Fraxel isn't doing the job, need some other solution. What should I do and how much would it cost? (Photo)

2-3 years ago I had my first fraxel non ablative done. Since then I've had 5 treatments for my acne scars. Nothing has so far worked. What should I do and how much would it cost?

Doctor Answers 3

A new & alternative laser treatment (to Fraxel) for deeper acne scars in darker skin types

From the photos it appears that you have a darker skin type.  Patients with Asian, Indian, Spanish, or African American backgrounds have more limited options.
Deeper acne scarring is best treated via a combination of subcision and aggressive CO2 fractionated laser resurfacing (i.e. Fraxel Repair).  The problem with darker skin types is that they are at a greater risk for hyper, and even worse, hypopigmentation and scarring after such resurfacing.  This leaves the option of non ablative skin resurfacing, at lower settings, often 10 to 15 monthly treatments to achieve dramatic results over time.  Filler injections would also help some of the deeper scars.

There is however a new treatment on the horizon, using the Precision Tx laser from Cynosure.  Its the same laser that is used for the Cellulaze procedure to permanently reduce cellulite.  Cellulite is similar to acne scars in that its caused by vertical contracture bands pulling the skin inward requiring subcision of these bands and thinning of the skin dermal layer.  A small puncture is made in the cheek or temple the size of the tip of pencil, The Precsion Tx 800 laser, which  is side firing, can be introduced under local anesthesia thru this opening, so it can be used to subcase the acne scar and also heat the dermal layer directly by firing the laser upward without burning the skin.  There is minimal to no downtime.

There is a plastic surgeon in NJ who was instrumental in developing the Cellulaze laser who has been using the same technology to treat patients with moderate to severe acne with darker skin types with dramatic results.  I have also started using this on my patients and this may turn out to become the preferred treatment choice in darker skinned individuals in conjunction with non ablative skin resurfacing. 

Good luck in your search and don't give up.

Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York

Board Certified Facial Plastic Surgeon (ABFPRS)
American Society forLaser Medicine & Surgery (ASLMS)
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for:
Allergan (Botox, Juvederm, Voluma), Galderma (Scultpra, Restylane, Silk),
Cynosure (Cellulaze, Precision Laser Lift) & Solta (Fraxel, Thermage)
Zeltiq( CoolSculpting)


Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 152 reviews

Fraxel and deep acne scars

When you have severe acne scars the Fraxel and the eMatrix are the best treatments for these acne scars.  Since you have had five treatments you may need to have some of the scars plumped up with fillers or Sculptra and/or dermabrasion to complete the process.  Please consult an expert in scar treatments for the best results. 

Fraxel isn't doing the job

  Of course Fraxel isn't doing the job.  You have very deep acne scars.  To treat this, you need deep facial resurfacing, not the light to medium treatment provided by fractional CO2 lasers.  I recommend deep facial resurfacing and I favor a Hetter Resurfacing Procedure done by a physician experienced in these procedures.
I don't think your dark complexion is an issue as I have a lot of success in treating patients similar to yourself.   see the bottom of the web reference page for photos. Good Luck!

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 116 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.