Acne Scar Removal

I am still trying to figure out what is the right laser and/or treatments for me. I have had acne for 2 decades and now want to get rid of the deep scars and wrinkles.

Doctor Answers 13

Ablative procedures most effective for acne scarring

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The best approach for treating acne scars is an ablative procedure (one that will remove skin tissue) that will target the dermal layer of the skin. Both laser treatments and chemical peels can offer this result.

For appropriate candidates, I would recommend CO2 laser as the most effective treatment option. CO2 lasers have been used to treat the skin for more than twenty years, and have earned their reputation as the “gold standard” for acne scar revision and facial rejuvenation.

Today, CO2 lasers are generally performed in a “fractionated” mode, which means that they are only removing small columns of the skin, leaving a large percentage intact. This method of performing the procedure greatly improves patient safety and significantly reduces downtime, while providing great results. The CO2 laser is able to reach the dermis of the skin, where collagen is produced. By depositing a controlled amount of heat into this layer of skin, it stimulates the skin to repair and produce new collagen, and “remodel” the scar tissue. For deeper scars, is may be preferable to use the laser in a “non-fractionated” mode, or to spot treat scarred regions with a high strength TCA peel.

TCA peels, or other peeling agents that can be performed to reach the dermis, are also a good option for those who are not appropriate candidates for laser treatment. There are many types of laser technologies on the market, and lots of marketing dollars to back them. Some non-ablative lasers claim to treat acne scars, but I would do my research before investing in them. While some may offer improvement, and some may be better than others, most research still shows that the “tried and true” ablative procedures provide superior results. These procedures can be performed safely by a qualified practitioner, and may offer a better return on your investment. 

Acne Scars and Active FX Laser Surgery

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You ask a very important question and acne scars are a common problem and can be difficult to treat, particularly based upon the degree of scarring.

If you have tried various peels and dermabrasion has not helped, Active FX and Deep FX are the latest in laser surgical technology. While there are many lasers out there that do close to nothing, this technology really works and, compared to the old CO2 lasers, there is very little down time (about 3-5 days total).

The procedure is rather expensive, but you can generally obtain good results with one treatment as compared to several; again this is dependent upon the degree of acne scars.

It should not matter that you have already done the other treatments; the only reason to put it off for a little while is the cost and the fact that emotionally you may need a break.

I have been particularly impressed with the Active FX laser and I was a bit of a skeptic going into it. I use this in my practice and patients seem to really like it.

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon

Liquid Silicone For Acne Scarring

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I have been trained by my mentor to inject acne scars with liquid injectable silicone and we get great results. It is the best treatment for most types of acne scarring and a lot more cost effective. In addition to using liquid silicone as a filler, we also sometimes perform light electrodessication or dermabrasion (skin resurfacing techniques) to improve the scars as well. I personally think lasers are a lot of hype when it comes to improving acne scars. Our photo gallery shows several great photos of patients treated in this manner. Hope this helps. I also dont recommend you waste your time with temporary fillers as you will spend a lot of money without great results.

Erbium and CO2 lasers treat acne scars well

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There are many options to treat acne scarring, so to achieve the best results for your specific case, consult an experienced specialist with a reputable practice. Lasers are a great way to resurface the skin and reduce scars, particularly the Erbium and CO2 lasers. The Erbium laser is a state-of-the-art laser that resurfaces the skin and reduce scars in under an hour. The results are almost instant, and only about 3-4 days of downtime are required. Another option is the CO2 laser. The CO2 laser penetrates the skin deeper than the Erbium; therefore, the results are a little better, but you would need about 7-10 days of downtime. Also, because this laser is more invasive, you do not need multiple treatments like the Erbium.

Choosing the best acne scar treatment

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Not all acne scars are the same.  Indentation, pigmentation, and depth to width ratio differ.  I would recommend a combination of techniques including percutaneous scar release, IIT, pulsed dye laser, and fractional co2 skin resurfacing for these scars.

Laser for Acne Scar and Wrinkle Removal

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Deep acne scars and wrinkles can be treated simultaneously with fractional laser resurfacing treatments.  There are two main type of fractional resurfacing lasers: ablative and non-ablative lasers.  Ablative lasers include the Fractional CO2 lasers, which ablate the top layer of the skin while sending laser energy through the skin to stimulate collagen production.  Typically only one treatment is necessary after an ablative laser treatment.  Non-ablative lasers send their laser energy through the skin, to stimulate collagen production and skin renewal without ablating the top layers of the skin.  These lasers, such as the Fraxel Restore require a short series of treatments, but are excellent for patients who cannot schedule a long period of 'downtime' after their visit.

Both Fractional CO2 laser and the Fraxel Restore will stimulate collagen production and healthy skin renewal, in order to smooth out both deep acne scars and fine lines and wrinkles on the skin.  

Eric Schweiger, MD - Account Suspended
New York Dermatologic Surgeon

Fraxel For Acne Scars

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Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Great advances in laser technology

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Over the last several years, the lasers utilized to treat acne scarring have made great advances. The DOT CO2 laser works wonderfully at helping acne scarring. It not only works at resurfacing the skin, it promotes collagen and will give you a wonderful texture. Without seeing you though, this is only general advice as you might or might not be a good candidate for this procedure.

Jeffrey Adelglass, MD
Dallas Facial Plastic Surgeon

Scar treatment

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I run the risk of offending you, but will tell the truth anyway: you need an evaluation by an experienced surgeon to tell you what your best treatment options are. There is no one treatment that works well for all scars.

Best Regards.

John P. Di Saia, MD
Orange Plastic Surgeon

Acne scar removal approach that works

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While it would be very nice if there was a simple answer to this question, there is not. You have many different options when it comes to acne scars because there are many different types of scars, ice pick, red, brown, rolling, boxcar, etc. There is no one solution for treatment and in fact, you may benefit from a combination of treatments for the best results. At Celibre Medical, we focus on laser treatments for acne scars.

Check into all of these and go to four or five consultation so that you know your options.

  • CO2 Laser Resurfacing
  • Erbium Laser resurfacing
  • Fractional Laser Resurfacing
  • Subcision (surgical)
  • Punch Excision (surgical)
  • Dermabrasion (surgical)

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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.