How dramatically can the Co2 laser improve my skin? Had severe acne breakouts when I was younger. (photos)

Question

I had severe acne breakouts when I was younger and had a lot of cystic or nodular acne. Eventually I was put on accutane after nothing else worked. The treatment worked but now I have severe acne scars and wrinkled skin. I don’t smoke or drink. I do however have a small keloid on my chest. I’m curious as to whether or not the Co2 laser would achieve the results I want. I’m 23 years old and 5’4” and I weigh 110 pounds if that matters. I also wanted to use the laser in combination with Bellafill.

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Dima Ali, MD · Answer

Thank you for your question. The good news is there are so many laser/energy based technologies that are truly amazing for acne and acne scarring. However, it's often not one treatment modality that's needed to achieve the desired results. Much depends on the type of scar. You are fair enough to have aggressive CO2 resurfacing if you are prepared for the downtime. If not, you can also consider treatments with little recovery that are radiofrequency based. Often I will combine 3+ treatments on the same day: RF, Laser, PRF, microneedling, a chemical peel, subcision and fillers. The bad news is that the results take time and multiple treatments. There is no quick fix (unless you have minimal atrophic scarring that can be fixed with a temporary or permanent filler). Hope this helps! Dr. Dima

Farhan Taghizadeh, MD · Answer

Dr. Taghizadeh recommends treating Acne scars with CO2 laser to stimulate collagen production in and around the scar in combination with neurotoxins to reduce the pull to the scar. As well as Bellafill

Jason Emer, MD · Answer

CO2 is the best laser for scars, but Erbium and Halo with Profractional are great alternatives. It may take a series of treatments to see improvements and to maintain. Keep in mind that a tailored combination approach will give you the most improvement with acne scars. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​

Nelson Lee Novick, MD · Answer

First, close up photos of the scars that bother you and a photo of the chest keloid would have been helpful. From what can be seen, at least of the forehead and glabella region between the eyes, the scars seen would be amenable to simple subcision to elevate and smooth them, and the forehead worry lines could be improved quite simply by the use of Botox (or other neurotoxins) to diminish the forehead muscular movements responsible for their development combined with the injection of a cohesive, low viscosity HA filler for the static lines that have already formed. Both of the aforementioned are quick, nonsurgical, relatively inexpensive and engender little to no significant downtime. By contrast, CO2 laser is a relatively expensive procedure, that, like dermabrasion, engenders significant downtime and carries risks for permanent scarring, dyspigmentation, etc.  And permanent fillers are ill-advised, as well, since they have the potential for eventuating into distressing adverse reactions, such as nodules and granulomas soon after treatment, but even five, ten or twenty+ years later. So, be very cautious in what you research on Drs. Instagram, Tik Tok and YouTube, as most of what you find there is from non-professional influencers, companies selling their products, rather than from true professionals. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck and Happy New Year.

How dramatically can the Co2 laser improve my skin? Had severe acne breakouts when I was younger. (photos)

Answers (5)

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