Is Fraxel the Only Option for Indented Scars?

Question

I have tons of indented acne scars, enlarged pores and a fairly large chicken pox scar on my eyebrow. Every skin laser office I go to recommends Fraxel. But I hear it is painful and the side effects are bad. Is Fraxel really my only option left? And if it is, is it worth it? I feel hopeless. Thank you.

Michael A. Persky, MD · Answer

Hi Rachel,
Fraxel laser is a very good treatment for acne scars.  If you are adverse to Fraxel, since you are in the New York area you are fortunate to have two very good, silled and experienced physicians who use Silicon-1000 to treat the scars you have described, Jay Barnett, MD in NYC, and Eric Joseph, MD in West Orange, NJ.
Silicon-1000 can give amazing results, but it is permanent.  Therefore it is essential that you do your homework, and only have a most experienced and skilled physician perform your treatment, as in the wrong hands Silicone can be a diaster.
Good luck and be well.
Dr. P

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

Scott Trimas, MD · Answer

There are many options available to treat indented acne scars. Some include the use of fillers like Restylane or Juvederm. Other options include dermabrasion or microdermabrasion. Fraxel is a very good option but so is the erbium laser. Fraxel in my opinion has mixed results in improving acne scarring and if it is significant may not go deep enough and requires multiple treatments. The use of the Obagi skin care system is a painless way that may give you some minor improvement as well. However, if your scarring is not too deep then the Fraxel may be the way to go and it can be done in various settings from deeper to less deep with less discomfort and faster healing.

Ran Y. Rubinstein, MD · Answer

Acne scars are best treated with combination therapy. The combination depends on the shape and depth of the scar. I would have to see a photo to tell you which treatments would work best. The following are your options- one or all in combination.

Fraxel laser resurfacing
Fillers i.e. Restylane, Juvederm for more superficial scars.
Sculptra to treat fat loss from acne which can accentuate the scars.
Surgical excision for ice pick scars.
Subcision for retracted scars due to scar tissue pulling them inward.

Michele S. Green, MD · Answer

I often use fillers like Restylane and Juvederm to fill acne scars. With repeated injections over time, the collagen reforms in these scars and they are truly less noticeable. I do have great results with a combination of injections and Fraxel laser treatment for scars. Silicone works but is permanent and not FDA approved.

Theodore Katz, MD, FACS (retired) · Answer

The Fraxel (and technologies similar to it - that is fractionally ablative lasers) have good to excellent results for facial acne scars and that is the reason why this is highly recommended. I don't know what you mean by "bad side effects" as in the hands of an experienced physician these should be limited. The pain can be controlled with proper sedation in the office and I have yet to have a patient who could not tolerate the procedure which takes about 20 minutes, once the facial skin has been "numbed". We use the term numb, but the topical agents just decrease the pain during the procedure. There should be no pain after the procedure.

Is Fraxel the Only Option for Indented Scars?

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