Long‐term improvement in the appearance of hypertrophic scars following a single treatment with acoustic subcision—A single center proof‐of‐concept study

• Published in: Lasers in surgery and medicine Vol. 54; no. 10; pp. 1251 - 1260
• Main Authors: LaTowsky, Brenda, Robertson, David W., Capelli, Christopher C.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2022; John Wiley and Sons Inc
• Subjects: Acne Vulgaris; acoustic subcision; Acoustics; Anesthesia; Assessments; Biomechanics; Cicatrix - therapy; Cicatrix, Hypertrophic - etiology; Cicatrix, Hypertrophic - pathology; Clinical Reports; Clinical trials; Collagen; Erythema; Eutrophication; Extracellular matrix; Fibroblasts; Fibrosis; Humans; hypertrophic scar; improvement in appearance; Mechanical properties; noninvasive; Pain; rapid acoustic pulse; Scars; Statistical analysis; Treatment Outcome; Wound Healing; rapid acoustic pulse; fibrosis; noninvasive; acoustic subcision; hypertrophic scar; improvement in appearance
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.23596

Introduction and Objectives Fibrosis, including hypertrophic scar formation, is a pathological condition characterized by excessive production and accumulation of collagen, and loss of tissue architecture, in response to wound healing. Alterations in the extracellular matrix (ECM) biomechanical properties may be important in modulating myofibroblasts and fibrosis formation. The acoustic subcision device uses rapid acoustic pulse technology to noninvasively improve the appearance of hypertrophic scars through both microdisruption of scar tissue matrix and downregulation of fibrotic fibroblasts leading to scar remodeling. The objective of this single‐site proof‐of‐concept IRB‐approved human clinical study was to evaluate the efficacy of acoustic subcision device for the improvement in the appearance of hypertrophic scars. Method Eleven hypertrophic scars in 10 participants were treated with a single 6‐minute acoustic subcision application without anesthesia. Posttreatment adverse events (AEs) and tolerability were recorded. At 12 and 89 weeks posttreatment, scar heights and volumes were measured, and participant satisfaction questionnaires were completed. Finally, at the last visit the scar appearance was assessed by the Principal Investigator (PI) using the Mecott Modified Scar Scale (MMSS). Results Immediately following the acoustic subcision treatment, only mild, moderate erythema or pinpoint bleeding were noted. The treatment sessions were considered tolerable by all participants with an average pain score of 2.2 (on a 0–10 pain score with 10 being the worse possible pain). The 12‐ and 89‐week assessments demonstrated mean height reductions of 46.3% and 56.8%, respectively from baseline. The differences in scar height were statistically significant (p < 0.01). The 12‐ and 89‐week assessments demonstrated a mean volume reduction of 63.2% and 58.1% respectively from baseline. The differences in the scar volume were statistically significant (p < 0.001). The PI graded an average improvement of 33.7% in scar appearance using the MMSS, a statistically significant change (p < 0.001). Finally, >90% of participants reported satisfaction with the improvement in their scar. Conclusion This proof‐of‐concept study showed that a single noninvasive acoustic subcision treatment session can safely provide statistically significant improvement in the appearance of hypertrophic scars with minimal treatment pain and meaningful participant satisfaction. More work is needed on a larger number of scars to verify this finding. Further improvement in appearance is expected with multiple acoustic subcision treatments and/or treatments in combination with currently available options. Additional trials to verify this are planned.