Which laser should I get done? The Fraxel or the Vbeam? (photo)

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi E,The best treatment for acne scars is fractionated CO2 laser, we prefer Fraxel repair laser for our acne scar patients. V-Beam laser is good for red spots. Good luck and be well.Dr. P

I approach these kinds of problems from the inside out, first making sure there is minimal ongoing sebaceous or acne activity. This might involve preparing the skin the 4-8 weeks of retinols, exfoliants and oil control agents. Then one could consider external treatments, such as laser. The V beam is a pulsed dye laser, mostly used for port-wine stains and vascular lesions, not skin resurfacing. A laser that uses controlled ablation would be my first choice and there are many, fraxel being a term used for a particular company.
More than one treatment would be needed in all likelihood, so I prefer a micro-abaltive rather than a fully ablative CO2 laser, which lends itself better to multiple treatments. Non-ablative erbium lasers like the Palomar Lux 1540 can also work, and take 6 or more sessions. In general the ablative lasers give better results, sooner. Pre-treating with a retinol and pigment control agent like hydroquinone helps the healing and decreases the risko f post-inflammatory hyperpigmentation.

Inflammatory acne often leaves many patients red or discolored.  If you still have active acne it should be treated first.  Lasers such as the V-Beam helps with inflammation and redness.  Fraxel laser will treat the scars.  Please consult a board certified dermatologist who is experienced with scar treatments and these lasers.

Judging from your picture there are a number of things going on at once. There is the issue of active acne characterized by nodules and redness, and there is residual scaring. In general, I recommend trying to clear up the acne first before going after the scaring. When it comes to acne concern, there is no magic bullet laser that will rid you of this condition, rather it is best handled with a combination medical therapy using a combination of topicals and systemic prescription meds together with Vbeam for residual redness or IPL with suction extraction such as Acclera or Isolaz. When the acne is controlled, then I go on to treat with Fractionated laser treatment using both CO2 and Erbium modalities. There are a number of equally good devices such as Erbium based Fraxel Repair and DOT CO2 by Deka.