What laser options should I go for? (Coolpeel co2/fontana erbium/eco2)

Question

I have grade 2 acne scars, mainly on my cheeks. I have a combination of small icepicks, boxscar/ uneven textures and tethered rolling scars. I'm a type 4 skin. Doctor 1 recomeneded 3 or so sessions of fontana erbium laser. His reason is that this should be able to treat the mild scar without the risk of hyperpigmentation. They also have eco2 laser on offer. Doctor 2 recomend 2 sessions of coolpeel co2 (with stronger intensity on particular spots/scars) and then subsision with fillers.

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

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Nadir Qazi, DO · Answer

Considering your skin type and the variety of acne scars you're dealing with, both Coolpeel CO2 and Fontana Erbium laser treatments are potential options worth considering. Coolpeel CO2 offers controlled ablation, targeting the outermost skin layer for resurfacing, while Fontana Erbium focuses on deeper tissue for collagen remodeling. These lasers can address different aspects of your scars, including texture and pigmentation. Doctor 1's recommendation for Fontana Erbium is a conservative choice for your skin type, prioritizing hyperpigmentation risks. On the other hand, Doctor 2's Coolpeel CO2 approach, followed by subsision and fillers, might provide comprehensive results by addressing both texture and volume issues. It's important to consult with both doctors to understand their strategies thoroughly and choose the treatment plan that aligns best with your goals, skin type, and comfort level.

Nelson Lee Novick, MD · Answer

I think a strong word of "buyer beware" caution is in order here. Just because the so-called light and energy-based  "bells and whistles" gizmos out there are expensive and have catchy names doesn't necessarily mean that they are really much more than just a whole lot of marketing and advertising hype and social media buzz. The fact is that the hard science to support the use of any of these devices lags woefully behind the hype and economic incentive to promote them. On the other other hand, subcision, which I have been using with gratifying results since 1995 has a proven track record for both safety and efficacy IN ALL SKIN TYPES for elevating and smoothing boxcar and rolling scars. Similarly, TCA CROSS, another relatively inexpensive technique which I have been using for over twenty-three years, has a proven track record of safety and efficacy IN ALL SKIN TYPES for ice pick scars. You would be wise to consult with an experienced, board certified cosmetic dermatologist acne scar specialist. And still another word of advice. Rather than requesting specific treatments that you may have learned about from Drs. Google, YouTube and Instagram, let the consulting doctor suggest the treatments because all too often, to their own later regret ("buyer's remorse"), patients frequently get what they ask for. Hope this helps and best of luck

What laser options should I go for? (Coolpeel co2/fontana erbium/eco2)

Answers (4)

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