Abstract
Background
Atrophic acne scars result from impaired dermal repair following inflammation of the pilosebaceous unit, leading to collagen degradation, dermal atrophy, and tethering by fibrotic strands. Conventional subcision mechanically releases these adhesions but provides limited biologic stimulation for dermal remodeling. Carbon dioxide (CO₂) gas subcision has emerged as a hybrid mechanical-biologic modality that integrates fibrotic release with CO₂ -induced vasodilation, microcirculatory enhancement, and fibroblast activation.Objective
To describe the clinical use and short-term outcomes of CO₂ gas subcision for atrophic acne scars and explore its potential as a minimally invasive hybrid treatment.Methods
CO₂ device (Trifill Pro, South Korea) and PDLLA (Juvelook, VAIM Inc., South Korea) was used in the study. A temperature-regulated medical-grade CO₂ system delivered controlled intradermal gas through a 30-gauge needle. Short CO₂ bursts were administered into the deep dermal or upper subcutaneous plane to detach fibrotic bands while inducing hypercapnia-associated biologic responses. Five patients with atrophic acne scars underwent a single session. Follow-up at weeks 2 and 4 included standardized photography, clinical assessment of scar depth and contour, and patient-reported satisfaction using a 0-10 Visual Analogue Scale (VAS).Results
Five patients completed follow-up at 4 weeks. All patients demonstrated qualitative improvement in scar depth and contour on clinical assessment. Mean patient satisfaction score (VAS) was high (range 7-9). No serious adverse events were observed. Mild transient erythema and edema resolved spontaneously within hours. Due to the small sample size and short follow-up, results are descriptive rather than statistically powered.Conclusions
CO₂ gas subcision appears to be a feasible and well-tolerated minimally invasive technique combining mechanical fibrotic release with biologic stimulation. This pilot case series suggests short-term improvement in atrophic acne scars; however, larger controlled studies with longer follow-up are required to confirm efficacy and durability.Evidence level
VBlinded manuscript without author contact information.