Questioning fractional CO2 laser resurfacing effectiveness?

I have a combination of considerably severe acne scars (especially boxscar and rolling scar). Trust me it is that bad. I've done 5x CO2 Fractional Laser resurfacing (+-10 days downtime is quite troublesome). Comparing from before treatment and after my 5th treatment, I would say it improves "only" around 25-30%. I completely understand on not aiming for "prefect" to be satisfied, but it is still very unsatisfying. Is it normal? Is it my skin that did not receive the treatment well or something?

Doctor Answers 4

Questioning fractional CO2 laser resurfacing effectiveness?

Traditional CO2 Laser combined with judicious dermabrasion will achieve a better result. Also consider combining with filler. Fat transfer will give a longer lasting result. There is also some evidence that the added stem cells also helps the skin look better. Nothing will get perfect. It should have about a 10 day recovery. 


Downey Facial Plastic Surgeon
4.8 out of 5 stars 16 reviews

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

I suggest posting photos for further evaluation. In combination with Fractional CO2 laser, acne scarring needs a combination of peels, subcision, microneedling/PRP and fillers. I suggest consulting with an expert for a formal skin care evaluation and to determine your short and long term treatment goals. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Fractional c02 for acne scars

Acne scars are really tough.  I prefer a fully ablative treatment (with similar downtown) plus the addition of subcision and fat grafting.  The idea of releasing the scars and then adding fat or fat plus sculptra will allow the space created by subcision to  be filled and help prevent reformation of the depressed areas.  Fully ablative treatments I  believe have a higher success rate than do fractional treatments.  I think also the combination of fat, subcision, and laser is a much better option

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Fractional CO2 for Acne Scarring

 Sorry to hear that you have not had better results. I usually tell patients that their scars will improve by 50%. My "50%" may be different from what the patient thinks is 50%. I tell patients that this means there will be obvious noticeable improvement but that the scars will still be visible. Realistic expectations are paramount.
 For deep boxcar-type scars, punch excisions are usually necessary prior to resurfacing. I wonder about the laser settings that were used. In almost 20 years of laser resurfacing, I have never had to treat a patient five times. No doubt your doctor and you have been trying to achieve the best results possible in a very severe case of scarring.

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.5 out of 5 stars 2 reviews

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