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

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

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

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.

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.

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!

A common misconception is that you cannot laser non-Caucasian skin. This is simply false. At our Beverly Hills practice, Dr. Obagi and I routinely laser patients with similar acne scarring to your from all backgrounds, skin colors, and ethnicities. We consistently obtain great results. Why? A thorough understanding and anticipation of the pigmentation response is important in order to control and prevent it. You have deep acne scars and will require a combination approach of subcision, fillers, and laser resurfacing with C02. The scarring will improve significantly but will not go away completely and its important to have realistic expectations. But you, as many of our patients are, will be pleased with the results. 

Acne scar revision is a specialised field. For the best results, one should target the acne scar type with ideal treatments. The web reference below will take you to a resource. I embedded all the videos in one page to help.Given your skin type, I would prefer microneedling and subcision over lasers.
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.