Pinholes and orange peel texture caused by ProFractional 7.5 months later—can fully ablative laser smooth this? (photo)

Question

25yo f. 7.5 months ago, I received one treatment of ProFrac on my whole forehead for 1 minor acne scar (it should have never been suggested, but I was naive). 200 microns, 11% dens, no coag—board certified derm said she overlapped pulses 50%. My prior skin was incredibly smooth and forehead pores were practically invisible. Since the treatment, I’ve had to deal with this orange peel texture due to puckering of the skin between each pinhole where the laser ablated tissue. These are NOT pores.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

treatment level you had done was very light. almost nothing. you just didnt have the right pre and post surgical skincare and you needed to start non ablative treatments like moxi or CB right after PF. we can do virtual skincare consult and get you peels and skincare and the right plan (see link). you need to start exfoliation peel now.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Jason Pozner, MD · Answer

I would treat with fully ablative erbium (sciton TRL) Depths depend on the tissue response at time of the procedure. More then one session may be necessary but you should be able to have this smoothed out

Pinholes and orange peel texture caused by ProFractional 7.5 months later—can fully ablative laser smooth this? (photo)

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Pinholes and orange peel texture caused by ProFractional 7.5 months later—can fully ablative laser smooth this? (photo)

Answers (3)

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Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.