If CO2 Laser for Acne Scar Doesn't Work, Does It Mean Nothing else Will?

Is CO2 the most aggressive treatment for acne scar? If that fails, does that mean the other less invasive laser will also?

Doctor Answers 1

Treatment of acne scars

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With acne or chicken pox scarring the problem is a difference in topography whereby the scar surface is at a deeper level than the surrounding skin. This is due to the active disease process destroying the deeper layers of the skin. Without this structural support the skin caves in in the area creating a depression or pit. The scars are noticeable because of the shadows that fall over them in a fashion analogous to the shadow on a street with tall buildings on either side.

To rectify this you need to raise the street &/or lower the buildings. The best current techniques to do this are to make small incisions around the edges of the small scars without excising any skin. This does not add new scars to the skin surface because the incisions are made within the confines of the acne or chicken pox scar pit. Not every scar is a candidate for this. The scar has to be small enough & the depth of the pit must have enough remaining layers of skin to contract with healing.

As these incisions heal the scar is squeezed by the surrounding healing procees. This causes this skin to pucker-raising the street. About 6 weeks later CO2 or Erbium laser may be used to even out the skin surface under magnification but is not always necessary. Some physicians place a dermal filler to raise the scars but there currently are no very good fillers available although I have had some good results with this technique.

Using laser resurfacing alone only results in a 30 to 60% improvement. Despite this it may take more than one laser resurfacing to achieve the desired improvement. Additionally, the acne would need to be quiescent to carry out this therapy. The treatment can also reactivate acne so close post treatment follow up is called for. I refer patients with active acne to dermatologists as they are better equipped than I to handle active acne. In some cases the depressed areas can be quite large in which case the only advisable treatment is scar excision.

Los Angeles Plastic Surgeon

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