Fractional Co2 Laser for Acne Scars on Asian Skin?

Thank you for the question.  Resurfacing lasers have been used to improve the appearance of acne scars for many years.  Some side effects of the traditional CO2 laser treatments have been reduced by applying the energy to the skin in through newer variable density methods called fractional or micro fractional  resurfacing.  Mixto™ SX Micro Fractional CO2 Laser is an example of a resurfacing machine with this new technology.  In experience hands, it is a proven skin rejuvenation treatment that makes it possible to promote healthy, younger looking skin with minimal treatment sessions, rapid healing and thereby less post-treatment down time. A single treatment can show significant improvement in skin texture and color while softening wrinkles.  With your skin type, even the new micro fractional lasers could cause some hyperpigmentation as the darker cells (melanin) is recruited to the skin layers heated by the laser. Due to the fact that CO2 reaches the shallow layers, reduced power settings could still stimulate pigmentation in your skin and would surely decrease the intended effect on the acne scars.  The best method of resurfacing for your skin type will be use of a technique that delivers less heat near the surface and more heat at the deeper levels of collagen production.  You may want to discuss the use of deep micro fractional radiofrequency device such as Fractora™ with your Doctor. Some of these can be effective at reaching the layers important for skin remodeling and sparing the levels that stimulate pigmentation. Unlike the Mixto™ CO2  fractional  laser that delivers results in a single 40-minute treatment , the microfractional radiofrequency  technique might require several sessions. The good news is that there is virtually no social down time following a  Fractora treatment, so it is easy to schedule and maintain your result.

Health and Happiness, Dr. Hester

Fractional CO2 laser treatments are possible in patients with darker skin, but certain precautions need to be taken. As others have mentioned, keeping the power/intensity settings lower and also decreasing the density of the treatments can be helpful to prevent post-inflammatory hyperpigmentation (PIH). Additionally, prepping the skin with pigment-blocking agents prior to treatment and employing them after treatment as well can be beneficial. Finally, prevention in the post-laser setting (SPF sunscreen) is critical.Keep in mind that acne scars are a tough problem regardless of skin type, and skin that tends to hyperpigment makes treating these scars even more challenging. Be sure to see an expert specializing in facial aesthetic treatments to review all of the options in detail.All the best,

Fractional CO2 laser resurfacing is a very good treatment for acne scarring. The small columns made in the skin are very good at stimulating collagen production, which can help with smoothing out old acne scarring. The issue with long wavelength lasers like Co2 is the potential for darkening skin in patients who have Type 4 skin like yourself. In New Mexico I have done a lot of fractional Co2 laser resurfacing on darker skinned patients, and for the most part we have had success in avoiding hyper pigmentation. Of course all patients are different, but here are a few strategies we employ to help prevent this complication.1. First, we select settings on the machine that tend to have reduced density and reduced energy. This is combined with phasing of the treatments to get the total energy into the skin we desire, but doing that over time instead of all at one time. Phasing allows us to get the total energy into darker skin with less risk. In patients who are very anxious about this issue, we can also do a test spot on a first phase of treatment to gauge response to the laser.2. The second part of treating patients at risk for hyper pigmentation is to selectively pre-treat with hydroquinone starting a week or two before the laser treatment. We do this less now but it is still an effective way both before or even after to manage this situation.3. Third, we are very selective about the products used in the post laser recovery process in darker patients. We have seen very excellent results with the Aminoplex/Bio2 line of laser recovery products. I feel the faster one heals and the better the post laser care, the lower risk of hyper pigmentation.4. Finally, the latest addition to our laser treatments in darker pigmented patients is combined use of PRP (TruPrp) with the fractional laser. Here we have noticed a trend to faster recovery, less hyper pigmentation, and better overall acne scarring response to the laser energy, allowing us to reduce settings even further.In summary, darker patients can be layered with CO2 as long as long as the practitioner has good experience with the procedure.