Acne scars: Is there any benefit to combining laser and Infini?

Hello. A doctor I consulted (one of the few who does Infini in my area) said he prefers to combine Fractional CO2 and Infini for better results. I consulted him because I was keen on Infini to avoid hyperpigmentation (being Indian). Is there really any reason to combine both? I mean if I can do CO2 confidently, should I even bother looking for RF devices in the first place? Or is it just a "More is always better" school of thought? Thank you Docs. Appreciate your help.

Doctor Answers 5

Acne Scars Respond Well To A Combination Of Nonsurgical Volume Restoration, Subcision & Medical Microneedling

Before you embark on laser and RF treatments for acne scars, I recommend you check out an answer to a Realself question I literally just finished answering another questioner on the subject of acne scar treatments. To enable you to access her question, it was entitled "Rolling acne scars with photos. I've tried everything. Is there anything else I can do?"

In her question, you will see that this individual underwent all kinds of laser treatments for her acne scarring to no avail--simply, in the end, wasting her time and money and leaving her feeling desperate.

Unfortunately, as I pointed out in my answer to her, lasers of all kinds, including fraxels, and radiofrequency devices of all stripes to date appear to be backed by far more manufacturer supported marketing hype than hard science. So, I urge a healthy dose of buyer beware before embarking on what might prove to costly, time consuming and disappointing.

Without a photo, it is hard to say what would actually be best for you. However, in general terms, I would suggest looking into  "The Nonsurgical 3D Vectoring Facelift," Subcision, and fractional medical microneedling, all of which you can learn more about through the archives of Realself.com. and all of which have yielded gratifying results in my own personal experience and have little chance of producing significant hyperpigmentation--even in people of color.

Good Luck to you.


New York Dermatologic Surgeon
4.8 out of 5 stars 23 reviews

Depends..... read more

I totally agree with Dr Weiner, it makes no sense to combine fractional CO2, when Infini delivers energy to the dermal layers, whilst CO2 has collateral damage to the epidermal or upper layers. Treating with two fractional devices contradicts each other. 

The cameo is that I do use fully ablative CO2 or Erbium with INFINI in the correct scar type. Classic examples include rolling and atrophic scars plus the odd box car scar. INFINI is great for atrophic and rolling scars, whilst one to two passes of fully ablative CO2 or erbium laser will predictably take care of the shallow box car scars. Combining both in fractional mode however, does not make sense. 

I really like and endorse the idea of PRP with INFINI. Logic prevails that if 200 shots are fired with the INFINI, and 49 micro needles per shot, that is nearly 10,000 micro channels to allow growth factors and cytokines to enter the skin. A split face study of mine will be out in mid 2016 regarding the combination of PRP and INFINI. Why micro needle when you can combine channels with RF and growth factors? I have largely replaced my CO2 Fractional lasers with INFINI, and even though I have 2 Fraxel machines, do not use the 1550 for scars anymore- Infini is much better. 

I am sure that specialists who have access to all machines would tend to agree on disagreeing. 


All the best, 

Dr Davin Lim 
Laser and aesthetic dermatologist
BRISBANE, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 60 reviews

Combining CO2 and Infini in Indian skin - No, makes no sense

One of the major benefits of using Infini in skin of color is the low risk of hyperpigmentation. When you add the CO2 laser, that risk goes much much higher. With the multiple depths of the Infini, I don't see what you gain using the laser except risk. If you want to do something additive to the Infini,  I would add PRP plus/minus fillers. Please don't combine with the CO2. A lower risk laser like the Fraxel 1927 for treating the superficial skin can be done. Bellafill can be added to deeper scars that don't improve with Infini

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 26 reviews

Infini vs. CO2 laser

Thank you for the question. Infini is my go-to treatment for acne scarring. I used CO2 in the past, but found that I had to lower the intensity of the treatment in darker-skinned patients and that this really compromised the results. I have not had any pigmentation issues with Infini. The only reason I could see to combine Infini and any type of laser would be persistent redness after Infini -- and in these cases, I use an IPL. Take care and best of luck!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 95 reviews

INFINI is much safer for Darker skin types.

I'm assuming you are talking about acne scars. INFINI is best treatment for deep acne scars on darker skin tones. It has multiple depths and directly targets where the scar is. PIH (Post Inflammatory Hyperpigmentation) is possible with both procedures but is notably worse with CO2 laser or with any laser for that matter. Depending on how severe you scaring is I generally recommend 3 treatments a few months apart. Post treatment you should expect some swelling for the first couple days only and light peeling throughout the week. it is very important to avoid sun exposure and to use a good sunscreen to be reapplied several times daily to avoid more hyperpigmentation. If PIH does occur its generally very mild and very responsive to topical Hydroquinone and lightening creams.

If there are scars that do not improve after treatment then Bella fill, a long term filler, can be used.

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 35 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.