human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Many methods have been proposed for the treatment of  acne scars  , with variable cosmetic results . Nonablative skin resurfacing is one method that has been proposed . Because of a need for more noticeable clinical improvements , the ablative fractional laser was recently introduced . OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers . METHODS A series of 20 patients ( skin phototypes IV – V ) with atrophic facial acne scars were r and omly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high ( group A ) and low ( group B ) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half . Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively . Clinical assessment scores were determined at each treatment session and follow‐up visit . RESULTS Although the use of the ablative fractional laser with high energy result ed in an improvement in patients ' acne scars , the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results , as assessed in photographs as well as by the overall appearance of the acne scars . With the combination method , fewer complications were observed . The authors have indicated no significant interest with commercial supporters Bipolar fractional radiofrequency ( FRF ) device was firstly FDA -approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation . The average energy at 60 mJ/pin was widely used to treat atrophic acne scars . However , the higher energy was delivered , the deeper ablation and coagulation were found . At present , the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin . The objective of the study was to explore and compare the efficacy of utilizing high energy ( 100 mJ/pin ) and moderate energy ( 60 mJ/pin ) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians . This is a split-face , double-blinded , r and omized control trial , pilot study by using parallel group design technique . Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled . All subjects received four monthly sessions of bipolar FRF treatment . Left and right facial sides of individual patients were r and omly assigned for different energy ( high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin ) . Acne scars improvement was blinded grade d by dermatologist using global acne scarring score ( GASS ) which was subjectively evaluated at baseline , 1- , 3- , and 6-month follow-up . Objective scar analysis was also done using UVA-light video camera to measure scar volume , skin smoothness , and wrinkle at baseline , 3- , and 6-month follow-up after the last treatment . Side effects including pain , erythema , swelling , and crusting were also recorded . Thirty subjects completed the study with full 4-treatment course . The mean GASS of high energy side and moderate energy side was significantly reduced at 1- , 3- , and 6-month follow-up visits . At 1 month follow-visit , high energy side demonstrated significant improvement compared with moderate energy side ( p = 0.03 ) . Postinflammatory hyperpigmentation ( PIH ) developed in 21/120 sessions in high energy side ( 17.5 % ) and 16/120 sessions in moderate energy side ( 13.3 % ) . Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy . Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians .  High energy setting demonstrated significant higher efficacy at 1 month follow-visit . However , the efficacy of both energy setting s was comparable at 3- and 6-month follow-up . In addition , side effects were significantly more intense on the side treated with high energy BACKGROUND The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies . Recently , microneedling treatment has been showing promising results with lower costs , quick healing time , and low risk of postinflammatory hyperpigmentation ( PIH ) . OBJECTIVE To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars . METHODS Forty-six patients with atrophic facial acne scars were r and omized to microneedling and laser groups , receiving 3 sessions performed monthly . Two blinded dermatologists applied the vali date d “ Quantitative Global Grading System for Postacne Scarring ” scale , before , 2 months , and 6 months after the treatment . Side effects were recorded at each follow-up visit and patient 's satisfaction was evaluated . RESULTS Both groups showed a significant improvement , and there was no statistically significant difference between results of both therapies ( p = .264 ) . The erythema after each session was longer in the laser group and 13.6 % subjects experienced PIH . No PIH was observed in the microneedling group . CONCLUSION This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars . Microneedling is well tolerated , with fewer side effects and lower down time BACKGROUND Current treatments for acne scars and enlarged facial pores have shown limited efficacy . OBJECTIVE To evaluate the efficacy and safety of the fractional photothermolysis system ( FPS ) with dynamic operating mode on acne scars and enlarged pores . MATERIAL S AND METHODS Twelve patients with mild to moderate atrophic acne scars and enlarged pores were included in this study . Three sessions of FPS treatment were performed for acne scars and facial pores monthly . Two blinded dermatologists who compared before and after photos based on a quartile grading scale conducted objective clinical assessment s of acne scar– and facial pore – treated areas . We took a biopsy immediately after one treatment with the laser from one of the authors to assess the histologic effects of the laser on facial pores . RESULTS Follow-up results at 4 months after the last treatment revealed that , of the 12 patients , for acne scars , five demonstrated clinical improvements of 51 % to 75 % and three demonstrated improvements of 76 % to 100 % , and for facial pores , five demonstrated moderate clinical improvements of 26 % to 50 % and three demonstrated improvements of 76 % to 100 % . Side effects , including pain , post-treatment erythema , and edema , were resolved within 1 week . CONCLUSION We suggest that the FPS may provide a new treatment algorithm in some cases with acne scars and enlarged pores . Considering the lack of placebo-controlled , split-face design of