Acne and Rosacea Charity Training Manual
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Fraxel Laser<br />
The Fraxel laser is effectively a CO 2 laser where the laser beam has been fractionated into multiple beamlets. The energy can be adjusted to allow different<br />
depths of the skin to be treated. The basic principle is the same as the Automated needling devices but uses laser rather than needles to injure the skin<br />
<strong>and</strong> induce a healing response with new collagen induction. The treatment is painful <strong>and</strong> downtime can be up to 1 week<br />
Trichloracetic Acid (TCA) Chemical Reconstruction of Scarred Skin (CROSS).<br />
This technique was developed in Korea <strong>and</strong> is particularly useful for small box scars. Up to 100% TCA is used<br />
<strong>and</strong> carefully applied to the base of the scar using a sharpened orange stick. As soon as frosting occurs, wash off<br />
with normal saline. The TCA causes a very local injury which induces new collagen production <strong>and</strong> allows the<br />
scar to fill <strong>and</strong> obliterate the sharp edges. After treatment, frosting lasts for about 30 minutes <strong>and</strong> is followed by<br />
the development of a soft scab which falls off after a few days. Treatment should be repeated every 6-12 weeks.<br />
Combining this with needling facilitates good results<br />
Frosting following TCA-CROSS<br />
Subcision<br />
Subcision is a very powerful technique that is needed when scars are tethered to deeper structures or in deeper rolling scars where the injury from the<br />
subcision gives good filling of the scar.<br />
Subcision can be performed as an isolated procedure or following automated needling devices treatment.<br />
The scar is marked with a surgical marker <strong>and</strong> the area infiltrated with lignocaine – if the scars are not<br />
marked before infiltration the local anesthetic will fill the area <strong>and</strong> it may not be possible to see where the<br />
scar is. Subcision is performed with a 19 gauge NorKor needle which has a cutting blade on the end. This is<br />
inserted into the mid-dermis <strong>and</strong> pushed back <strong>and</strong> forth across the scarred area. The needle is then swept<br />
crosswise in a fanning technique with the cutting blade at the advancing edge. Heavy pressure is the applied<br />
to the area to prevent hematoma formation. If hematomas form, they can give a palpable or even visible<br />
lump in the skin that can persist for several weeks.<br />
NorKor Needle
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