Which laser do I need to repair previous deep fraxel laser scars from 7 years ago? (Photos)

Thank you for your question and for sharing your photos and treatment history. I understand the frustration that comes with persistent skin texture changes and unsatisfactory outcomes from prior procedures. Based on your photos and description, here are my thoughts:

1. Understanding the Current Skin Condition:
The visible textural changes, wrinkling, and linear scarring—particularly in the perioral and lower face regions—are consistent with dermal atrophy and post-laser fibrosis from previous deep resurfacing.

The combination of Myorisan (isotretinoin) use and deep Fraxel treatment could have contributed to delayed healing or exacerbated scarring if the skin barrier was compromised at the time.

The fat transfer, while intended to restore volume, may have led to contour irregularities or failed to integrate properly, especially if underlying scarring or inflammation was present.

2. Recommended Laser Modalities:
To improve the texture, lines, and scarring, a carefully selected resurfacing strategy is needed. Here are the safest and most effective laser options for your case:

A. Fractional Ablative CO₂ Laser (low-density, high-energy)
Best suited for deep lines, wrinkles, and scarring in photodamaged or previously lasered skin.

Must be used conservatively given your history of prior laser burns.

Fractional CO₂ lasers such as Lumenis Ultrapulse (Active/Deep FX) or Fraxis Duo allow for customizable treatment depth and density.

This would likely yield the most dramatic improvement in skin texture, especially when combined with proper pre- and post-treatment care.

B. Er:YAG Laser Resurfacing (e.g., Sciton Contour TRL)
An excellent alternative for more precise tissue ablation with less thermal damage than CO₂ lasers.

Suitable for thinner, fair skin types and useful for treating perioral wrinkles without over-treating the surrounding areas.

Can be adjusted for both full-field and fractional treatments.

C. Radiofrequency Microneedling (e.g., Morpheus8, Genius, Sylfirm X)
A non-laser option but effective for dermal remodeling, especially in scarred or previously treated skin.

Less aggressive than lasers, with a lower risk of further pigment or texture irregularities.

Can be combined with fractional lasers in staged treatment plans.

3. Key Considerations:
Aggressive resurfacing (like full-field CO₂) should be avoided in patients with previous burns or scarring unless done with extreme caution by a specialist in laser dermatology.

A test spot or small area trial is strongly advised before treating the full face to evaluate how your skin responds, given your past laser sensitivity.

Skin priming with retinoids, antioxidants, or barrier repair may be recommended pre-treatment, and strict sun protection post-treatment is critical.

Summary:
Given the extent and chronicity of your scarring and the visible fine wrinkling, a fractional ablative laser—either CO₂ or Er:YAG—performed by a highly experienced practitioner would be the most appropriate first-line treatment. This should be paired with careful assessment of skin thickness, healing history, and risk factors. Depending on the response, secondary treatments like RF microneedling, PRP, or resurfacing maintenance can follow.