Is Mixto Fractional CO2 Laser Effective for Acne Scars?

Fractional CO2 laser such as Mixto, Total Fx, Fraxel Repair delivers CO2 laser energy via pixelated fashion where effective resurfacing and collagen remodeling can take place with typically one week of downtime. However, moderate to severe acne scarring may benefit from punch excision of ice-pick scarring ahead of time and multiple treatments may be necessary 4-6 months apart for severe acne scarring or for ethnic skin where the energy and penetration of the laser cannot be too aggressive to minimize post-treatment pigmentation.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Mixtor Fractional Laser and Other Treatments for Deep Acne Scars

As severe acne scars, isolated or generalized, involve a deep scar process that extends to the deep dermis and sometimes even deeper it would be unusual to see dramatic differences after a single Fractional CO2 laser treatment. Realistic expectations are important and one should expect improvment but not total correction with each treatment. In my own experience I have not found a significant difference in results between a Fractional CO2 treatment and the Obagi Blue Peel. Dermabrasion and Ablative lasers including confluent CO2 lasers are more helpful but have the significant increased risk of permanent hypopigmentation and post inflammatory hyperpigmentation. It takes several months to see the full effects of collagen remodelling. Severe isolated acne scars can be improved at times with surgical undermining or even excision by a plastic surgeon.

I agree with my colleague completely. I would add that because of the leap forward that the Mixto and similar fractional CO2 lasers represent, it is safe and acceptable to consider a second treatment if necessary.
For acne scarring patients, a second treatment gives a significant added improvement.

Mixto fractional laser resurfacing works beautifully to help reduce scarring caused by acne. This CO2 (carbon dioxide) laser helps to deliver a precise matrix of Microspots that penetrate to the dermis and stimulate the formation of new collagen. At the same time, immediate shrinkage of damaged tissue is achieved.
The Mixto improves pigmentation problems, reduces pore size appearance, wrinkles, acne scars, and other textural irregularities. The laser has an additive effect and many patients will notice greater improvement when they have multiple sessions.
Compared to traditional skin resurfacing, clients experience less downtime and are more comfortable during the procedure. It is unlikely that anyone procedure will completely smooth the skin from acne scars but my patients have noticed an improvement ranging from 30-60 %.

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

I have used the Mixto Micro fractional CO2 laser on acne scars as well as chickenpox and trauma scars in over 300 patients since 2007.  I have found about a 50% reduction after one treatment. In the past 2 years, I have started using a proprietary combination of another laser first then using the Mixto Microfractional laser at the same time, followed by a customized skin care program can reduce these scars up to 85% with only one treatment.  I also agree that excision of deep ice pick scars before the laser helps achieve superior results

I would like to add that MiXto SX Micro Fractional Laser is particularly effective for treatment of skin conditions such as fine and coarse wrinkles, raised or unsightly scars (such as from acne scarring), uneven pigmentation and dilated pores. Deep pits and depths caused by acne can be reduced signicantly for smoother, tighter skin. My patients have identified the elimination of fine wrinkles, sun damaged skin, acne scars, brown on the face and hands as an important part of restoring a youthful appearance.

I have performed Mixto Laser on several patients with superficial acne scars and there is a noticeable difference.
However, usually more than one treatment may be required for the best result. Mixto Laser is not as effective for deep (ice pick) acne scars. Other treatments such as excision and dermabrasion may be needed in addition to Mixto Laser.