East Asian with fitzpatrick skin type 4: I have moderate to severe acne scarring that pretty much covers most of both my cheeks. The scarring is pretty broad in that it covers large areas of my face and gives a rolling look to the skins texture.
Fraxel Restore or Repair, Which is More Suitable for Me?
Doctor Answers 4
Fraxel restore for acne scars
It is likely that the Fraxel restore will be a better option for you. Rolling scars respond to treatments that build collagen under the skin over time - the restore laser will do this. I often combine it with punch excisions and CROSS procedure using 90% TCA for any ice pick scars. I don't think the Fraxel re:pair laser is better for acne scars unless there are a lot of ice pick or wider box car type scars that may also benefit from excision.
Asian skin is very dangerous to treat so see a very skilled Board Certified Dermatologist or Board Certified Plastic Surgeon for therapy. Much lighter levels are needed or hyperpigmentation will occur. Be cautious and be patient. I see many Asian skin laser complications because they are not treated at the proper levels.
Treatment of acne scarring
For patients with moderately severe acne scarring, I find that subcision of depressed scars and excision of ice-pick type or severely depressed scars is the best approach to start with. I have been treating acne scars using a variety of techniques including traditional laser resurfacing, nonablative fractional lasers, ablative fracitional lasers, injections, and surgical techniques for more than 15 years. I find that a combination of surgical excision and technology-based treatments provide the best outcomes. There is no single treatment that will give the best ultimate result. Treatment of acne scarring is more of a long run as opposed to a short sprint. That said, it is extremely gratifying to see peoples' lives change as they gain new self confidence related to the improvement in the appearance of their acne scars.
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I have both the Fraxel Repair and Fraxel Restore Lasers. They are very different.
The best treatment in my hands for contoured, rolling scars is a combination of subcision and Fraxel repair lasers. With Asian skin it is necessary to protect the skin from the sun while healing until the color is back to normal which could be several months. Asian skin is much more likely to hyperpigment following this procedure, so total sun avoidance is essential until completely healed. The Fraxel Restore laser will give some improvement after multiple treatments, but never as good as a single Fraxel repair treatment combined with subcision.
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