Which would you recommend; Dermapen vs. fractional laser for acne scarring? (photos)

I have acne scarring from cystic pimples when I was younger. They're shallow boxcar type. I also have large pores and just all over uneven texture. I've had one dermapen treatment before, a derma roller treatment and laser before but never continued treatments because of money issues. This time I want to go all the way and get all the number of treatments I need done to achieve desired results. I know it takes time. Which treatment should I choose? Photo attached.

Doctor Answers 8

Laser usually outperforms needling... here is why-

At our clinic we have over 14 lasers, but we also have Dermapen (Professional,) as well as skin needling. 
I have been performing scar revision for nearly a decade now, and before the use of fractional lasers such as Fraxel, Profractional and CO2 CORE, Active Fx etc... , I did use skin rolling, especially on darker skin types. 

First of all I absolutely agree with Dr Rapaport with his answer- ALWAYS treat the SCAR and not find a treatment to suit you. This gives best results. 

Lasers not only break down the scars (as do deep Dermapen), but also denature collagen via the use of heat, this controlled heat stimulates cells to lay down new, and fresh collagen, and hence in most cases out performs Dermapen. (Exceptions include v v dark skin, but then we have erbium for this). If you visit acnespecialists.com.au I may have some old photos of skin needling, but 99% of the time I use other lasers and procedures to get my scars sorted. 

Why do we offer Dermapen then, if other treatments are better? It really comes down to pricing and what the patient wants. We thus cater for all budgets and needs, but best advice is always given first


Dr Davin Lim 
Laser and cosmetic dermatologist
BRISBANE, Australia

UPATE-As of Jan 2016, my provisional trials of INFINI RF MICRONEEDLING now makes this my favourite treatment for rolling, mixed, atrophic and tethered scars, as well as small to medium pores. I have started using this system in Sept 2015, and the results for these type of scars are great. This is not just micro needling but energy based micro needling 

Davin Lim

Brisbane Dermatologist
4.7 out of 5 stars 77 reviews

Dermapen vs Fraxel?

Acne treatment should be based upon the type of scars. Boxcars will respond to Fraxel erbium or co2. Boxcars will also respond to aggressive needling plus PRP  and subscision.
Large pores respond best to Fraxel erbium (restore). Combination therapy is often better than a single modality. ,
Hope that helps.

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.6 out of 5 stars 40 reviews

Laser vs microneedling for acne scars

Thank you for your question.  It's difficult to say if one is better than the other as the laser offers many other benefits that microneedling doesn't.  However, if improvement in your acne scars is your goal, and if you're on a budget, microneedling is the way to go.  Having professional dermapen treatments at the highest setting over 5-6 sessions will give you 30-40% improvement in the acne scars on the entire face.  I would consider performing Bellafill first into all of the scars to maximize the scars before microneedling to get the best results.  If you have deep icepick scars that don't improve when you pull the skin apart, then you want those removed surgically first, then have the Bellafill, then have the professional microneedling performed. Hope that helps. 

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

Acne scars

A combination of deep and superficial treatments work best.  Under the acne scar I use an FDA approved 5 year filler; Bellafill.  Bellafill plumps out the acne scar and stimulates collagen production under the skin.  For the surface I use Dermapen with Regenica Growth factor recovery serum to also encourage collagen production.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 45 reviews

Fraxel Laser for Acne Scars

Fraxel laser will yield much better results for acne scars over Dermapen. Fraxel will also improve the pore size and texture of the skin as well. There are times that a combination of lasers or treatments are needed. You may also need Restylane injected into the acne scars to plump the area. Please consult a board certified dermatologist with experience with Fraxel and acne scar treatments. 

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Acne Scarring and Dermapen

Microneedling is best for milder scars.
A dermaroller or other microneedling treatment can improve the appearance of shallow, diffuse acne scarring along with improving all-over skin tone and texture. For very deep acne scars, I would recommend combining microneedling with another treatment such as dermal fillers, laser resurfacing or scar treatment, including scar excision. In some cases, combining microneedling with a regimen of other procedures may give you the best results. Since some of the treatments you’ve tried already are actually more aggressive than microneedling, I’m not sure you’ll get the results you hope for from a dermaroller.

Gary Motykie, MD
Los Angeles Plastic Surgeon
4.3 out of 5 stars 68 reviews

Depends on your skin tone

For patients with pigment to their skin, like anyone other than Caucasians, I prefer microneedling.  There is no risk of hyperpigmentation or scarring with microneedling like there is with lasers.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Dermapen or Fractional Laser for Acne Scarring?

Thanks for your question and my first recommendation is to consult with a board-certified dermatologist or plastic surgeon well versed in lasers and also in dermal pens such as the Dermapen. There is no question that most laser procedures will work better than most of the pens that are on the market. Dermal pens work over time, are associated with some bleeding at the time of the procedure, and multiple treatments will be needed to see any appreciable results with your type of acne scarring.

Lasers, mainly the fractional lasers as well as the fractional RF devices (eMatrix and soon the Venus Viva) as well as the fractionated RF microneedling devices like the EndyMed Intensif will all work on these acne scars that you show in your photo. Each one will have some downtime, more so when we talk about ablative fractional lasers, but the results with these for acne scars are proven and tried so I would find a physician in your area who does these, learn about them, and what the best option will be for you.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 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.