CO2 fractional laser vs. microneedling for acne scars. (Photos)

Question

Hi there! I'm debating between CO2 fractional laser and micro needling for my acne scars. Micro needling seems a little bit more appealing because of the shorter recovery time. Which treatment would give me the best results?

John L. Burns Jr., MD · Answer

I believe the number of treatments over time is more important than a single aggressive treatment.  Microneedling with PRP can be done less expensively and therefore lends itself better to repeat procedures which is the key to a long term result.

Raffy Karamanoukian, MD, FACS · Answer

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

William Groff, DO · Answer

Scars can be improved considerably, but not always resolved. Instead of wondering which type of procedure to go for, spend some time finding an expert dermatologist who specializes in resurfacing the skin and treating scars. Most of the time, a combination approach that includes both Fraxel or another laser and microneedling works best. Be sure to consult a board-certified dermatologist who will spend time analyzing your skin and coming up with the optimum treatment plan.

Hooman Khorasani, MD · Answer

I appreciate the question and the photos, they are very helpful.  Acne scars can be very distressing and effect how we feel in the presence of others.  I understand that microneedling has less downtime and can achieve good results, but some of the deeper ice-pick scars may not respond. If you are considering a bit more expensive and increased downtime I would consider lasers. I  would recommend that you look into either laser (such as Deep Fx/Active Fx).  As others have stated you will need several treatments so which ever treatment fits your budget and time may be best.  I would recommend seeing a Board Certified Dermatologist or Plastic Surgeon for a consultation prior to choosing.

Daniel Barrett, MD · Answer

Dear Angelamnq,I would certainly have to examine you but in general, treating acne and the scars takes a comprehensive approach.There are a variety of ways to treat the scars .  A good first step is to get on a skin care regiment that normalizes and conditions your skin such as ZO Skin Health.  The next step that is relatively inexpensive is a peel or series of peels.The next step up would be laser resurfacing such as fraxel. Even with laser, some of the "ice-pick" scars still subsist and remain. I've found in my practice that local subscision, using a needle to elevate the scar followed by fat grafting gives the best results for these deeper acne scarsDaniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Lisa Jenks, MD · Answer

I get better results with a series of 3 - 6 microneedling treatments as long as they are combined with PRP (protein rich plasma).  I do make sure my scar patients know that their skin will never be "perfect".  There is no treatment available that gets completely rid of all the scars.  However, a series of microneedling and PRP should significantly improve a majority of the scars.  I recommend that you have a consultation with a physician who specializes in aesthetic medicine.

Laura Riehm, MD · Answer

Thank you for your question.  No one has perfect skin, but you can probably get significant improvement in your acne scars.  We never recommend dermarolling because of the damage it creates.  The needles are placed on a cylinder.  If you think about it, the needles enter at an angle, go straight down and come about out in the opposite direction at an angle.  Instead of putting tiny holes in your face, it is putting tiny slits.  If you do go the needling route, you must use a microneedle in safe and somewhat sterile environment.  This site is filled with stories of weird infections post-microneedle.After a complete consultation in a medical setting, you would probably be a candidate for a several treatment options depending on your skin type, severity of the scars and how much downtime you can take.  Keep in mind that more intense/deeper treatments require more downtime, but you will need less treatments.  If you choose a short downtime treatment plan, you will need more treatments in the series.  The most gentle would be something like the PicoSure FOCUS treatment with almost no downtime.  It is safe for all skin types, but you would probably need 3 to 6 treatments.  Another option would be a fractional 1540 nm laser treatment like ICON or Fraxel.  With these treatment you could have redness and swelling for 1 to 3 days, but need less treatments.  Based on your skin type, you may not be a candidate for a fractional CO2 treatment with 7 days of redness and swelling.  Look for a medical setting with a doctor in house, where they have multiple laser options.  Best of luck.

John Louis Ratz, MD · Answer

You're asking the wrong question. The results are dependent on the skill and experience of the doctor performing the procedure. Hands down, the CO2 laser will give the best results when performed by a skilled and experienced doctor. One skilled in micro-needling, on the other hand, may give you a better result than one without experience with the laser. I also think you should be more concerned about the end result than the time it takes to recover.

Lawrence Broder, MD (license disciplinary actions) · Answer

We recommend both, but we have also seen great results with the Skinfinity RF + Microneedling with PRP, which is the "Time Machine Procedure" minus the filler. The Radio Frequency technology for resurfacing is specifically designed to treat acne scars, amongst many other things. Combining this procedure with Microneedling with PRP gives you those added results, plus less downtime. A series of 3 Microneedling procedures with PRP of course is a great option for acne scars if the cost of RF is too high, but we have definitely seen phenomenal results with the RF so it might be worth looking into. Good luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

If CO2 were to be done, it has to be low density due to your skin colour. This is possible. I would use insulated RF Microneedling and PRP at the same time, as this can speed up your recovery. Insulated RF microneedling has a lesser chance of skin colour changes after the procedure. Regardless, even with combination therapy, you will require 3-4 sessions. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. 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 surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
  
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. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
  
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

CO2 fractional laser vs. microneedling for acne scars. (Photos)

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