If Fraxel laser didn't improve the acne scars on my face/chest/shoulders/back, will CO2 fractionated laser give better results?

Question

I've suffered with acne scars for years. Had ablative laser resurfacing about 15 years ago for scars on face, which helped. However, I'm unhappy w/the scars on my chest, upper back, and shoulders, which are hypo-pigmented. Some of the scars (basically atrophic) are depressed & others are flush w/skin & tend to crinkle if I raise my shoulders (if that make sense). Did multiple test spots on shoulder & chest w/Fraxel but NO results. I'm told that CO2 Fractionated may yield good results. Thoughts?

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

Mark Karolak, DO, FAOCO · Answer

Acne scar treatment is usually best
suited to a combination of therapies, especially when the scars have multiple
symptoms (textural, color, and depth), as yours do.

My first step is very often to treat the surface depth irregularities.
This can be achieved with surgical techniques, or subcision (needle releases
the skin from bottom and filler/fat helps lift it up to the same level as the
surrounding skin).

With areas of high movement, such as along the collarbone and chest, you
will need to be cautious about any treatments involving excision due to the
stress that may be placed along any excision lines. This could lead to scarring
that is even worse.  Subcision may be
better suited to these areas.

Next, pigmentation is usually best treated with laser therapies.
However, I wouldn’t use a CO2 laser here (at least not to treat the pigment).
Instead, I would recommend fraxel Re:Store Dual or possibly a Vbeam laser.

Finally, if you have areas with textural issues, Radio Frequency
MicroNeedling or a series of fractional laser resurfacing treatments (like
fraxel Re:Store Dual), may help.

That may seem like a lot, but the right physician should be able to
develop and guide you through an appropriate treatment plan that is best suited
to your type of scarring.Please
select a physician with all of these therapies at his/her disposal, and a
strong background in acne scar treatment.

Jason Emer, MD · Answer

I suggest a formal consultation with an expert for a combiatnion approach. I find that fraxel often isnt always the best option especially when someone has a lot of ice pick scars.  I think a formal consultation is requred.  Best, Dr. Emer.

J. Kevin Duplechain, MD, FACS · Answer

Treatment of   acne scars off the face are going to be more difficult to treat. If the scars are depressed, subcision and fat grafting will enhance the effect of CO2 resurfacing.  I would anticipate the need for a couple of laser treatments, as  it is unlikely that a single treatment will fix the problem.

Shobhan Manoharan, MBBS, FACD · Answer

The further from your face you go, the harder the scars are to treat.  I suspect you had fraxel dual with the 1550nm wavelength, which we often do use for scarring, but produces moderate responses over a series of treatments.  I often use it as a low down-time procedure for facial scars, rejuvenation, stretch-marks and non-facial scars.  A fractionated CO2 device (such as Fraxel Re:Pair or the Syneron CORE) may produce more significant results, but have a lower threshold for complications and a higher down-time.  See an experienced laser dermatologist or plastic surgeon for your best treatment combination.  Best wishes, Shobhan.

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  There are multiple Fraxel devices out there, I suspect you may have tried the Fraxel Dual.  Yes, a fully ablative laser, like a fractionated CO2 should give you better results, but again I would proceed with test spots as you did previously.  Other options include Infini, and even Laser Genesis.  Regards, Dr. Matt Elias

If Fraxel laser didn't improve the acne scars on my face/chest/shoulders/back, will CO2 fractionated laser give better results?

Answers (6)

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