What should the intervals be for fractional laser resurfacing for someone in their 20s?

Question

I want fractional laser resurfacing (non-ablative) for acne scars as well as skin tightening. I am in my 20's and want this to really tighten my skin as much as it can and help acne scars and discoloration. How many treatments would u recommend and at what intervals should I space treatments? I do not have too many acne scars or any that are too deep. Thank you

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

Jason Emer, MD · Answer

This is difficult to answer without pictures, but based on your description, a combination approach will give the most improvement. These types of scars and hyperpigmentation need a combination of lasers, Cosmelan, microneedling/prp, subcision and fillers. It will take a series of treatments and some need life-long treatments to maintain. However, in our practice, we do combined treatments on the same day. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Hratch Karamanoukian, MD, FACS · Answer

I recommend that you see my colleague in Santa Monica for evaluation and consultation. His name is Dr Raffy is a board certified plastic surgeon and skin care specialist

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You’re asking about time intervals between non-ablative laser treatments while in your 20s. You have some acne scars and some pigmentation, but state your acne scars are not very deep.
Without the benefit of a photo and a physical exam, I can offer you some guidance as how I counsel patients who are young like yourself in similar situations. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. We have had various lasers in our practice beginning with the original CO2 lasers in the early 90s. Right now, there are many very well-marketed, popular lasers. One of the things you have to be aware of is a very clear understanding of what kind of expected outcome you can have depending on what type of device or strategy is being employed. 
I think laser companies have done an exceptional job in creating a share of mind where consumers are driven to ask for very specific brands of lasers. I think most physicians would say that you have to be well aware of the science and intention of the device, rather than specific brands. 
Generally, I try to dissuade younger people in doing things that require a lot of thermal energy or anything that would potentially compromise the integrity of their skin long-term. There’s a duality where you want to see a result, you have to be more aggressive. At the same time, if you are more aggressive, then you have more downtime, and you have to justify the downtime for the outcome.
Although you named non-ablative fractional lasers, there are many different modalities that can provide comparable results. This is where the art of doing this type of management for conditions such as acne scars and pigmentation. The laser device enterprise is still dealing with the common issues, but with only one particular category of tools. As physicians, we can use multiple modalities and tools. For example, for pigmentation alone, we can use treatments such as Q-Switch laser that can be modified with different pulse widths to treat different conditions such as stimulating collagen, improving acne scars, and improving pigmentation, which is one modality. There are other modalities such as mirconeedling, platelet-rich plasma (PRP)injection, or a combination of microneedling and platelet-rich plasma (PRP).
Again, generally for a younger person, there’s a certain amount of time and investment that is often a little more cost-sensitive because they’re starting their lives and working. It’s important to deliver good value. That said, you have to ask yourself if your acne scars are not that deep, then what kind of outcome are you going to be satisfied with. 
I would also caution you about the word tightening. Tightening is really not the goal, especially if you are younger. A youthful face is not a tight face.  A youthful face has glowing skin and volume. I would stay away from the concept of tightening, but at the same time understand that whatever modality, if it’s less invasive, you may be challenged to appreciate the full benefit. 
In our practice, for a situation like yours, I would sometimes combine Q-switch laser to treat the pigmentation and to do collagen stimulation. From there, do something for the epidermis such as HydraFacial which is a microdermabrasion using water and glycolic acids. In a way, we’re getting the polishing and stimulating the skin at the same time. It sometimes takes more than one approach to get a good result as opposed to one particular device. 
Learn more about your options. Meet with physicians to discuss these issues. If you end up going to a place where they have lots and lots of lasers, it won’t take a lot of effort for someone to think t we have the best laser for your problem, and not think of other modalities and solutions. I think physicians will have less of a bias, depending on who you go to. Understanding what your issues really are, and what kind of expected outcome is important for you to invest time and energy into pursuing anything. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Davin Lim, MBBS, FACD - Account Suspended · Answer

It really depends on what your skin quality is like NOW, as well as your exceptions and goals. If you are in your 20s, a fractional laser like Clear and Brilliant maybe all you need - one session every 3-6 months, as you age you can step up to a higher power laser, and in your late 30s possibly even consider ablative CO2 fractional - really depends on many factors. All the best, Dr Davin S. Lim. Brisbane. Australia.

Azadeh Shirazi, MD - Account Suspended · Answer

It really depends on the type of factional laser. For example, the Fraxel or the Halo lasers may require multiple treatments, anywhere from 3-6 treatments spaced at 4 week intervals. If we are talking about a fractionated CO2 laser resurfacing, you may need this just once. So really the best approach is to see a board-certified dermatologist to determine the best treatment for your acne scarring and skin tightening.

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