at 2 weeks after treatment. The difference in facial contouring volume measured by Vectra H1 imaging system on IncoA side was significantly higher (P = .033) when comparing to NSS side in patients aged <36 years old. However, there was no statistically significant difference in face-lifting when comparing between IncoA and NSS evaluated by two blinded dermatologists (P = 1.00). Facial asymmetry was found in 36.4% of subjects. This study demonstrated the face-lifting effect of IncoA intradermal injection. Further studies with larger number of subjects and proper method of evaluation should be done to verify these findings., (© 2020 Wiley Periodicals LLC.)

Background: Olive leaf extract (OLE), a naturally extracted product from olive leaves, contains oleuropein and other bioactive phenolic compounds. Oleuropein was identified to have various medical properties. It was also found to inhibit the effects of both acute and chronic UVB-induced skin damage as well as accelerate wound healing activity., Aims: To evaluate the efficacy of olive leaf extract-containing cream on facial rejuvenation., Methods: This is a prospective pilot study with a total of 36 participants, who presented with photoaging skin. All participants applied the olive leaf extract-containing cream (SUPERHEAL™ O-Live Cream, PhytoCeuticals, Inc, USA) to their whole face twice daily for 2 months. Primary outcomes measured in the study were the changes in the biophysical properties of the skin assessed with the following parameters: melanin and erythema index, transepidermal water loss (TEWL), skin hydration, skin pH, sebum level, texture, and wrinkles., Results: After 2 months, TEWL decreased significantly (P = .007) and maintained the results 1 month after discontinuation of the treatment (P = .007). Skin hydration also increased significantly after 2 months (P = .004). Wrinkles improved significantly on all follow-ups (P < .001, P = .001, P = .001, respectively). An image of the skin captured using Visioscan® showed improvement of the skin texture 2 months after treatment. Majority of the participants (64%) noted improvement in their skin texture., Conclusion: Olive leaf extract-containing cream provided benefits on skin rejuvenation in human skin., (© 2020 Wiley Periodicals LLC.)

Background: Postacne erythema (PAE) is a common sequela of inflammatory acne vulgaris, treatment of which has been challenging due to limited options available and the variability of results for each modality. Recently, a 577-nm high-power optically pumped semiconductor laser (HOPSL) initially developed for vascular lesions has shown promising results for the treatment of PAE., Aims: To evaluate the efficacy and safety of 577-nm HOPSL in the treatment of postacne erythema., Methods: This was a split-face, randomized controlled trial pilot study. Twenty-one patients with PAE on both sides of their face were enrolled. Each subject's face sides were randomly assigned to either receive 577-nm HOPSL treatment (QuadroStar PRO™, Asclepion Laser Technologies) using the scanner handpiece, 1mm spot size, 80% coverage, 12-15 J/cm 2 , 30 ms, 2 passes for 3 sessions at 1-month intervals, or no treatment at all. Outcome measures such as overall improvement, the Erythema Index (EI), and Melanin Index (MI) from 3 different areas on both treatment and control sides were assessed at baseline, and 1-month follow-up after each treatment session. Side effects including pain, erythema, swelling, and crusting were also recorded., Results: Upon completion of the treatment period, the mean EI was significantly decreased in both treated and nontreated sides of the face (P < .001 and P = .001, respectively). The laser-treated sides already demonstrated significant reduction in the mean EI compared with nontreated sides at 1 month after the 2nd treatment (P = .007). The mean MI of both sides, however, did not show any statistically significant differences from baseline, and likewise when comparing between sides. Patients reported more improvement on laser-treated sides compared with nontreated sides. Reported side effects were limited to mild discomfort during treatment and transient facial erythema lasting approximately 30 minutes., Conclusion: Patients who received treatment with the 577-nm HOPSL had better outcomes with minimal side effects at 1 month after 2 treatments as compared to those who did not receive any treatment. Therefore, the 577-nm HOPSL may be considered as an effective adjuvant treatment for PAE and early erythematous atrophic scars., (© 2020 Wiley Periodicals LLC.)

Therapy with light-emitting diodes (LED) has been associated with the reduction of erythema and accelerated wound healing. LED phototherapy has been used in various clinical practices including post-laser wound healing enhancement. Fractional laser resurfacing is one of the popular dermatological procedures; however, the duration and degree of downtime may limit daily life activity and studies on the effect of LED low-level light therapy (LED-LLLT) on post-ablative laser wound care are still limited. To evaluate local and systemic effects of LED-LLLT on post-ablative laser erythema and wound healing acceleration after fractional ablative laser resurfacing. The study was divided into two arms. First, a prospective split-face randomized controlled and single-blinded study involved 17 patients (split-face group) to determine the local and systemic effect of LED-LLLT. Patients with acne scars or rhytides were treated with a single session of fractional CO 2 laser followed by 830/590 nm LED-LLLT on one side of their faces. The duration of post-laser erythema, the erythema index, and transepidermal water loss were collected at baseline, and compared with 7-daily follow-up visits posttreatment for the non LED- and LED-treated sides. The second controlled arm of the study was performed on an additional 19 subjects (CO 2 group). The patients received a single fractional CO 2 laser treatment without any LED-LLLT with the same follow-up protocol. All measurements were compared with the results from the patients from the split-face group. In the split-face group, the duration of erythema post laser was equal (7.4 ± 2.8 days). No significant reduction in the erythema index and transepidermal water loss was seen in the LED-treated vs the non-treated side (p values = 0.99 and 0.78 respectively). For the second part of the study that compared the results between the split-face group and the control CO 2 only group, the duration of the post-laser erythema was comparable (p value = 0.32). However, the percentage difference of the erythema index from baseline in the split-face group was significantly lower than the CO 2 group on days 1, 4, 5, and 7 post-laser treatment (p value = 0.03 on days 1, 4, 5, and 0.04 on day 7) and the LED-treated side provided the lowest percentage difference of the erythema index followed by the non LED-treated side compared with the control CO 2 only group. 830/590 nm LED-LLLT may provide both local and systemic effects on the degree of post-ablative laser erythema in human skin, however, appropriate protocol settings should be considered to achieve a significant clinical outcome.