our study , optimized , prospect i ve studies should be conducted to fully assess the efficacy of FPS with dynamic operating mode BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications , especially in patients with darker skin . OBJECTIVE To compare the efficacy and safety of a long‐pulse neodymium‐doped yttrium aluminium garnet ( Nd : YAG ) laser and a combined 585/1,064‐nm laser for the treatment of acne scars . MATERIAL S AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long‐pulse Nd : YAG laser or combined 585/1,064‐nm laser treatment sessions at fortnightly intervals . Treatments were administered r and omly in a split‐face manner . RESULTS Acne scars showed mild to moderate improvement , with significant Echelle d'évaluation clinique des cicatrices d'acné ( ECCA ) score reductions , after both treatments . Although intermodality differences were not significant , combined 585/1,064‐nm laser was more effective for deep boxcar scars . In patients with combined 585/1,064‐nm laser‐treated sides that improved more than long‐pulse Nd : YAG laser‐treated sides , ECCA scores were significantly lower for combined 585/1,064‐nm laser treatment . Histologic evaluations revealed significantly greater collagen deposition , although there was no significant difference between the two modalities . Patient satisfaction scores concurred with physicians ' evaluations . CONCLUSION Both lasers ameliorated acne scarring with minimal downtime . In light of this finding , optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response . The authors have indicated no significant interest with commercial supporters Fractional photothermolysis has been shown to improve various types of scarring , including atrophic  acne scars . The aim of the present authors was to assess the efficacy and safety of the nonablative fractional photothermolysis in the treatment of moderate and severe acne scars . Eighty-seven patients with moderate or severe acne scarring were treated with six sessions with a 1540-nm Erbium glass fiber laser at 3-week intervals . Six months after the final session , 7/87 ( 8 % ) patients showed a moderate improvement , whereas 80/87 ( 92 % ) patients had a marked improvement . In a subset of patients , the present authors also applied in vivo reflectance confocal microscopy to highlight the relevant microscopic changes . Hence , early and late posttreatment findings , most importantly the replacement of a coarser collagen with a new one , similar to the collagen seen in healthy skin , were observed . In accordance to previous studies , the present authors conclude that nonablative fractional photothermolysis is a safe and effective treatment for moderate or severe acne scarring BACKGROUND AND OBJECTIVES Acne scarring is a common and difficult to treat condition . The plasma skin regeneration ( PSR ) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis . PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions . In this study , we investigated the safety and efficacy of single-treatment , high-energy , double-pass PSR for the treatment of acne scarring . STUDY DESIGN / MATERIAL S AND METHODS Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study . All patients underwent a single PSR treatment with two high-energy passes ( 3.5 - 4.0 J ) . Treatments were performed in an outpatient clinic setting . Nine patients completed 6 months of follow-up . Improvement was determined by patient question naires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment . RESULTS On average , patients reported 34 % improvement in their acne scarring at 3 months and 33 % improvement at 6 months . Blinded physician ratings of patient photos demonstrated 19 % improvement at 3 months and 34 % at 6 months . Re-epithelialization was complete by 4 - 6 days after treatment , and no serious adverse events were encountered . CONCLUSION PSR appears to provide a safe and effective single treatment , minimal downtime alternative for the treatment of acne scarring . Additional studies are warranted to further demonstrate the safety and efficacy of this device Fractional microneedling radiofrequency ( FMR ) is one of the promising methods in acne treatment . Moreover , bipolar radiofrequency ( BR ) generates heat thereby which induces neocollagenosis . FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar . This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment . Furthermore , mechanism of the FMR treatment was investigated through skin tissues obtained from subjects . Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR . Two sessions of treatment was done 4 weeks apart in a total 12-week prospect i ve single-blind , r and omized clinical trial . Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety . Skin tissues were acquired for investigation of molecular changes . FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR . Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks , respectively . FMR treatment result ed in significant reduction of sebum excretion . Both treatments showed no severe adverse effects other than erythema . The FMR showed superior efficacy in acne and acne scar compared with BR . Increased expression of TGFβ and collagen I and decreased expression of NF-κB , IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR Background : Despite the many advances , scarring , particularly acne or pimple scarring , does not have a satisfactory treatment . A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology , which utilizes radiofrequency emission in the treatment of acne scars . Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes . Setting s and Design : A prospect i ve study of 30 r and omly selected patients with acne scars was carried out . Material and Methods : Thirty healthy patients with different types of acne scars – ice pick , box and rolling type – were r and omly selected . The scars were either shallow or deep , varied in size from 2 to 20 mm and ranged in number from 10 to 50 . These 
    Output:
    
agent
Discussion : Ablative lasers seem to achieve the highest degree of efficacy , albeit this is associated with significant pain and downtime , and the risk for long-term pigmentary changes .
