Fraxel vs CO2 Laser for Acne Scars

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!

Doctor Answers 5

Fraxel is very good for acne scars

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I have found Fraxel to be the safest and best single procedure for treating acne scars.

Other modalities can also be useful in the overall treatment plan, but Fraxel has supplanted everything else we use since it came along a couple of years ago.

Nothing, including Fraxel, is "miraculous" for acne scars, and one needs to have reasonable expectations of what can be done.

Schenectady Plastic Surgeon
4.6 out of 5 stars 13 reviews

I use both

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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

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Fraxel vs. CO2

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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.

Both Fraxel and CO2 Laser work well for acne scars

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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!

Tomi L. Wall, MD
Oakland Dermatologic Surgeon

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.