Fractional CO2 Laser for Hypertrophic scars. Effective, side effects? (Photo)

I was considering getting fractional co2 laser for these hypertrophic scars. However I am uncertain of side effects such as hyper pigmentation or hypo pigmentation in my skin type which is ST 4 I ve heard a single pass with fractional co2 laser is effective at controlling PIH in ST 4 but 3 passes are more effective at treating hypertrophic scars What should I be looking at in order for it be effective without risk of PIH. i.e No. of passes, setng for co2 laser How long to see results Thank you

Doctor Answers 5

Fractional lasers for forehead scars

I would suggest lighter fractional lasers, IIT, and skin resurfacing to help reduce the scarring on the forehead. Co2 laser may be too strong for this. Best, Dr. KaramanoukianLos Angeles


Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Scar on Face -- Lasers (Fraxel, Co2, Erbium), Microneedling/PRP, Subcision, Surgical Revision

Scars can be treated with ablative lasers but you may do better with erbium or fractional non ablative.  Please see an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Hypertrophic scars and laser resurfacing

Your questions are specific to the setting that should be used on hypertrophic scars based on your skin type and type of scars. The settings will be specific to the laser being used as different companies have different settings and your treating provider should have experience with the laser on your skin type to make suggestions 
Your other option besides CO2 laser resurfacing is using an Erbium laser which has a lower risk of PIH  in your skin type due to the decrease in coagulation produced by the laser, so less thermal injury is created. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Fractional CO2 for scarring

Fractional CO2 is the gold standard for treating hypertrophic scars. It allows precise manipulation of parameters to target the exact needs of your scar, such as depth and density. It also allows enhanced topical delivery of drugs to the scar immediately after treatment with the laser. 
The questions about number of passes, energy, etc. are not a one-size-fits-all approach, and best left in the hands of an expert. For example, the post inflammatory pigment changes that you ask about are mostly determined by the density of treatment, not as much by the energy of treatment - you can treat very deeply into a scar with significant spacing between this treatment areas and reduce your risk of pigment change.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 78 reviews

Fractional resurfacing for hypertrophic scars

Fractional c02 resurfacing has been shown to be very effective for hypertrophic scars.  In fact one company developed particularly useful settings to improve the results.  The risk of hyperpigmentation is real, and it may be something that you should expect, knowing that you can likely treat it following the treatment.  Some physicians prescribe products like hydroquinones or  natural skin lighteners like  arbutin or kojic acid, but the results are mixed with regard to success in minimizing the hyperpigmentation.  Hypopigmentation is  much less likely with the kinds of lasers that are currently available, but it is  still a risk.  I would plan to have 3-5 treatments over 6-8 months.

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