I am looking for a way to get rid of acne scars. Heard good things about some laser skin treatments but i don't know how to choose between them all because there are so many laser treatments that are said to work on lots of problems, but i really just want to know which one works the best on acne scars.
Laser Treatment for Acne Scars
Doctor Answers 22
CO2 laser is the best for acne scars
I believe that the CO2 laser will give the best results for scars of the face. The best of these is the Fraxel re:pair Laser. This uses fractional technology, which has eliminated the risks of further scarring or hypopigmentation.
Nothing is going to remove all the scars, but with one or two treatments with the Fraxel re:pair, it should be significantly better.
Laser or Dermabrasion?
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.
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.
Choice is less complicated with an experienced provider
The reason there are so many options for acne scar correction, is because there are different types of acne scars and there are relative strengths and weaknesses to all modalities to correct or improve acne scars. It is therefore very important to seek the advice of a board certified dermatologist with experience in all modalities in order to pick the one best for you.
- Mild scars? Perhaps just SilkPeel or a series of peels is necessary.
- Can't afford downtime? Cooltouch might be perfect.
- Deeper scars? Fraxel Re:Store has been a true breakthrough, but does have 1-3 days of swelling that you must be prepared to experience.
- Active acne? Isolaz may be for you.
- Finally, severe scars may benefit from true resurfacing either with traditional dermabrasion, or a fractional CO2 laser device like Juvia or Fraxel Re:Pair. These procedures have at least one week of social downtime, but give the most dramatic result.
Please get the advice from someone familiar with the options and prepared to provide the one best for you.
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Best laser for acne scars
The only way to know for sure what the best treatment for you will be is to see a physician in person who treats acne scars routinely. I highly recommend getting more than one opinion so you can compare the approaches. If two or three plastic surgeons or dermatologists tell you the same thing, then you can be more confident that it's the best treatment for you.
Laser and Other Treatments for Acne Scars
Fractional CO2 Laser vs other treatments for Acne Scarring
As severe acne scars, isolated or generalized, involve a deep scar process that extends to the deep dermis and sometimes even deeper it would be unusual to see dramatic differences after a single Fractional CO2 laser treatment. Realistic expectations are important and one should expect improvment but not total correction with each treatment. In my own experience I have not found a significant difference in results between a Fractional CO2 treatment and the Obagi Blue Peel. Dermabrasion and Ablative lasers including confluent CO2 lasers are more helpful but have the significant increased risk of permanent hypopigmentation and post inflammatory hyperpigmentation. It takes several months to see the full effects of collagen remodelling.
Many treatments for acne scars
There are many different treatments for acne scars and there is not one that works for every patient. The first step is to ensure that any active acne is under control. The next step is to determine the best course or courses of treatment. This may include lasers, dermabrasion, dermaroller, excision, fillers, or other options. Finding a facial plastic surgeon, dermatologic surgeon, or plastic surgeon who offers a variety of treatments is going to be your key. Don't be swayed by advertising pictures which promise miraculous results as most single treatments will get about a 50% improvement (there are some exceptions).
Laser Treatment for Acne Scars
There are many other treatments besides lasers for acne scarring including: subcision for rolling and “box car” scars. Other treatments include “punch” or circular removal, microneedling, chemical peels, dermabrasions, and dermal fillers like bellafill or high grade sillicone. Consult with a board certified dermatologist for the best procedure for your condition.
A combination of treatments works best for acne scar revision.
Never choose a treatment, always find a solution for YOUR scars? Confused? Read more.
Rolling scars can NOT be TCA CROSSED but best treated with either CO2 Fractional followed by dermal fillers.
Box car scars in dark skin types should be treated with full erbium (if shallow) or combination erbium, CO2 Fractional and dermal fillers.
Always find a solution based upon your scar type, never go for a treatment because its there. Sometime simple solutions provide better outcomes than the most expensive hyped up laser systems.
Dr Davin Lim
Aesthetic and Laser Dermatologist
Brisbane and Gold Coast
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.