Dear John,I will try to answer your question without having a photo of your skin and scars available.Fraxel Restore treatments are very effective for most acne scars. Very deep scars may need a combination approach which would include dermal fillers and possibly subcision.To answer your Fraxel Restore question, the more treatments you have the more results you will see. I find that 3 treatments is typically not enough to see a dramatic result. I also find it helpful to compare pre and post treatment photos as often times patients don't appreciate the changes until the photos are compared because the improvement is gradual overtime which is not as easy visualize when one looks in the mirror on a daily basis.When it comes to laser settings, there are three parameters that can be adjusted.1. PASSES. This is typically 8 passes regardless of skin type. Patients who have a low pain tolerance can have more passes, such as 10 to 12 which distributes the same amount of pulses in the end but does so more spread out so there is less pain. 2. JOULES. The greater the Joule count the deeper the laser penetrates into the skin. If one is treating pigment, I will typically set the Fraxel Dual (newer version to the older Fraxel Restore) to 10J and use the Fraxel 1927. For deeper problems, such as scars and deeper wrinkles, I will use the Fraxel Dual 1550 (the old Restore) and set it to 60 to 70 Joules around the cheeks for scars and deeper lip lines. Patients with darker skin color will not need a lower Joule setting.3. DENSITY. The treatment level (density) defines what % of the skin is treated. The higher the density, the more aggressive the treatment. Patients with darker skin should have a lower treatment densities to avoid a common risk of laser, hyper pigmentation. John, in summary, you may want to ask your doctor to increase the depth (Joules) of your treatment as this will add to your results. With patients of darker skin types, I will often go below a treatment level of 8, as low as 5 or 6, with double the amount of treatments to get the same results in the end without the risks. I am attaching an article for your review that demonstrated this approach- go deep, i.e. high Joules, but low on the density i.e. treatment level, double the amount of treatments, safer, with equal results in Asians.Hope this was helpfulRan Y. Rubinstein, MDBoard Certified Facial Plastic Surgery, Newburgh, New York Assistant Clinical Professor, New York Presbyterian HospitalEducation Faculty for Solta Medical- manufacturer of Fraxel, Clear & Brilliant, and Thermage.
