What sort of results can I expect with Picosure for acne scars and are the results permanent? (photo)

Question

Hi, I have acne scars from my teenage days (see pic). I avoided fraxel as I was worried about pigmentation (as I have a wheatish complexion) but picosure has emerged as a great alternative. I was wondering if the results with picosure are permament? and what sort of results can i expect? Can I expect a 50% improvement say over 4 sessions? Thanks

Harold J. Kaplan, MD · Answer

Hello W.  Picosure is not the right type laser for your your situation.  Q-switched lasers like the picosure are very good when it comes to getting rid of sun damage and getting mild skin rejuvenation (collagen stimulation).  Your acne scars are deeper (icepick) and you will not achieve much benefit (if any) using this type of laser.  
Fractional laser resurfacing is a much better option for you, albeit usually more expensive and definitely with recovery time associated with it.  When our patients that really need fractional laser resurfacing ask about "non-ablative" lasers like the Picosure, we usually encourage them to save their money and vacation time for the right procedure, fractional laser resurfacing.

Laura Riehm, MD · Answer

Thank you for your question and posting a picture.  (Dr. Kaplan below appears to be confused that PicoSure is not a q-switched laser).  No one has perfect skin, but you can probably get significant improvement in your scar.  Some lasers are proven very effective on acne scars.  Surgeons really like to work with knives.  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 scar 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 for both scars and sun damage.  It is safe for all skin types, but you would probably need 1 to 3 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 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 and experience treating your scars.  Prices vary by market.  Best of luck.

Davin Lim, MBBS, FACD - Account Suspended · Answer

I do use Pico lasers, even in the most powerful setting of 0.71 using the 6 mm spot size, this laser is less than ideal for the treatment of established scars. Much more effective methods. I only have one before and after of Pico lasers in the context of acne scars. I know the initial papers showing to replicate fractional lasers, however as a Key Opinion Leader for Cynosure - the maker of Picosure, I DO NOT ENDORSE this laser for acne scarring, with the exception of mild, early scars in Ethnic skin types. This laser is one of the best for skin rejuvenation in type 3-6 skin, and gives great pore size reduction with minimal downtime. Not every laser is perfect, hence I use over 30 energy devices to get the job done. 
Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  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.
As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.
 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. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

What sort of results can I expect with Picosure for acne scars and are the results permanent? (photo)

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What sort of results can I expect with Picosure for acne scars and are the results permanent? (photo)

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