What is best laser to treat past acne scars/large pores while having melasma? (Photos)

.Fraxel treatment improves tone, texture for scarred skin. There is minimal down time and it is designed to see an improvement in just one treatment. Melasma does respond well to the fraxel laser for most patients, but there are some where it may be worse after laser treatments. 

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

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

Profractional  is excellent for the acne scars and can be combined with Halo for any pigment and more superficial problems.  These can be performed with topical anesthesia and a downtime of several days to a week.  For active acne we would make a different recommendation. For acne scars you need deep fractionated laser in addition to the more superficial treatments.

In cases like yours I often like to combine treatments. Devices like vivace which combine radio frequency with micro needling penetrate deeply to help with texture and pores while maintaining safety with melasma. I then approach the pigment and melasma with a lighter fractionated laser like halo or a Pico second laser. This plan takes multiple treatment sessions but works nicely and safely.