Background: Epidermal growth factor (EGF) is one of the important peptides in wound healing process. The effects of EGF have been increasingly studied in various types of ulcers. However, data on postablative laser resurfacing wound is still limited., Objectives: To evaluate the effects of the topical EGF ointment on wound healing process and postinflammatory hyperpigmentation (PIH) prevention after fractional ablative laser resurfacing., Materials and Methods: This is a randomized split-face study. Nineteen healthy subjects were enrolled and completed follow up protocol. Patients received single treatment of fractional carbon dioxide laser on both cheeks. After randomization, each patient was assigned to apply one side of the face with topical EGF ointment and another side with petrolatum. Wound healing was evaluated by duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss on the daily follow up period of seven days after treatment. PIH was evaluated at 2, 3 weeks and 1, 2 months follow up by photographs and melanin index., Results: Most of patients were female with Fitzpatrick skin phototype III to V. Comparing with control (petrolatum), EGF treated side showed no significant difference in duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss (P-value = .58, .22, .78, and .51, respectively). Incidence of PIH was 52.6% on EGF side and 57.9% on petrolatum side, however, it was not statistically different (P = .56). The melanin index was also not different as well (P = .96)., Conclusion: Topical EGF might provide significant wound healing stimulation for chronic wound more than acute wound. Further studies, especially in post laser wound or other cosmetic purposes are needed., (© 2018 Wiley Periodicals, Inc.)

Background: The supratrochlear and supraorbital artery branches from the ophthalmic artery are the primary suppliers of blood to the forehead. Filler injection into the forehead without precise knowledge of its vascular topography poses a risk of severe complications., Methods: Twenty hemifaces from 11 cadavers were dissected., Results: Based on the presence of the deep branch of the supratrochlear artery, two main arterial distribution patterns of the forehead were observed. Type I (deep branch of the supratrochlear artery-present pattern) was classified into two subtypes: type Ia, in which the layer superficial to the frontalis was supplied medially by the superficial branch of the supratrochlear artery and laterally by the superficial branch of the supraorbital artery, and the deep branch of the supratrochlear artery and the deep branch of the supraorbital artery were distributed deep to the frontalis; and type Ib, in which the layer superficial to the frontalis was supplied by the superficial branch of the supratrochlear artery and the superficial branch of the supraorbital artery in addition to the central artery or the paracentral artery, and the layer deep to the frontalis was supplied the same with type Ia. For type II (deep branch of the supratrochlear artery-absent pattern), the layer superficial to the frontalis was supplied the same with type Ia; only the deep branch of the supraorbital artery supplied the layer deep to the frontalis., Conclusion: This study yielded novel arterial systems of the forehead and provided guidance for the safe forehead augmentation.

Botulinum toxin type A (BTX-A) is now extensively employed for cosmetic concerns. Upper face rejuvenation, including glabella frown lines and crow's feet lines, received FDA approval for cosmetic uses. However, other off-label uses for lower face conditions have been employed for texture and contouring purposes, including masseter hypertrophy and vertical banding of the neck. BTX-A for rejuvenation of the aging neck is an effective and popular treatment with high patient satisfaction rates. Alleviating the aging appearance of the neck by BTX-A is the result of denervation of hyperkinetic platysma. Concerning an extensive area of treatment and the relationship of treated muscles with other nearby muscles, dermatologists should be aware of potential adverse effects of the BTX-A injection. We herein present a case of dysphagia following botulinum toxin injection for the treatment of platysma bands., (© 2016 Wiley Periodicals, Inc.)

