I'm a Filipina woman with deep acne scars. A dermatologist recommended a light Fractional CO2. I was told new CO2s are safer. I was classified as Type 4 and I'm afraid of hyperpigmentation. What can I expect from Fractional CO2 treatments?
Fractional Co2 Laser for Acne Scars on Asian Skin?
Doctor Answers (9)
Fractional Co2 can be Performed in Darker Skinned Patients
1. First, we select settings on the machine that tend to have reduced density and reduced energy. This is combined with phasing of the treatments to get the total energy into the skin we desire, but doing that over time instead of all at one time. Phasing allows us to get the total energy into darker skin with less risk. In patients who are very anxious about this issue, we can also do a test spot on a first phase of treatment to gauge response to the laser.
2. The second part of treating patients at risk for hyper pigmentation is to selectively pre-treat with hydroquinone starting a week or two before the laser treatment. We do this less now but it is still an effective way both before or even after to manage this situation.
3. Third, we are very selective about the products used in the post laser recovery process in darker patients. We have seen very excellent results with the Aminoplex/Bio2 line of laser recovery products. I feel the faster one heals and the better the post laser care, the lower risk of hyper pigmentation.
4. Finally, the latest addition to our laser treatments in darker pigmented patients is combined use of PRP (TruPrp) with the fractional laser. Here we have noticed a trend to faster recovery, less hyper pigmentation, and better overall acne scarring response to the laser energy, allowing us to reduce settings even further.
In summary, darker patients can be layered with CO2 as long as long as the practitioner has good experience with the procedure.
Hyperpigmentation is common, and will resolve.
1. Deep Fractional laser is better than 'light' laser
2. We keep the density (coverage low) but go very deep (Fluence or power)
3. PIH may occur, but the use of HQ and or Lytera can reduce the chances of PIH
4. PIH is transient, ie. will resolve in time ( 3-5 months), quicker if you sun protect and use fading agents. The target are the scars- I am results driven and not prevention.
5. As suggested by all the other Specialists, you will need between 3-5 treatments for optimal outcomes.
To summarise- if PIH or hyperpigmentation occurs, its not the end of the World, the use of fading creams, plus sunprotection can resolve this issue- it is the acne scars that we target.
Hope this reassures your fears,
Dr Davin Lim
CO2 Treatment on Asian Skin
Any CO2 laser, even fractional, can be associated with side effects. In Asians, we usually are most concerned with post-inflammatory hyper pigmentation which can last for several months if not treated appropriately. All patients should be treated with the appropriate topicals prior to the procedure, and the provider should be familiar with the device and the expectations. There is no such thing as a light fractional CO2 - the depth is determined by the energy used and all devices can be superficial or deep. Most importantly, make sure the provider performing the procedure is skilled and knowledgable.
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Fractional CO2 for darker skin and acne scars. Can Fractional CO2 be used for dark skin and acne scars
Fractional CO2 and chemical peels work wonders for acne scarring in patients of all colors. In my practice in Santa Monica and Beverly Hills, I recommend the fractional CO2 laser for acne scars and for deep wrinkles. Patients who have darker skin types, including Filipino and Hispanic skin can benefit from the Fractional CO2 laser, but I would recommend a regimen of Melaquin AM and Melaquin PM before and after the laser session. Melaquin helps control the post laser hyperpigmentation and allows for a more controlled recovery. If you have acne scars, you can also benefit from chemical peels and other types of acne surgery, including subcision, punch grafts, and acne excision. Dr. Karamanoukian.
Fractional CO2 for acne resurfacing in darker skin
I have treated a large number of non-Caucasian patients with the fractional CO2 laser, including several with very dark skin. It is very important to find a physician with experience in treating darker skin. In any patient where I may be concerned about the possibility of changing the skin pigmentation, I always perform a test spot with the laser and wait 4 weeks to see how the skin responds. If there are no side effects, then I proceed with the laser treatment. In terms of acne scarring, you will likely want to have more than one treatment. Acne scarring can be improved with fractional CO2 laser resurfacing, but because of your darker skin, your treatment should be more conservative to reduce the risk of side effects.
Don't Expect Much
Fractional CO2 Lasers can give some improvement in fine lines and blotchy pigmentation but significant improvement in acne scarring requires much deeper treatments. These deeper treatments are usually performed with traditional CO2 lasers or deep phenol peels. I am afraid that some of the newer lasers have been over hyped by the companies that sell them and utilize this technology we find ourselves in the position of making sure our patients have realistic expectations.
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Hello, I am Dr. Behnam and I am a fractional CO2 specialist. I treat a lot of patients that are darker skin (including type 4), including Asians. One of the most common side effects is pigmentation. It is very important that an experienced physician treats you. The setting have to be lowered. In addition, I have developed a regimen where it minimizes the pigmentation as much as possible. Patients use Bleaching cream for at least one month, then immediately after the procedure they use a special non-hydroquinone bleaching cream for a week, then start the hydroquinone again after a week and add on tretinoin cream 2 weeks later. This regimen in combination with lower setting has practically eliminated pigmentation changes in my practice. You can see some before and after images of darker skin individuals on my website . Remember, a lot of technicians may do CO2 but you want to trust your face to a physician who is experienced and does it all the time. Overall,I think it will work but you may need 2 or more sessions. Dr. Behnam
Fractional CO2 for acne scars
Fractional CO2 laser can be an excellent tool to treat acne scars. However, it is important to visit with a doctor experienced in treating acne scarring as laser is not always the best solution and certainly not the only one.
Since acne scars come in differents shapes and sizes, the treatment must be directed at the type of scarring you have. While a laser may be good for certain types of acne scarring, you may need a different treatment for other types.
Depending on the laser settings used, the fractional laser can be very safe and effective for darker skinned patients. you do however have a higher risk for increased pigementation after the procedure which can be treated with topical medication.
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.