Fractional Co2 Laser for Acne Scars on Asian Skin?

I'm a Filipina woman with deep acne scars. A dermatologist recommended a light Fractional CO2. I was told new CO2s are safer. I was classified as Type 4 and I'm afraid of hyperpigmentation. What can I expect from Fractional CO2 treatments?

Doctor Answers 11

CO2 Treatment on Asian Skin

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Any CO2 laser, even fractional, can be associated with side effects. In Asians, we usually are most concerned with post-inflammatory hyper pigmentation which can last for several months if not treated appropriately. All patients should be treated with the appropriate topicals prior to the procedure, and the provider should be familiar with the device and the expectations. There is no such thing as a light fractional CO2 - the depth is determined by the energy used and all devices can be superficial or deep. Most importantly, make sure the provider performing the procedure is skilled and knowledgable.

Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Fractional CO2 Laser Resurfacing on Asian Acne Scar

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I believe the dermatologist recommended light Fractional CO2 because Asian skin has more pigment producing cells (that's why Asians are darker), and when you laser you are causing inflammation which can turn your skin even darker.  The thing is when you turn the laser down to a lighter setting you are compromising potential result for safety.  In the world of resurfacing, the "stronger" the treatment which = more downtime = more result = potentially more risk of hyperpigmentation/complications.  It's a real balancing act, if you would.  You can expect the treated area to be more red initially, then brown, then fading hopefully to your own skin color.  Your skin may or may not peel, depending on the setting.  You may also require multiple sessions.  The best way to judge is to perform a test spot using the treatment setting and then tailor to your individual needs.  There are ways to "pretreat" the skin and prime the skin ready for resurfacing.  These options should be throughly discussed with your provider.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
4.9 out of 5 stars 59 reviews

CO2 laser can be used on Asian skin

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CO2 laser can certainly be done on Asian skin if performed by the right person. However, because each person is different and there is a possibility of hyperpigmentation, it is really important to go to an experienced specialist with a reputable practice. I recommend that you have a consultation with either a facial plastic surgeon or a dermatologist with CO2 experience. Please keep in mind that, depending on the severity of the scarring, there are also less evasive options that you can use (for example, Erbium pixel resurfacing).

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 170 reviews

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Hyperpigmentation is common, and will resolve.

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I treat type 4 skin and above on a daily basis. Here are the facts-

1. Deep Fractional laser is better than 'light' laser
2. We keep the density (coverage low) but go very deep (Fluence or power)
3. PIH may occur, but the use of HQ and or Lytera can reduce the chances of PIH
4. PIH is transient, ie. will resolve in time ( 3-5 months), quicker if you sun protect and use fading agents. The target are the scars- I am results driven and not prevention.
5. As suggested by all the other Specialists, you will need between 3-5 treatments for optimal outcomes. 

To summarise- if PIH or hyperpigmentation occurs, its not the end of the World, the use of fading creams, plus sunprotection can resolve this issue- it is the acne scars that we target. 

Hope this reassures your fears, 

Dr Davin Lim 
Laser Dermatologist

Brisbane Australia

Fractional Co2 can be Performed in Darker Skinned Patients

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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. 

Farhan Taghizadeh, MD
Phoenix Facial Plastic Surgeon

Fraxel For Acne Scars

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Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Fractional CO2 for darker skin and acne scars. Can Fractional CO2 be used for dark skin and acne scars

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Fractional CO2 and chemical peels work wonders for acne scarring in patients of all colors.  In my practice in Santa Monica and Beverly Hills, I recommend the fractional CO2 laser for acne scars and for deep wrinkles.  Patients who have darker skin types, including Filipino and Hispanic skin can benefit from the Fractional CO2 laser, but I would recommend a regimen of Melaquin AM and Melaquin PM before and after the laser session.  Melaquin helps control the post laser hyperpigmentation and allows for a more controlled recovery.  If you have acne scars, you can also benefit from chemical peels and other types of acne surgery, including subcision, punch grafts, and acne excision.  Dr. Karamanoukian.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Fractional CO2 for dark skin individuals

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Hello, I am Dr. Behnam and I am a fractional CO2 specialist. I treat a lot of patients that are darker skin (including type 4), including Asians. One of the most common side effects is pigmentation. It is very important that an experienced physician treats you. The setting have to be lowered. In addition, I have developed a regimen where it minimizes the pigmentation as much as possible. Patients use Bleaching cream for at least one month, then immediately after the procedure they use a special non-hydroquinone bleaching cream for a week, then start the hydroquinone again after a week and add on tretinoin cream 2 weeks later. This regimen in combination with lower setting has practically eliminated pigmentation changes in my practice. You can see some before and after images of darker skin individuals on my website . Remember, a lot of technicians may do CO2 but you want to trust your face to a physician who is experienced and does it all the time. Overall,I think it will work but you may need 2 or more sessions. Dr. Behnam  

Ben Behnam, MD
Santa Monica Dermatologic Surgeon

Fractional CO2 for acne resurfacing in darker skin

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I have treated a large number of non-Caucasian patients with the fractional CO2 laser, including several with very dark skin. It is very important to find a physician with experience in treating darker skin. In any patient where I may be concerned about the possibility of changing the skin pigmentation, I always perform a test spot with the laser and wait 4 weeks to see how the skin responds. If there are no side effects, then I proceed with the laser treatment. In terms of acne scarring, you will likely want to have more than one treatment. Acne scarring can be improved with fractional CO2 laser resurfacing, but because of your darker skin, your treatment should be more conservative to reduce the risk of side effects.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon

Don't Expect Much

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Fractional CO2 Lasers can give some improvement in fine lines and blotchy pigmentation but significant improvement in acne scarring requires much deeper treatments. These deeper treatments are usually performed with traditional CO2 lasers or deep phenol peels. I am afraid that some of the newer lasers have been over hyped by the companies that sell them and utilize this technology we find ourselves in the position of making sure our patients have realistic expectations.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 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.