Topical anaesthetic cream (TAC) is commonly used as a pre-treatment of ablative fractional resurfacing (AFR) laser. Most of anaesthetic cream contains distilled water as major component. Therefore, pre-operative TAC may interfere the photothermal reaction in the skin treated with fractional carbon-dioxide (FCO 2 ) laser and fractional erbium-doped yttrium aluminium garnet (FEr:YAG) laser. The objective of the study was to compare the ablative width (AW) and coagulative depth (CD) of AFR laser with and without pre-treatment with TAC. Four Thai females who underwent abdominoplasty were included in the study. The excised skin of each subject was divided into four areas. TAC (eutectic mixture of local anaesthesia; EMLA) with 1-h occlusion was applied only on the first and second areas. The first and third areas were treated with FCO 2 at 15 mj and 5% density. The second and fourth areas were treated with FEr:YAG at 28 J/cm 2 and 5% density. Six biopsied specimens were obtained from each area. A total of 96 specimens (24 specimens from each area) were collected from four patients and examined randomly by two dermatopathologists. The ablative width and coagulative depth from each specimen were determined. In FCO 2 -treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 174.86 ± 24.57 and 188.52 ± 41.32 μm. The mean CD of the specimens that were pre-treated with TAC and control was 594.96 ± 111.72 and 520.03 ± 147.40 μm. There were no significant differences in AW and CD between both groups (p = 0.53 and p = 0.15). In FEr:YAG-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 381.11 ± 48.02 and 423.65 ± 60.16 μm. The mean CD of the specimens that were pre-treated with TAC and control was 86.03 ± 29.44 and 71.59 ± 18.99 μm. There were no significant differences in AW and CD between both groups (p = 0.16 and p = 0.24). The pre-treatment with TAC provided no statistically difference from the control group on AW and CD of both FCO 2 and FEr:YAG laser irradiation. However, there was a tendency to have narrower AW and deeper CD of the areas that were pre-treated with TAC when comparing to that of the control.

Background: Botulinum toxin type A (BTA) has been approved for the treatment of strabismus, blepharospasm, muscle spasm, cervical dystonia, pain syndrome, glabella wrinkles, and severe primary axillary hyperhidrosis. Intradermal injection of BTA has been used off-label by many clinicians for the purpose of face-lifting effect. Few studies on onabotulinumtoxinA (ONA) demonstrated no clinical efficacy on face-lifting effect when comparing to normal saline solution (NSS). So far, there is no split-face comparison study on face-lifting effect of abobotulinumtoxinA (ABO)., Objective: To determine the face-lifting effect of ABO intradermal injection and NSS., Methods: Twenty-two subjects with symmetrical faces on both facial expression and expressionless were randomly injected with ABO at 1:7 cc dilution (500 unit or one vial in 7 cc of NSS) on one side and NSS on the other side using intradermal injection technique. Standardized photographic documentation was obtained at baseline, and at 2 weeks after treatment. The face-lifting effect was graded by two blinded dermatologists using photographic comparison and rated by the patients. Side effects were also recorded at the end of the study., Results: Face-lifting effect was demonstrated in 40.9% and 4.5% of patients with ABO and NSS, respectively. There was a statistically significant difference in face-lifting effect when comparing between ABO and NSS (P = 0.021). The face-lifting was reported in 50.0% of patients receiving ABO injection. The patients with oval-face shape tended to respond better with ABO (P = 0.046). The odd of face-lifting effect for patients aged younger than 32 was higher than patients aged older than 32 with the odds ratio of 7.9 and 95% confidence interval of 1.1-56.1. Facial asymmetry was found in 22.7% of subjects., Conclusions: This study demonstrated the face-lifting effect of ABO intradermal injection. Patients with oval-face shape and aged younger than 32 tended to respond better. Therefore, patient selection should be emphasized to improve efficacy of this technique., (© 2016 The Authors. Journal of Cosmetic Dermatology Published by Wiley Periodicals, Inc.)

Bipolar fractional radiofrequency (FRF) device was firstly FDA-approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation. The average energy at 60 mJ/pin was widely used to treat atrophic acne scars. However, the higher energy was delivered, the deeper ablation and coagulation were found. At present, the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin. The objective of the study was to explore and compare the efficacy of utilizing high energy (100 mJ/pin) and moderate energy (60 mJ/pin) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians. This is a split-face, double-blinded, randomized control trial, pilot study by using parallel group design technique. Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled. All subjects received four monthly sessions of bipolar FRF treatment. Left and right facial sides of individual patients were randomly assigned for different energy (high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin). Acne scars improvement was blinded graded by dermatologist using global acne scarring score (GASS) which was subjectively evaluated at baseline, 1-, 3-, and 6-month follow-up. Objective scar analysis was also done using UVA-light video camera to measure scar volume, skin smoothness, and wrinkle at baseline, 3-, and 6-month follow-up after the last treatment. Side effects including pain, erythema, swelling, and crusting were also recorded. Thirty subjects completed the study with full 4-treatment course. The mean GASS of high energy side and moderate energy side was significantly reduced at 1-, 3-, and 6-month follow-up visits. At 1 month follow-visit, high energy side demonstrated significant improvement compared with moderate energy side (p = 0.03). Postinflammatory hyperpigmentation (PIH) developed in 21/120 sessions in high energy side (17.5 %) and 16/120 sessions in moderate energy side (13.3 %). Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy. Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians. High energy setting demonstrated significant higher efficacy at 1 month follow-visit. However, the efficacy of both energy settings was comparable at 3- and 6-month follow-up. In addition, side effects were significantly more intense on the side treated with high energy.