Acne scars become dark in color after fractional CO2 laser.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,

In darker skin patients, PIH is universal following CO2 laser - 6-12 months even, depending on the settings. Its impossible to comment with out seeing or touching. If you have deep fibrosis, you do need to use a strong CO2 low density laser, the other option is to use microneedling RF but with caution. Time is your greatest friend for now. Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 



As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 



The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.