I'm interested in Fraxel restore or Pearl for some deep wrinkles and mild acne scarring. Any suggestions?

one drs says I must go off the spironolactone as he is concerned the skin won't be healthy and heal properly. Now the other doctor recommending Fraxel says it is of no concern. Any thoughts? And what of smokng. One doc says it doesn't matter and the other will not touch me til I quit for 4 weeks. I am trying to get the four weeks but I keep slipping. Is laser not an option?

Doctor Answers 4

Fraxel for Acne Scarring

There are a lot of great options for acne scarring and in consultation with a board-certified dermatologist or plastic surgeon, you should be able to determine which one is best for you based on how much downtime you can give and the amount of scarring you have. There are now non-ablative fractional lasers that work over time, usually 4-6 treatments in 4-6 months to improve scars with minimal downtime.

There are ablative fractional devices like the ones you are asking about that usually work in 1-2 visits but can have downtime lasting up to a week or so. And now we have RF fractional devices and RF microneedling devices that work really well for scars with less downtime and because they are RF are colorblind and can be used on all skin types. So that is why it is important to learn what is out there and not necessarily rely on one device – options are good and you need to know them all in today’s laser world.

As far as spironolactone, it is not necessary to stop this and I see no need why this would play any kind of role in your laser care. Smoking does cause a delay in wound healing, so not smoking is very important to make sure that you heal the best you can following your procedure. So get the facts and learn what’s out there and have the best procedure for you by the best doc in your area.


Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Treatment of acne scarring.

Acne scarring is a complex condition.  There are multiple types of scars and varying degrees of scarring with each of the scars subtypes.  It is impossible to determine whether laser treatment is the best initial option for your scars without seeing photographs of them.  While I typically am not concerned about spironolactone, there is no question that smoking can slow the rate at whichResurfacing wounds feel.  Again, it really depends on how aggressively the procedure is performed as to what your relative risks will be following a resurfacing procedure.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Fraxel laser for acne scars

Fraxel is a wonderful laser to treat acne scars.  You should be healthy and not be taking Accutane for at least six months to a year.  Spironolactone should have no interaction with the Fraxel laser.  I always advise patients to stop smoking because of the health and skin benefits but it is not a contraindication that you quit for 4 weeks.  Fraxel will help improve the mild acne scarring and mild wrinkles.  Very deep wrinkles may need fillers or more aggressive lasers.  Please consult a board certified dermatologist with experience in lasers for wrinkles and scar treatments.

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Spironolactone and laser

sprionolactone has no effect on wound healing post co2 laser resurfacing.  there is no reason to be of concern. the only medication most physicians worry about is isotretinoin and you should not do any fractional laser until you are off this for 3-6 months.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.