case report
1440 nm Affirm™ Treatment of
Acne Scarring
Mitchel P. Goldman, MD
La Jolla Spa MD
A 33 year old Hispanic female patient with acne scarring on the BEFORE AFTER
cheeks was exhibiting scattered, yet mild papulopustular acne Patient with skin type IV before (left) and after five Affirm Tx (right)
vulgaris with inflammation, which began 3-4 years previously with
intermittent outbreaks of cysts.
The treating physician, blinded physician and patient all noted
Additionally, post-inflammatory hyperpigmentation and a significant improvement (80%) in superficial scarring with softening
varying degrees of surface defects in contour and volume of deeper scars. The patient feels and notices a softer and
was evident on the cheeks. The acne scars were scattered, smoother skin texture and the intensity of her acne outbreaks have
soft, and less than 3 mm in diameter with a few scattered lessened, leaving her very happy with the results and is
superficial soft “ice-pick” scars less than 2 mm in diameter. recommending this treatment to friends and family.
The patient was taking Minocycline 100 mg a day one week
prior to menses for the last six months. She was treated three
times with amino levulonic acid activated after one hour with
15 minutes of Blu-U light (405-420nm wavelength) over the last
two years and noted a significant decrease in oil secretions.
Her skincare routine is La Roche Posay Purifying Cleanser BID,
Cool Clenz Acne Pads (2% salicylic acid) QHS, Spa MD Sheer
Moisture QD, Spa MD oil-free sunscreen QD and DYG mineral
make-up.
Her acne scarring was treated using the 1440 nm Nd:YAG
laser with Combined Apex PulseSM (CAP) technology
(Affirm™, Cynosure) five times at three week intervals with
the following parameters resulting in the subsequent responses:
1 pass 2.0 J/cm² - No skin/sensation changes
1 pass 2.3 J/cm² - Slight warmth/tingling sensation, no erythema
1 pass 2.5 J/cm² - Mild warmth/tingling sensation, faint diffuse
erythema along cheek bones/ lateral
forehead lasting less than ½ day
1 pass 3.0 J/cm² - Moderate warmth, at this point patient noted
circular erythema bilateral cheeks/lateral
forehead/chin for less than 24 hours consistent
with beam size
2 passes 2.0 J/cm² - Mild-moderate warmth/tingling sensation,
mild diffuse redness bilateral cheeks/forehead
less than 12 hours