Fractional and CO2 Lasers for acne scars on very dark southeast Asian? I'm about level V on Fitzpatrick (Photos)

Question

I have gotten PRP, Fractora Firm, and have done multiple microneedling sessions at home for the past two years. My boxcar scars have responded well, but my rolling scars, tethered boxscar scars, and icepicks are sill present. I was looking to improve the results via fractional/CO2 lasers done however I'm a very dark southeast Asian (Level V). I've heard that ethnic skin types may receive an HQ regimen beforehand to prevent and PIH. It's a little hard to tell my skin tone with these photos

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

Jason Emer, MD · Answer

A combination approach will give the most improvement. Co2 is the best laser for scars, but Erbium is a great alternative for darker skin types. These types of scars need a combination of lasers, microneedling/prp, TCA cross, punch excision 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

John L. Burns Jr., MD · Answer

Given your Fitzpatrick Skin Type V I would suggest microneedling instead of CO2 laser resurfacing which is likely to result in post inflammatory hyperpigmentation.  I use the Dermapen 3 in combination with subcision and Bellafill to treat acne scars.

Yuly Gorodisky, DO, FACOS · Answer

The Fractora treatment (RF microneedling) may be a safer alternative to CO2. You may also try Sculptra injections. The icepick scars may respond to TCA placed into the scar directly. Go to a few consultations to evaluate your options, but even though improvement is possible, the scars may not ever be completely smooth.

Raminder Saluja, MD · Answer

Thank you for posting your question.  I do not recommend fractional CO2 laser for darker skin types in that the risk of post inflammatory hyperpigmentation is much higher.  The type of treatments I often recommend are: Fractional non-ablative lasers such as 1540, or the Picosure Focus Lens or Infinit which is radiofrequency delivered via a handpiece with microneedles on it.  Straight micro-needling will help, but a more robust treatment may be with the assistance of lasers or radiofrequency.
Hope that helps and best of luck!

Fractional and CO2 Lasers for acne scars on very dark southeast Asian? I'm about level V on Fitzpatrick (Photos)

Answers (7)

Answer: Scars

Answer: Scars

Answer: Fractional CO2 laser and Dark Skin

Answer: Fractional CO2 laser and Dark Skin

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Fractional and CO2 Lasers for acne scars on very dark southeast Asian? I'm about level V on Fitzpatrick (Photos)

Answers (7)

Answer: Scars

Answer: Scars

Answer: Fractional CO2 laser and Dark Skin

Answer: Fractional CO2 laser and Dark Skin

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Recommended reading

Everything you need to know about Fractional Laser

Our mission is to create a world where every investment in modern beauty is Worth It.