PicoSure or Fraxel for acne scarring and hyperpigmentation?

Question

Not sure which of these two lasers to go for, been offered treatments with both. Picosure is a fairly new treatment, but apparently its more effective and has no down time. Sounds too good to be true, but there is more information regarding fraxel. Which do you think is better for treating acne scars and hyperpigmentation?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

Jason Emer, MD · Answer

A combination approach will give the most improvement. These types of scars need a combination of Cosmelan, lasers, microneedling/prp, subcision, salt facials and fillers. It may take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Monika Soni, MD · Answer

I use both lasers and they both yield great results. It all depends on your condition. It is hard for me to tell you which one is better for you. I usually use combination of treatments to achieve best results, beside laser it is important that your provider determines other treatments that may be benefitial to you such as TCA CROSS peel, fillers, microneedling, etc. Fraxel is used for more severe acne while Picosure is used for early acne scars. Either way I would advise you to wait for newer scars to heal as much as they will before proceeding with treatments. The best advise that I can give you is to make an appointment with experienced provider and get examined so you can receive personalized treatment plan for your own condition.

Bruce E. Katz, MD · Answer

Thank you for your question. It’s really hard to say without photos. However the PicoSure laser has been developed and approved for tattoo ink removal, acne scars and any other blemishes you dislike. The PicoSure is FDA-approved and highly effective for removing regrettable tattoos and scars. Typically, one session for the face is about 10-15 mins. I recommend getting a in person consultation with a board-certified dermatologist.

Hardik Soni, MD · Answer

I use both lasers and they both yield great results. It all depends on your condition. It is hard for me to tell you which one is better for you. I usually use combination of treatments to achieve best results, beside laser it is important that your provider determines other treatments that may be beneficial to you such as TCA CROSS peel, fillers, microneedling, etc. Fraxel is used for more severe acne while Picosure is used for early acne scars. Either way I would advise you to wait for newer scars to heal as much as they will before proceeding with treatments. The best advise that I can give you is to make an appointment with experienced provider and get examined so you can receive personalized treatment plan for your own condition. Good luck!

David E. Berman, MD (retired) · Answer

the pico is the newest state of the art laser and it is very helpful for acne scarring. it will also cause much less redness than the Fraxeldavid berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

If you have early and mild scarring in darker skin type, then Picosure Focus can be an excellent treatment. If you have more severe scars than Fraxel maybe used. One can also combine both treatments in the same day, depending on the Fraxel wavelength. Both pico and Fraxel and improve hyperpigmentatoin, however pico IMO is better than Fraxel in this setting. Acne scar revision is a specialised field. For the best results, one should target the acne scar type with ideal treatments. The video link below will take you to a resource. I embedded all the videos in one page to help.

For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgery.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars.

All the best,

Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

PicoSure or Fraxel for acne scarring and hyperpigmentation?

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