What would be the best laser for pitted acne scars? Would pixel work?

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Report I would suggest Pixel laser it is an FDA-approved fractional skin resurfacing laser that addresses a variety of common skin concerns including aged and sun damaged skin, scars, wrinkles, age spots, and fine lines. It creates small microscopic wounds within the skin that heal and stimulate new collagen production that in turn tightens and smoothes out the skin's surface. Pixel laser can dramatically improve one's skin without significant downtime or discomfort.

Of the three types of acne scars, pitted scars are the most difficult to change with fractional laser treatments - if by pitted you mean box car or ice pick scars. Rolling scars respond best to all treatments, including laser, subcision, filler - followed by shallow box car scars. Ice pick scars, if large, do best with microsurgery, ie punch excision. Smaller ice pick scars can be treated with TCA most of the time. I'm not a big fan of Infini due to the amount of coagulation it causes, but some patients with severe nodular scarring may need it. We have much success as well with PRP microneedling for rolling and some box cars. See someone who has multiple tools.