Are TCA peels or CO2 fraxel lasers better for pebblestone papular scars on whole face? (Photos)

Question

I used 0.01% tretinoin for my acne and it worked wonders but I suppose it also gave me almost whole face of pebblestone scarring due to overproduction. I lowered my dose to 0.025% and use it more sparingly (I can't stop using it since if I don't use it 3 days I get couple of pimples on the 4th day). I feel like they don't get bigger or more in number but I don't know how to get rid of them completely. I think they are too small and too many for steroid injections.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question, and I'm glad your acne has improved.  Which procedures to have done will depend on your skin type (coloring and amount of pigment), lifestyle, and skill and experience of your provider.  I would recommend a consultation with your dermatologist who might have some suggestions for you.  Both fractional CO2 laser and deeper chemical peels can be useful for acne scarring, but it depends on the patient and you wouldn't want to risk any worsening or pigment issues if you choose something too aggressive for your skin type. Please see an expert, and best of luck!

Are TCA peels or CO2 fraxel lasers better for pebblestone papular scars on whole face? (Photos)

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