Is there any risk of fat atrophy with CO2 SmartXide laser resurfacing?

YES, any procedure will have risks. Paper will be out next year on the risks of high powered devices including CO2 and insulated RF and fat atrophy. Dermal thickness should be tested if high powered devices that penetrate to the mid fat layer is contemplated. Now, histology has shown that the attachment points of certain types of scars lie in the mid fat layer, some much deeper than that. So, if thermal injury is large, you do have a chance. I do use a lot of CO2 laser and this laser (SmartXide) is one of the best, however I use this only as a tool, and not my primary method of scar revision in the fat layer- subcsion or manual methods are far better, augmented with low density CO2. Subcsion was first reported in 1995. Since then this technique has taken many pathways. Most dermatologist and plastics still perform the old method- using sideways motion to break scars down. In the original papers this took 6-10 sessions using a needle. This still can be effective, but its OUTDATED. Since then other methods have evolved including-


The use of other size needles
The use of NOKOR or cutting needles
The use of cannula techniques


Of all these techniques, cannula stands out. The most recent paper this year shows that it has the best rate of scar breakdown with much less side effects than with NOKOR. Namely less bruising and ‘lumps’ from bleeding. 



The results of subcision is extremely variable and will depend on the technique and experience of your Plastics or Dermatologist. Ensure they can perform all techniques competently. This is especially important with dermal fillers (or fat transfer). If one subcises a depressed scar and find it has NOT got significant tethering, a filler is needed. In this situation filler or fat is needed to elevate the scar. Subcision is my preferred method for scar revision, as I can feel how many scars I am breaking with my 3 level cannula technique. This is now considered the Gold Standard in subcsion as reviewed by peer papers. All other modalities including lasers, energy devices and peels are considered ‘instruments’ in the way I practice acne scar revision. Remember treat the scar type with a method, and you will achieve the desired outcomes. Subcsion releases and remodels acne scarring from underneath. Needless to say this just a method, the results you will achieve is 90% dependent on the skill sets of your Plastic surgeon or Dermatologist.  



All the best, Dr Davin Lim 

Acne Scar Specialist. Brisbane. Australia.