الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Scarring is a common side effect of acne vulgaris. Depending on whether there is a loss or growth of collagen, there are two fundamental types of post acne scars (atrophic and hypertrophic scars). Atrophic acne scars are more common than keloids and hypertrophic scars. They are divided into three categories: icepick, boxcar, and rolling scars. Severe acne scarring is linked to significant physical and psychological suffering. Several methods have been used for atrophic post acne scarring treatment. Chemical peels, laser therapy, RF, subcision, carboxytherapy and microneedling are current treatment options and all have some efficacy in the treatment of atrophic acne scars. Results can vary based on the type of scarring and the treatment modality used. Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It aims to break the fibrotic strands, which tether the scar to the underlying subcutaneous tissue. The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms during the course of normal wound healing. It can easily be combined with other treatments for maximum efficacy. Blunt blade subcision is done by blunt blade cannula with a blunt head and thin wall. It can undermine the depressed scars with lower risk of neurological and vascular damage, and needle stick injuries to the surgeon. Carboxytherapy, refers to cutaneous and subcutaneous administration of CO2 gas. The effect of carboxytherapy on the skin is combined mechanical and biological as CO2 gas accumulates in the tissues and induces dilatation of capillaries which results in increased blood flow to the tissues. Also CO2 gas injection beneath the scars by needle with high pressure can cause fibrotic tissue breakage, producing the effects of subcision The aim of this study Was to compare the efficacy and safety of subcision using carboxytherapy versus blunt blade cannula subcision in treatment of atrophic acne scars This study included 20 patients with bilateral facial atrophic acne scars. Digital photos were taken before study initiation and 3 months after the end of treatment. All patients treated with carboxytherapy (2 sessions, 1 month apart) and subcision using a blunt blade cannula (1 session) on the right & left sides of the face respectively. Patients were evaluated clinically according to the Goodman’s qualitative global scarring grading system before and 3 months after treatment. Clinical assessment of patient improvement by quartile grading scale and patient satisfaction after 3 months of the end of treatment were recorded. The clinical results: Regarding the qualitative grading of post acne scars, there was a statistically significant difference (p1 < 0.001) after 3 months of treatment in comparison with baseline on both sides of the face. Meanwhile, the difference between the two sides of the face was statistically insignificant both at baseline and at follow up (3 months after the end of treatment) (p value = 1.000 & 0.219 respectively). Regarding the degree of improvement after treatment according to physician opinion (by quartile grading scale) on the two sides of the face ; there was no statistically significant difference between the two sides of the face (p= 0.222). There was no statistically significant difference between the two sides of the face regarding patients’ satisfaction after 3months of the end of treatment (p= 1.000). The procedure was well-tolerated by most patients. The side effects in our study were minimal to negligible, with pain during sessions and transient edema that developed immediately after session and resolved within hours were the most reported complaints. There were no complications during follow up period.