Comparison of efficacy of Micro needling with Platelet rich plasma versus Micro needling with Vitamin C for improvement in the appearance of Atrophic Facial Scars

INTERVENTION: topical local anesthetic (5% EMLA cream) is applied over scars 45 mins before procedure. Autologous PRP is prepared during this time interval ( of EMLA application) before starting microneedling, All the procedures will performed by primary researcher. Micro needling is done on each scarred skin in vertical, horizontal and both diagonal directions for 4 times (standard application) at a depth of 1.5mm, then PRP is injected at 0.1 ml/cm2 (approximate dose) in group A patients while vitamin C(500mg) 0.1 ml/cm2 is injected over the scarred areas in group B patients and micro needling is repeated again as above. PRP is made by taking 20ml of blood through venous puncture, first soft spin is at 1500 resolutions/min(RPM) for 10 minutes and then second hard spin is at 2500RPM for 10 minutes. from this 20ml we get 4.5ml of PRP Ice packs will be applied over treated areas in both groups and strict photo protective measures are advised during course of treatment for all the patients. Total of 3 sessions 4 weeks apart are done in all the cases. time duration of each session is one hour and thirty minutes primary researcher is post graduate resident in plastic surgery department of Jinnah burn and reconstructive surgery center. PRP is injected at 0.1 ml/cm2 in group A patients while vitamin C 0.1 ml/cm2 is injected over the scarred areas in group B patients both before and after microneedling.. strength of vitamin C injection used is 500mg a total of 4.5ml of prp is obtained from 20ml of blood. CONDITION: atrophic facial scars post acne atrophic facial scars post burn atrophic facial scars post infectious e.g., chicken pox post trauma atrophic facial scars PRIMARY OUTCOME: to compare the efficacy of microneedling with PRP vs microneedling with Vitamin C for improvement in scar quality and grade by Good Man and Baron Scale. (Goodman GJ, Baron JA. Postacne scarring: A qualitative global scarring grading system. Dermatol Surg 2006;32:1458‐66) ; Each patients were photographed and were assessed by a consultant Plastic Surgeon(who is blinded with the treatment modality used) SECONDARY OUTCOME: to compare the efficacy of microneedling with PRP vs microneedling with Vitamin C for improvement in pigmentation of scarred area wiil be assessed by a consultant plastic surgeon (who is blinded) using hyperpigmentation scale proposed by Wang et al (Wang LZ, Ding JP, Yang MY, Chen DW, Chen B. Treatment of facial post‐burn hyperpigmentation using micro‐plasma radiofrequency technology. Lasers Med Sci DOI 10.1007/s10103‐014‐1649‐6) INCLUSION CRITERIA: 1. Age above 10 years to 50 year/either sex 2. Goodman and baron II, III,IV scars. 3. Atrophic Scars more than 1 year 4. Post burn, trauma, surgery and acne atrophic scars over face