Non-ablative fractional photothermolysis ( FP ) has a much safer profile but can not achieve as good cosmetic results .
The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile .
Conclusion : Multiple devices have been used with varying levels of efficacy and very different safety profiles .
There is an overall lack of high- quality evidence about the effects of different interventions .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Many methods have been proposed for the treatment of  acne scars  , with variable cosmetic results . Nonablative skin resurfacing is one method that has been proposed . Because of a need for more noticeable clinical improvements , the ablative fractional laser was recently introduced . OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers . METHODS A series of 20 patients ( skin phototypes IV – V ) with atrophic facial acne scars were r and omly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high ( group A ) and low ( group B ) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half . Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively . Clinical assessment scores were determined at each treatment session and follow‐up visit . RESULTS Although the use of the ablative fractional laser with high energy result ed in an improvement in patients ' acne scars , the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results , as assessed in photographs as well as by the overall appearance of the acne scars . With the combination method , fewer complications were observed . The authors have indicated no significant interest with commercial supporters Bipolar fractional radiofrequency ( FRF ) device was firstly FDA -approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation . The average energy at 60 mJ/pin was widely used to treat atrophic acne scars . However , the higher energy was delivered , the deeper ablation and coagulation were found . At present , the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin . The objective of the study was to explore and compare the efficacy of utilizing high energy ( 100 mJ/pin ) and moderate energy ( 60 mJ/pin ) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians . This is a split-face , double-blinded , r and omized control trial , pilot study by using parallel group design technique . Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled . All subjects received four monthly sessions of bipolar FRF treatment . Left and right facial sides of individual patients were r and omly assigned for different energy ( high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin ) . Acne scars improvement was blinded grade d by dermatologist using global acne scarring score ( GASS ) which was subjectively evaluated at baseline , 1- , 3- , and 6-month follow-up . Objective scar analysis was also done using UVA-light video camera to measure scar volume , skin smoothness , and wrinkle at baseline , 3- , and 6-month follow-up after the last treatment . Side effects including pain , erythema , swelling , and crusting were also recorded . Thirty subjects completed the study with full 4-treatment course . The mean GASS of high energy side and moderate energy side was significantly reduced at 1- , 3- , and 6-month follow-up visits . At 1 month follow-visit , high energy side demonstrated significant improvement compared with moderate energy side ( p = 0.03 ) . Postinflammatory hyperpigmentation ( PIH ) developed in 21/120 sessions in high energy side ( 17.5 % ) and 16/120 sessions in moderate energy side ( 13.3 % ) . Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy . Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians .  High energy setting demonstrated significant higher efficacy at 1 month follow-visit . However , the efficacy of both energy setting s was comparable at 3- and 6-month follow-up . In addition , side effects were significantly more intense on the side treated with high energy BACKGROUND The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies . Recently , microneedling treatment has been showing promising results with lower costs , quick healing time , and low risk of postinflammatory hyperpigmentation ( PIH ) . OBJECTIVE To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars . METHODS Forty-six patients with atrophic facial acne scars were r and omized to microneedling and laser groups , receiving 3 sessions performed monthly . Two blinded dermatologists applied the vali date d “ Quantitative Global Grading System for Postacne Scarring ” scale , before , 2 months , and 6 months after the treatment . Side effects were recorded at each follow-up visit and patient 's satisfaction was evaluated . RESULTS Both groups showed a significant improvement , and there was no statistically significant difference between results of both therapies ( p = .264 ) . The erythema after each session was longer in the laser group and 13.6 % subjects experienced PIH . No PIH was observed in the microneedling group . CONCLUSION This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars . Microneedling is well tolerated , with fewer side effects and lower down time BACKGROUND Current treatments for acne scars and enlarged facial pores have shown limited efficacy . OBJECTIVE To evaluate the efficacy and safety of the fractional photothermolysis system ( FPS ) with dynamic operating mode on acne scars and enlarged pores . MATERIAL S AND METHODS Twelve patients with mild to moderate atrophic acne scars and enlarged pores were included in this study . Three sessions of FPS treatment were performed for acne scars and facial pores monthly . Two blinded dermatologists who compared before and after photos based on a quartile grading scale conducted objective clinical assessment s of acne scar– and facial pore – treated areas . We took a biopsy immediately after one treatment with the laser from one of the authors to assess the histologic effects of the laser on facial pores . RESULTS Follow-up results at 4 months after the last treatment revealed that , of the 12 patients , for acne scars , five demonstrated clinical improvements of 51 % to 75 % and three demonstrated improvements of 76 % to 100 % , and for facial pores , five demonstrated moderate clinical improvements of 26 % to 50 % and three demonstrated improvements of 76 % to 100 % . Side effects , including pain , post-treatment erythema , and edema , were resolved within 1 week . CONCLUSION We suggest that the FPS may provide a new treatment algorithm in some cases with acne scars and enlarged pores . Considering the lack of placebo-controlled , split-face design of our study , optimized , prospect i ve studies should be conducted to fully assess the efficacy of FPS with dynamic operating mode BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications , especially in patients with darker skin . OBJECTIVE To compare the efficacy and safety of a long‐pulse neodymium‐doped yttrium aluminium garnet ( Nd : YAG ) laser and a combined 585/1,064‐nm laser for the treatment of acne scars . MATERIAL S AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long‐pulse Nd : YAG laser or combined 585/1,064‐nm laser treatment sessions at fortnightly intervals . Treatments were administered r and omly in a split‐face manner . RESULTS Acne scars showed mild to moderate improvement , with significant Echelle d'évaluation clinique des cicatrices d'acné ( ECCA ) score reductions , after both treatments . Although intermodality differences were not significant , combined 585/1,064‐nm laser was more effective for deep boxcar scars . In patients with combined 585/1,064‐nm laser‐treated sides that improved more than long‐pulse Nd : YAG laser‐treated sides , ECCA scores were significantly lower for combined 585/1,064‐nm laser treatment . Histologic evaluations revealed significantly greater collagen deposition , although there was no significant difference between the two modalities . Patient satisfaction scores concurred with physicians ' evaluations . CONCLUSION Both lasers ameliorated acne scarring with minimal downtime . In light of this finding , optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response . The authors have indicated no significant interest with commercial supporters Fractional photothermolysis has been shown to improve various types of scarring , including atrophic  acne scars . The aim of the present authors was to assess the efficacy and safety of the nonablative fractional photothermolysis in the treatment of moderate and severe acne scars . Eighty-seven patients with moderate or severe acne scarring were treated with six sessions with a 1540-nm Erbium glass fiber laser at 3-week intervals . Six months after the final session , 7/87 ( 8 % ) patients showed a moderate improvement , whereas 80/87 ( 92 % ) patients had a marked improvement . In a subset of patients , the present authors also applied in vivo reflectance confocal microscopy to highlight the relevant microscopic changes . Hence , early and late posttreatment findings , most importantly the replacement of a coarser collagen with a new one , similar to the collagen seen in healthy skin , were observed . In accordance to previous studies , the present authors conclude that nonablative fractional photothermolysis is a safe and effective treatment for moderate or severe acne scarring BACKGROUND AND OBJECTIVES Acne scarring is a common and difficult to treat condition . The plasma skin regeneration ( PSR ) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis . PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions . In this study , we investigated the safety and efficacy of single-treatment , high-energy , double-pass PSR for the treatment of acne scarring . STUDY DESIGN / MATERIAL S AND METHODS Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study . All patients underwent a single PSR treatment with two high-energy passes ( 3.5 - 4.0 J ) . Treatments were performed in an outpatient clinic setting . Nine patients completed 6 months of follow-up . Improvement was determined by patient question naires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment . RESULTS On average , patients reported 34 % improvement in their acne scarring at 3 months and 33 % improvement at 6 months . Blinded physician ratings of patient photos demonstrated 19 % improvement at 3 months and 34 % at 6 months . Re-epithelialization was complete by 4 - 6 days after treatment , and no serious adverse events were encountered . CONCLUSION PSR appears to provide a safe and effective single treatment , minimal downtime alternative for the treatment of acne scarring . Additional studies are warranted to further demonstrate the safety and efficacy of this device Fractional microneedling radiofrequency ( FMR ) is one of the promising methods in acne treatment . Moreover , bipolar radiofrequency ( BR ) generates heat thereby which induces neocollagenosis . FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar . This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment . Furthermore , mechanism of the FMR treatment was investigated through skin tissues obtained from subjects . Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR . Two sessions of treatment was done 4 weeks apart in a total 12-week prospect i ve single-blind , r and omized clinical trial . Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety . Skin tissues were acquired for investigation of molecular changes . FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR . Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks , respectively . FMR treatment result ed in significant reduction of sebum excretion . Both treatments showed no severe adverse effects other than erythema . The FMR showed superior efficacy in acne and acne scar compared with BR . Increased expression of TGFβ and collagen I and decreased expression of NF-κB , IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR Background : Despite the many advances , scarring , particularly acne or pimple scarring , does not have a satisfactory treatment . A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology , which utilizes radiofrequency emission in the treatment of acne scars . Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes . Setting s and Design : A prospect i ve study of 30 r and omly selected patients with acne scars was carried out . Material and Methods : Thirty healthy patients with different types of acne scars – ice pick , box and rolling type – were r and omly selected . The scars were either shallow or deep , varied in size from 2 to 20 mm and ranged in number from 10 to 50 . These 
    Output:
    