Laser
If the question was what is the best laser for treatment of acne scarring? The answer would unequivocably be the CO2 laser. The reason for this is that the best results are typically obtained with the depth of injury and the extent of and depth of the thermal injury of the treatment.
CO2 laser creates a great degree of collateral thermal damage and consequently produces the most dramatic results when it comes to correcting acne scarring and/or effacement of lines and wrinkles. The problems with CO2 laser treatment are extended downtime, prolonged erythema (redness), and eventual loss of pigmentation that invariably occurs with this modality.
This leads to the next topic, a more old fashioned, but tried and true treatment for acne scarring and scar revision.
Dermabrasion
Dermbrasion (as opposed to microdermabrasion) is an older modality which uses a rotating diamond tipped fraise (wheel) to remove the epidermis and portion of the dermis. The extent of the injury to be corrected is determined by the depth of injury created, which is gauged by the Surgeon's eye and experience. A depth of injury comparable to CO2 laser treatment is feasible with Dermabrasion. However, several factors make Physicians less comfortable with Dermabrasion than they perhaps should be:
- It is a very technically dependent treatment,
- Wide availability of a variety of lasers which produce a fairly uniform depth of injury based on the individual laser and the laser settings.
The aesthetic problem with acne scarring is caused by topographical irregularities, catching shadow and light. The benefit of Dermabrasion is that scars can be selectively planed down to be less noticable. The benefit Dermabrasion carries over CO2 laser is less thermal injury, far less chance of hypopigmentation (loss of pigmentation), and a much smaller window of erythema (redness of the face).
Due to its benefits, I incorporate Dermabrasion regularly into my practice for purposes of acne scarring and scar revision.
