Severe acne scars. What's best: Fraxel Dual, Infini, or CROSS? (Photo)

Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited. You should stay out of the sun 2-4 weeks.

Ideal treatment for acne scars depends on the type of scarring you have.  It's somewhat difficult to tell from the pictures provided, but you would probably benefit from combination treatment with Fraxel and microneedling with PRP and/or fillers.  Acne scar therapy can be difficult and it is important to find a provider who has ample experience in treating many types of acne scarring.

It sounds that you have been through a few of the more conservative options for acne scarring. Everyone has a different threshold for when to move to something with a longer recovery period. I will say that the results of TCA cross, Fraxel Dual are good for the right patient. Depending on your skin laxity and the depth of the scars (hard to tell exactly from the photos), it is hard to say exactly what kind of results to expect for you. I generally recommend for patients that have gone through multiple modalities such as you have, with persistent scarring, that they should also consider dermabrasion for residual acne scarring (not to be confused with microdermabrasion). The downside is downtime, the cost is similar or often less, and if you can take that extra time to recover (2-3 weeks), I find the results to be quite dramatic. The alternative with shorter recovery time would be your fractionated CO2 ablative lasers. Otherwise I would find the other options equivalent - with results depending on the comfort of the surgeon performing the procedure. Good luck!

I would suggest you continue with more Fraxel laser treatments (1550nm) to get the best results.  Combining Fraxel with PRP injections for scars has also been very effective for me and can reduce significantly the number of laser treatments you may need.  You can spot treat resistant ice pick scars with CROSS which I have found very effective in that situaion.  Depending on your skin colour, switching to an ablative fractional laser (such as Pearl Fractional) would decrease the number of treatments you need but increase the down time with each treatment.  Hope this helps.

Acne scar revision is a
specialised field. For the best results, one should target the acne scar type
with ideal treatments. 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, 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. I think of all the treatments, for YOUR scars, INFINI followed by dermal filler will give you the best results- in that order. 



All the best,

Dr Davin Lim

Laser, surgical &
aesthetic dermatologist

Brisbane, Australia