Erbium laser or ultrapulse CO2 for indented scars?

Question

Hello In the case of slightly indented scarring or atrophic scarring, in expert hands which laser technology is better to smooth out/ blend in a scar which is slightly atrophic? Ultrapulse co2 or erbium? There is so much conflicting scientific information and it seems some experts prefer co2 while others prefer erbium. I am specifically concerned with treatment of a slightly indented scar (not acne!)

Randal Haworth, MD, FACS · Answer

The choice of laser technology for treating slightly indented or atrophic scars can vary depending on several factors, including the scar type, your skin type, and the preferences and experience of the treating physician. Both Ultrapulse CO2 and erbium lasers can be effective for scar treatment, but they have some differences in their characteristics and potential benefits.

Ultrapulse CO2 lasers are known for their ability to deliver precise, controlled energy to the skin. They can effectively target and resurface the scar tissue, stimulating collagen production and promoting skin regeneration. CO2 lasers have been used for many years in scar revision procedures and can provide noticeable improvements in scar appearance.

Erbium lasers, on the other hand, are also commonly used for scar treatment. These lasers are typically considered more gentle and have a shorter downtime compared to CO2 lasers. Erbium lasers work by removing the outer layers of the skin, stimulating collagen production and promoting skin rejuvenation.

The choice between Ultrapulse CO2 and erbium lasers may depend on factors such as the scar's characteristics, the depth of the scar, the expected downtime, and the individual's skin type. Your dermatologist or plastic surgeon, who has expertise in scar revision and laser treatments, will be able to assess your specific case and recommend the most appropriate laser technology for your needs.

I hope this helps,
best of luck !

Juan Guillermo Breton, MD · Answer

Both laser work great for any type of scars, even queloid scars, the issue is that since every patient in different is up to your provider to adjust your parameters depending on your skin type and the scar in which he/she is goin to work with

Mahmood Siddique, DO · Answer

Both Erbium and Ultrapulse CO2 lasers can be effective for treating slightly indented or atrophic scars, but they work in slightly different ways.
Ultrapulse CO2 penetrates deeper and is more aggressive, which can be beneficial for stimulating collagen and remodeling deeper scars. It typically offers more noticeable improvement but comes with a longer downtime and higher risk of pigmentation changes, especially in darker skin types.
Erbium laser is more precise with less thermal damage, making it better for superficial scarring and patients looking for shorter recovery times. It’s often preferred when precision and minimal downtime are priorities.
In expert hands, both technologies can yield good results. The choice often depends on your skin type, scar depth, downtime tolerance, and individual response to treatment. For slight atrophic scars, Erbium may be sufficient, but Ultrapulse CO2 could offer more significant collagen stimulation if more aggressive treatment is needed.

Nadir Qazi, DO · Answer

Both Erbium and CO2 lasers are powerful tools that can effectively address atrophic scars and improve skin texture. The choice between the two depends on various factors, including the specific characteristics of your scar, your skin type, and your individual preferences.

Erbium lasers are known for their precision in targeting the water content in the skin's tissue. They work by removing thin layers of the skin's surface, promoting collagen production and stimulating skin rejuvenation. Erbium lasers are generally considered to have less thermal damage to surrounding tissue compared to CO2 lasers, which can result in a quicker recovery time. They are often favored for treating lighter skin types and less severe scarring.

Ultrapulse CO2 lasers deliver high-energy pulses of light that can effectively resurface the skin. They can be used for deeper resurfacing compared to Erbium lasers, making them a suitable choice for addressing more severe scars and skin irregularities. CO2 lasers promote collagen remodeling and skin tightening, leading to a smoother and more even skin texture. However, they typically require a longer recovery period due to the more extensive tissue removal.

For slightly indented scars, both Erbium and CO2 lasers can potentially yield positive results. It's important to remember that individual responses to treatments can vary, and the effectiveness of either laser will also depend on the skill of the practitioner performing the procedure.

Before undergoing any laser treatment, I strongly advise seeking out a reputable and experienced practitioner who can thoroughly evaluate your scar and create a tailored treatment plan. A thorough consultation will help determine which laser technology is best suited to your specific scar type and provide you with a clearer understanding of what to expect in terms of results and recovery.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Before considering any of the supposedly "next big thing," relatively expensive light and energy-based devices out there, many of which are here today and gone tomorrow, you might wish to consider subcision, a simple and relatively inexpensive technique for elevating and smoothing all kinds of indented, atrophic scars (from all causes) that has a nearly three decades' long track record for both safety and efficacy in all skin types. Since there is essentially no cutting or procedural work done on the the surface of the skin, there is essentially no concern for the kinds of scarring and hyper or hypopigmentation adverse reactions that can be seen with lasers. Nor, unlike as can be the case with lasers, is there any significant downtime following subcisions. According to a recent article entitled, "The Dangers of Dr. Google...there's also plenty of questionable and inaccurate info floating around out there. Even facts can be presented in a misleading way...The unregulated nature of social media means that users can be vulnerable to unsubstantiated claims--there are no editors fact-checking posted content." So, there is little surprise that you are confronted with conflicting information.  You would be wise to consult with a board certified cosmetic dermatologist. Best of luck.

Milan Shah, MD · Answer

Both Erbium laser and Ultrapulse CO2 lasers can be effective for treating indented scars. Erbium lasers are known for their precision and ability to resurface the skin with minimal heat damage. Ultrapulse CO2 lasers, on the other hand, are more aggressive and can penetrate deeper into the skin, stimulating collagen production.The choice between the two depends on factors such as the type and severity of scars, skin type, and individual preferences. Consult with a skilled healthcare professional to determine the most suitable option for your specific case.

Erbium laser or ultrapulse CO2 for indented scars?

Answers (7)

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