Tetra CO2 or Fraxel Dual – Which Is Better for Acne Scars?

Question

Hi! I’m trying to decide between Tetra CO2 (CoolPeel) and Fraxel Dual to treat my acne scars. I’m in my late 20s with fair to medium skin tone and no active acne. I’d love to hear from providers or patients who’ve tried either (or both). Which one delivers better results for textural acne scars? What’s the downtime like for each? How many sessions are usually needed? Thanks so much for any advice or experience you can share!

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jennifer Reichel, MD · Answer

With 20 years of experience treating acne scars, I have found that laser resurfacing is almost always the best first step in treatment. Keep in mind that it can take multiple treatments and use of "multi-modalities" to significantly reduce the scars. Also keep in mind that we do not have technology that will completely remove scars. However, they can be made significantly better.  CO2 lasers (I prefer Lumenis Deep and Active FX, but the Tetra laser is also good) are the most aggressive for treatment of acne scars, but I usually reserve them for the "last step" if needed. This is because it usually takes more than one treatment when used as the first step and most patients can not tolerate multiple treatments with the CO2 laser.  
My FAVORITE laser for acne scars is the Fraxel Dual (using only the 1550 Restore wavelength). I use a series of 4 treatments spaced 4 to 6 weeks apart and then the patient and I re-evaluate and decide if that is all that is needed, or if we should do 1. More Fraxel, 2. CO2 or 3. RF microneedling. 
Make sure that you see a DOCTOR for your treatment and that they have access to all of the types of treatment options!

Anna Chacon, MD, FAAD · Answer

Hi there, thank you for your great question, and I’m glad you’re looking into effective options for treating textural acne scarring. Both Tetra CO2 (CoolPeel) and Fraxel Dual are excellent resurfacing technologies, but they work in slightly different ways and can be better suited depending on the depth and nature of your scars.

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