Fraxel or Er Yag for Pitted Scars?

i have icepick and boxcar type scars and asked around for prices on different lasers. i want to get the most fo my money, and one dr. told me fraxel for $900 each session with 3+ treatments and another told me YAG for $300 for about 5 sessions. can i get just as good results with the YAG. i dont want to spend more if i dont need to.

Doctor Answers 2

Fraxel laser and acne scarring

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Your acne scarring will not improve sufficiently with only laser treatment.  Mulitple Fraxel Restore laser treatments, one or two more aggressive and more down-time Fraxel Repair laser treatments may work better than a yag laser, but none of these, nor dermabrasion, fully ablative carbon dioxide laser resurfacing and chemical peels would improve the icepick scars tremendously.  In almost twenty years of treating acne scars, I have found that tiny punch grafts work better than excision, puch elevation or puch excision. Subcision works for only some craterform scars, not icepick scars. The CROSS technique of multiple sessions of application of a concentrated TCA (trichloroacetic acid) to the base of the scar may lift it over time by wounding the base and allowing it to heal, but punch grafts are more likely to make the scar fill in flush.  Resurfacing is then done after the punch grafts are done.

Make sure you discuss with your doctor the type of recovery you should expect after  your laser treatment.  Different physicians have different techniques and follow different protocols based on their training and experience.  Also discuss the risks. This is an elective cosmetic procedure that you are choosing to do on your face, don't choose based on price alone. Make sure the physician has great experience and results, and thoroughly discusses the risks and convalescence with you.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Fraxel versus YAG laser for treatment of acne scarring

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First, it is important to consider which type of Fraxel you are referring to. The older Fraxel (Restore) is a fractionated non-ablative laser and the newer Fraxel (Repair) is a fractionated ablative laser.  Fraxel has also come out with a dual wavelength (1550nm + 1927 nm) version of the Restore laser; this is also non-ablative. With the price given as $900/treatment, I'm assuming that you are referring to the Fraxel Restore.

You can get quite a bit of improvement in acne scarring as well as wrinkles with a series of treatments with a non-ablative laser. Non-ablative lasers are also great in that you have very little downtime (you may look a little red for the rest of the day, but, you shouldn't have any areas of open skin).

In my opinion, you can get significantly more improvement in acne scarring in one to two treatments with the fractionated, ablative carbon dioxide laser (i.e. Fraxel Repair) +/- an erbium component (i.e. "CO3" laser).  A downside of this laser is that you have more down-time after the procedure. You will have open areas of skin on the treated sites but when these areas of skin heal ("re-epithelialize") over the 4-7 days following the procedure, the results are pretty spectacular. 

None of these laser treatments are perfect solutions for ice-pick scarring, however. For ice-pick scarring, oftentimes you will either need excision (surgical removal), subscission (freeing up of the "bound-down" scar tissue under the surface of the skin with a small blade), or treatment of the inside of the ice-pick scar with a highly concentrated acid (i.e. TCA in the CROSS method). 

Your best bet would be to find a doctor who is familiar with each of the above techniques. I sometimes perform subscission (to areas of indented, ice-pick scarring) at the same time as the fractionated ablative CO2 (carbon dioxide) laser to maximize the improvement in acne scarring.

Monika Kiripolsky, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 5 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.