What's the best semi-ablative or non-ablative laser for skin resurfacing, acne scarring, and hypopigmentation?

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

Thank you for sharing your question. There is no miracle solution that will only 4-5 days of recover, but the erbium laser works very well without significant downtime. It is probably the closest  option for what you are looking for. See an experienced Oculofacial Surgeon for detailed evaluation and guidance. Good luck,

I most commonly use fractional CO2 for acne scars, but will use Erbium in some cases. Most laser treatments are going to provide very little improvement if the patient is totally healed within 4 days. Most are going to come with a week or so of healing. In many cases, a series of laser treatments is needed, and most patients will benefit from a combination of treatments including laser resurfacing, microneedling with PRP, filler injections, etc. Be sure to see a physician who specializes in facial aesthetic procedures.All the best,

A combination approach will give the most improvement. These types of scars need a combination of lasers, Cosmelan, microneedling/prp, subcision and fillers. Co2 is the best laser for scars, but Erbium is a great alternative. It may take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Since every patient’s skin is different, I suggest you seek consultation with a board-certifiedfacial plastic surgeon who can take a detailed medical history and exam your skin. Dependingyour goals and skin type, you could be a candidate for fractionated CO2, Deep FX or Fraxel.Acne scarring may respond well to fractional radiofrequency. If you are at risk for pigmentationissues, then radiofrequency should most definitely be considered. Hypopigmentation isespecially concerning. Make sure you seek the advice of a skilled and experienced physician.

The ideal laser resurfacing as with all cosmetic procedures would have no incisions, no pain, no downtime, and perfect results. When a patient attempts to dictate the procedure the result is usually much less than satisfactory. There are many good laser surgeons in the Dallas area. The patient should choose one and have confidence that the surgeon will do his/her very best. Unfortunately there will be recovery, pain, cost, etc.

Really do need a close assessment before committing to a procedure. You options include fillers and less invasive methods like subcision, all the way to lasers. Hypo pigmentation can be treated with latiesse and narrowband or 308 Eximer laser. ReCell can help in a minority of cases. Blending in is the key. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
 

For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 

 

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 

Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

The fractional ablative CO2 lasers have a great track record for improving scars and skin texture, and inducing collagen. Settings may be adjusted downward to minimize down time - or you may opt for multiple treatments - but the results will be less impressive. You need high energy, fractional, ablative for scar treatment. In my practice one treatment with MiXto CO2 at appropriate settings would do the job, but the peeling might not be complete in the first 4 days. Concealer and makeup may be applied on day 3 or 4. The CO2 is the "gold standard" for resurfacing. As mentioned below, there are other options, but this is the one I would recommend. Best wishes.