Resurfacing techniques are, in some respect, all the same. They injure the dermis, causing collagen formation when the dermis repairs, and leveling off of scars by microtightening and reduction in topographic irregularities such as the edges of acne scars. Of course this is a slight oversimplification, and minor differences exist between the techniques. The degree of control and precision is higher with lasers, lower with peels and dermabrasion. Lasers have an additional effect of heating the tissue, increasing the formation of collagen over peeling techniques. There may be some theoretic benefit in repeat very light resurfacing over time as well.
All resurfacing techniques also all have inherent drawbacks. The deeper the TCA peel / CO2 / factionated laser / dermabrasion treatments, the higher the chance for whiteness, scarring, atrophic "shiny" appearance of the skin, hyperpigmentation complications etc. Period. There is no magic bullet.
Since there is a limit in what resurfacing can accomplish, doctors and patients must be realistic in their goals. You simply cannot turn the laser high enough to eradicate most severe acne scarring. Doing so would cause a third degree burn with severe scarring, along with all the other undesirable changes mentioned above.
In some acne patients, tightening of the skin via facelifts helps immensely, in combination with resurfacing. Some patients with pitted acne scarring or "ice pick" marks can benefit from direct removal of the scars and closure, obviously not performed at the same setting as resurfacing or facelifting.
