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Blunt Blade Subcision : An Evolution in the Treatment of Atrophic Acne Scars


Subcision is the mainstay of atrophic acne scar treatment but the efficacy and safety of the procedure is controversial.
Various instruments (such as Nokor and conventional needles, cataract blades,and wires) and techniques have been advocated but their effectiveness is indispute.

Moreover, subcision has lost overall popularity given the high risk of needlesticks for surgeons, moderate patient satisfaction,and the possibility of neuro-vascular injuries and also complications such as permanent discoloration.

Blunt Blade Subcision
this novel technique of subcutaneous undermining using a blunt subcision blade seems to be a safe and effective method for atrophic acne scar treatment. The technique is associated with a short recovery time and a low rate of serious complications.In addition, the technique’s simplicity and low cost could make it a suitable first step in the treatment of most cases of atrophic acne scars.
Paper Review: Eighteen patients with bilateral atrophic acne scars considered eligible for subcision were enrolled. Before subcision, a tumescent solution was injected subdermally to anesthetize the treatment area and aid the dissection of the dermal-subcutaneous tissue. Patients underwent treatment using the blunt subcision blade, a long metal blade with gradually narrowing edges, and a rounded blunt tip. Early postoperative complications, overall aesthetic improvement and persistent discoloration, or lumpiness were assessed 7 days after subcision and at a 6-month follow-up visit.
Moderate to marked improvement of atrophic scars was observed in 15 cases (83.3%). Mild to moderate tenderness, periorbital ecchymoses, and swelling were reported by some patients, but resolved completely within 1 week after the procedure. No cases of persistent discoloration or lumpiness were observed at the final visit.

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Chronic Migraine : Prevention and Treatment with Botulinum toxin type A (Botox) injection

How does botulinum toxin work in chronic migraine?
The simple answer is that we don’t know fully. A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system. The trigeminovascular system is a sensory pathway thought to play a key role in the headache phase of a migraine attack.Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles. Botulinum toxin has been shown to reduce pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain, and bladder pain.More research into the mechanism of action of botulinum toxin will hopefully shed light into all the pathways that it acts upon.
Is Botox® right for me?
  Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features. There are, however, other treatments available to patients with chronic migraine, and it is important that patients have an informed discussion of their headaches and the options for treatment with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox® is taken.

Who can inject Botox® for chronic migraine?
At present the use of Botox® is restricted to a few specialist headache centres, but as time goes on there should be increasing numbers of trained injectors available. In all cases, however, you should ensure that the person injecting has received appropriate training, both in the diagnosis and management of chronic migraine, and in the delivery of Botox® according to the proven PREEMPT schedule. Please note that the referral process differs for each location.  In the first instance, patients who are struggling to manage their symptoms should discuss this with their general practitioner (GP) and if appropriate, seek referral to a specialist with an interest in headache disorders.  Read more about seeking medical advice.On visiting a migraine clinic a detailed history of the patient’s condition will be taken, including symptoms, frequency of attacks and any medication tried in the past or currently taking.  Keeping a diary can help with this.
Availability of Botox® for treating chronic migraine on the NHS