Fraxel vs CO2 Laser for Acne Scars

Question

I have a small area on my cheek with a few shallow atrophic acne scars. I've had a TCA peel (35%) and full face Erbium. Dermatologists say it isn't bad enough for C02 but haven't been dramatically improved with other options. They are now offering Fraxel. But I'm afraid that they offered it because it’s new and expensive.  I'd rather do 1 shot with C02 rather than 5 with Fraxel. Are there real benefits to Fraxel, other than relieving people of a few days downtime? I don't think that's worth it. Picture isn't that accurate. Thanks!

Ron Shelton, MD · Answer

Unfortunately, as you stated, the photo is not as revealing as the examination your physician can perform. I understand your position of doing one treatment with CO2 but we do often find that acne scars improve more with multiple Fraxel treatments than one CO2. Statistically it appears that there is more risk of scarring with CO2 or Dermabrasion than with Fraxel RE:store. You can consider one Fraxel RE:pair but we have less long term data with this more invasive laser. The end results of Dermabrasion and CO2 are often thinner and paler skin. Multiple Fraxel treatments usually do not cause lightening or thinning. Some patients receive continued improvement with more treatments than 5 with Fraxel Re:store. Another advantage with Fraxel RE:store is that segmental areas can be done without treating the whole face, so if your scarring is limited to one area, then the treatment might take less time and be less costly than a whole face treatment. This can not be done with CO2 as it would leave lines of demarcation within your cosmetic units and the difference in color and texture would be noticeable.

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

Joshua L. Fox, MD · Answer

The Fraxel has a better safety profile as well
as significantly less social downtime.The C02 is better than the Fraxel at treating some conditions, but
regarding the type of acne scarring I see from your photo, I’m not sure C02
would be a better choice.

Tomi L. Wall, MD · Answer

I have both lasers and use and like the results with both lasers. I initially thought that Fraxel would not be strong enough to work on acne scars. However, I have been seeing better and better results, especially with the right treatment parameters. Now, I believe the results can equal those of CO2 in some cases.

	The benefit of Fraxel is definitely less downtime, but also less risk of long term permanent discoloration (hypopigmentation) and less infection risk. The benefit of CO2 is definitely less treatments needed and added benefit for deep wrinkles if you have those also. I think the decision should be yours based on this information.

	Good luck!

Mary P. Lupo, MD · Answer

I have both Fraxel Restore and Active/Deep FX in my office and use both for acne scars. I really actually like Fraxel Restore better, and I am not prejudiced since I have both. There is no contest, however, for wrinkles. Active/Deep Fx is vastly superior to Fraxel Reatore. Good luck.

	PS The TCA was a waste of time for those types of scars.

Fraxel vs CO2 Laser for Acne Scars

Answers (6)

Answer: Both Fraxel and CO2 Laser work well for acne scars

Answer: Both Fraxel and CO2 Laser work well for acne scars

Answer: I use both

Answer: I use both

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Everything you need to know about Fraxel Laser

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Fraxel vs CO2 Laser for Acne Scars

Answers (6)

Answer: Both Fraxel and CO2 Laser work well for acne scars

Answer: Both Fraxel and CO2 Laser work well for acne scars

Answer: I use both

Answer: I use both

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Recommended reading

Everything you need to know about Fraxel Laser

Our mission is to create a world where every investment in modern beauty is Worth It.