Fraxel Laser for Acne Scars on Asian Skin?

Question

Hi, I have acne scar in my cheek and few bump (pimple). I want to get rid of that scar. Is Fraxel laser good for me? I'm Asian, 21 yrs old and have white skin. I'm afraid after I get Fraxel, my skin will be red and burned. Thanks

Harold J. Kaplan, MD · Answer

PIH (Post inflammatory hyperpigmentation) is possible after Fraxel and numerous other laser treatments for your skin type. With that said, we offer Erbium resurfacing for acne scars and rarely have the condition develop. It occurs in less than 5% of Asian and Hispanic patients in our practice. We would suggest looking into the following laser options. While PIH can and does occur in some patients, it is most often transient. We would focus on finding the most appropriate laser technology for the type of scars you have and then weight the risks and benefits from there.

Erbium Laser Resurfacing
Fractional Laser Resurfacing (including fractional CO2).
Full CO2 resurfacing (depends on how severe your case is).

Erbium Laser Resurfacing
Fractional Laser Resurfacing (including fractional CO2).
Full CO2 resurfacing (depends on how severe your case is).

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Ron Shelton, MD · Answer

Fraxel has worked very well to reduce acne scarring in some individuals. 
Fraxel has worked very well to reduce melasma, or facial pigmentation, in some Asians
There is no guarantee that you won't devlop a hyperpigmentation.  A test spot can be performed behind your ear first and if no reaction develops, another test can be done, this time on the frontal face. If you develop post inflammatory hyperpigmentation from the test, then you shouldn't have the treatment, especially if this pigmentation doesn't clear wtih appropriate counter measures. If you pass the test, and no pigmentation occurs, it unfortunately doesn't mean that you won't develop the hyperpigmentation.
Proceed cautiously.

Michael A. Persky, MD · Answer

Hi Jilodo,
Asian skin is prone to post inflammatory hyperpigmentation (PIH) which causes the treated skin to darker more than untreated areas.  Patients need to weigh the benefits of improving their scars verus the risk of living with darker skin for an unpredictable amount of time.  We have treated many Asian patients, the PIH always fades over time.
Most Asian patients are pretreated with topical skin care to help minimize possible PIH, and then treated after their laser treatment with skin lightening products.  Fraxel restore is much less likely to cause PIH than Fraxel repair.
Your skin should not be burned.
Good luck and be well.
Dr. P

Monika Soni, MD · Answer

You can undergo Fraxel laser treatment as long as your acne breakouts are under control. We all have or or two pimples now and then, and it is completely fine to proceed with Fraxel treatment. It is important that your provider thinks that your skin is ready for laser treatment in order to minimize any side effects. Moreover, your provider has to know what topical and oral medications were you using since there has to be certain time gap between your last application or dose and first laser treatment (as it is the case with Accutane and other medications). Good luck!

Heidi A. Waldorf, MD · Answer

There are different types of fraxel devices.  The Fraxel Dual using the erbium wavelength is appropriate for acne scars in all skin types.  Multiple treatments are required.  Whether or not Fraxel alone or combination treatment is appropriate for you is something your dermatologist can discuss after a careful evaluation.  Whatever you have done, you must use careful sun protection to avoid the risk of post-inflammatory hyperpigmentation.I hope this answer was helpful. Best wishes.

Angela Sturm, MD · Answer

Fraxel Dual works on acne scars and on all skin types. Acne scarring requires increased intensity in the treatment to stimulate collagen that will help smooth out the depressions. Therefore, you will be red and swollen for 3-4 days, then you will have a bronze appearance and some light flaking of the skin. Although your acne scarring will probably not be completely gone, it should be improved with several treatments.

Martie Gidon, MD, FRCPC, FAAD · Answer

Fraxel restore laser is an excellent treatment for acne scars in Asian skin.  Usually 5 to 6 treatments are necessary, depending on the scarring.  The laser settings are lower than those used in lighter complexions and the treatments are further apart to prevent postinflammatory hyperpigmentation.

	You should start using a fading cream and tretinoin cream before your treatments to prevent PIH and have 2 treatments 6 weeks apart.  If you are developing any PIH, delay your next treatment by a few months, and then resume treatment.  You must avoid sun exposure and any tanning.

	Ensure your treatments are done by an experienced board certified dermatologist or plastic surgeon.

Narin (Joe) Apisarnthanarax, MD · Answer

Fraxel is my treatment of choice for mild to moderate acne scars.  First, I always recommend to have your acne under relatively good control prior to Fraxel therapy.  Fraxel Re:store works through a mild resurfacing effect, combined with deep collagen stimulation.  Its really this deeper collagen stimulation that makes it effective for remodeling acne scars and sets this treatment apart from other devices.  Fraxel will not take away your scars completely, and it does not do much for deeper "ice pick" scars, but it can smooth out mild to moderate depressions.  In the right candidate, it can improve acne scarring by 50-75% after 4-5 treatments.

	Since Fraxel Re:store is a non-ablative laser, there is significantly less risk of pigmentation issues compared to ablative CO2 treatments.  Your skin will be red and swollen after the treatment, though with proper settings, it should not be "burned."  Recovery time is short, with the redness and swelling being the worst for the first 24 hours.   Dandruff like peeling can be seen for up to a week after treatment.

Jerome Potozkin, MD · Answer

A series of Fraxel Restore laser procedures typically works well for acne scarring in most skin types. I would make that your acne is well controlled if not completely gone as acne can flare after Fraxel treatments. Some patients may be require pre and post-treatment with a hydroquinone cream to prevent post-inflammatory hyperpigmentation (PIH).

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