What next when fractional CO2 laser failed to deliver results for acne scars? (photos)

Question

I have undergone 5 fractional CO2 laser procedures so far with each requiring 5-6 days downtime recovery period. Lo and behold I am only able to witness a 10 percent improvement as opposed to the 80 percent promised by my doctor. My pitted scarrings are still very very visible and I need advice on what to turn to next if i do not wish to continue with temporary fillers. I am Asian and prone to hyperpigmentation with a mixture of ice pick and rolling scars.

Thomas A. Pane, MD · Answer

If you have done fractional CO2 without enough improvement, you likely need to consider ablative CO2 laser.  This can be done safely in type III/IV skin although some small variations in the treatment and post-care regimen is likely depending on the clinical experience of your doctor.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Shobhan Manoharan, MBBS, FACD · Answer

I would be inclined to first treat the ice pick scars with TCA CROSS.  This may require 1-3 treatments spaced monthly.  Following that, the options I would suggest would depend on your recovery time.  If you had 10 days down-time, I would suggest full-ablative erbium:YAG resurfacing combined with fractionated CO2 laser on the day.  This may give the more intensive remodelling required.  You will need pre and post- treatment fading, and despite this will most likely end up with some pigmentation, lasting for up to a year.  This will however fade, and the scars will improve, and can be covered with makeup while fading.  You will need to find a laser surgeon experienced with dealing with Asian skin.  If you have less down-time, or not willing to experience the post-inflammatory hyper pigmentation, I would suggest either a course of Fraxel 1550nm or Radiofrequency (we use the e-matrix) treatments.  Also, there are some very exciting results coming through for acne scarring on darker skin with the Focus lens on the Picosure laser (which we have just acquired) which may also suit, with no down-time.  Most importantly, find a specialist who knows how to manage Asian skin.  All the best, Shobhan.

What next when fractional CO2 laser failed to deliver results for acne scars? (photos)

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What next when fractional CO2 laser failed to deliver results for acne scars? (photos)

Answers (3)

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Everything you need to know about CO2 Laser

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