Laser Skin Resurfacing - Pros and Cons?

There are several laser available for the treatment of acne. If the correct laser is used, it is usually a good way to improve acne scars. In general...Pros:1) Moderate improvement of acne scars2) Evening out of skin tone3) Tightening of skin4) Improvement of wrinkles5) Removal of sun damage6) Removal of brown marks and age spots7) Improved pores 8) Appearance of slight elevation of cheeks9) Increase healthy collagen production10) Adds overall glow to skinCons:1) Hyper or hypopigmentation 2) Small risk of scarring3) Mild discomfort during or after procedure4) Possibly not fully correcting the problem5) Multi-modality may be required

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Laser skin resurfacing can work very well to improve acne scars. Keep in mind that all acne scars are different, and some might respond better to other procedures like dermabrasion, filler injections, scar excision, microneedling, etc. In many cases, a combination of treatments is used to achieve the best possible results. Also know that acne scars are very difficult to completely eliminate, but can almost always be improved through a multi-faceted approach.The pros of laser resurfacing for acne scars are that significant improvements are possible through a series of treatments. Also, laser resurfacing can help to improve the overall appearance of the skin by improving wrinkles, creating subtle tightening, improving pigment issues, and improving overall skin quality and texture by stimulating collagen production.The cons are that the procedure can be uncomfortable in some cases and may require anesthesia. There is also some down time involved, post-procedural care required, and the skin will be sensitive post-procedure. There are also risks of pigmentary changes, scarring, lack of improvement, and need for future treatments, but these are uncommon when performed by an expert.Laser resurfacing can be an outstanding way to improve one's overall facial appearance and is something that we recommend and perform routinely in our practice.All the best,

The numbers of different lasers that exist for facial resurfacing seem endless. Gentle lasers such as Clear&Brilliant, PicoSure focus, LaserGenesis can be done for mild textural change and Fraxel Restore / Dual for moderate changes in lines, acne scars, texture, pores and Fraxel  Repair carbon dioxide laser and others are done for deeper lines and scars and tightening.The doctor performing laser resurfacing won't have just one laser for all skin conditions, or skin types. I 

Acne scarring can be a tricky problem that is resistant to treatment. The pros of laser resurfacing are that it is one of the single most effective treatments and that it undeniably improves the structure and function of your skin via inducing new collagen formation. The cons are that there is a variable amount of downtime after the procedure depending on what type of laser treatment is selected and that the results tend to take months to fully come in. The optimal way to treat acne scarring is using multiple different modalities – including ablative and non-ablative lasers, minor surgical procedures such as subcision, radiofrequency and ultrasound devices, and injectable fillers – to achieve the best result. Patience is the key as the treatments are sometimes best done in stages and improvements come in gradually over time.

Acne scars are not all equal. Some are nodular, others inflammatory, while others may be ice-pick like. Laser skin resurfacing using a fractional CO2 laser is very effective for scars. Atrophic scars can be resurfaced in combination with dermal fillers or Sculptra. A ResurFX treatment using an Erbium Glass laser is also very effective but may require 4-5 treatment sessions. 

LASER resurfacing has changed over the last 10 years.  As technology has improved, LASER resurfacing has changed from a deep, fully ablative procedure with significant risk for side effects, to a more targeted solution with much less risk for side effects such as hypopigmentation, hyperpigmentation, or scarring.

LASER resurfacing can be effective in skin texture, discolorations, acne scars, fine lines, and deep lines.  The key here is to chose the right combination of LASER procedures and protocols designed for you based on your unique skin anatomy and goals.

The use of resurfacing lasers for acne scars is one of the best options provided your skin does not have too much ethnic color present.  If you have a lot of “color” or pigment irregularity, the risks are increased.  This is why a consultation with a Board Certified Dermatologist and Plastic Surgeon are critical for a thorough evaluation.  Treating acne scars requires a deeper treatment so the risks change.  Use of the eMatrix is also good with acne scars and is a little more pigment friendly than lasers. When performed in the right hands, acne scars can improve.

Scars resulting from cystic acne are depressed and anchored to the underlying tissue. A CO2 laser, which can be the most aggressive treatment, may produce a small amount of skin tightening and decrease the thickness of the skin somewhat, but it will not release the anchored scar. Therefore, any improvement will be modest.

Laser resurfacing these days is almost entirely fractional resurfacing and particularly this is the case for acne scarring which typically responds best to Erbium fractional like Fraxel and Palomar 1540 among others. Why is fractional a good idea for acne scarring?

Repeated sessions are tolerable (as opposed to more painful CO2)
Erbium lasers cause collagen rebuilding
Downtime is minimal
Low risk of infection

Repeated sessions allow new collagen to form beneath the scars and around the scars so the surface plane of the skin becomes more level.
It is, however, next to impossible - so far - to completely obliterate acne scars. One reason is that there has been significant tissue loss and tough fibrous tissue from the scar makes it less susceptible to collagen remodeling.