Why have my pores and acne scars gotten worse after my 2nd Fraxel session? (Photos)

Question

I've gotten fraxel twice now. The first time around, my skin looked awesome as it healed. I got the 2nd session 4 months later, but the doctor went "stronger" and went over my skin multiple times (more than he did the first time - almost too much) and now my skin looks WORSE. My acne scars look even more noticeable than it did before AND my pores have gotten bigger. My skin looks worse now than ever. WHY DID THIS HAPPEN? AND IS THIS SUPPOSED TO HAPPEN? PLEASE HELP. What should I do now?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Hooman Khorasani, MD · Answer

Thank you for the post. I am sorry your acne scarring is worsening.  You should see a dermatologist to address underlying active inflammatory acne which may be contributing to scarring.  Treatments include topical agents, oral tablets and light based treatments such as PDT.  Once the acne is under control, your atrophic scars can be addressed.  It looks like you have ice pick, rolling and box car scarring.  You have Asian skin and need a combination bespoke multimodal approach.  The best treatment may involve subcision and microneedling with PRP along with an injectable filler using a "tower technique'.  Sometimes TCA cross helps and sometimes resurfacing lasers help.  Given you are Asian, a conservative / low energy approach is needed and meticulous pre and post treatment care is needed (with strict sun protection, SPF 50 products and sometimes hydroquinone / retinoid based agents). I hope this helps.

Monika Soni, MD · Answer

fraxel induces local damage and stimulates microinflammation during the healing process so its not surprising to see the skin flare. Please go back to your doctor, he/she may be able to give you some medication to reduce the acne flare. Use a topical that is non allergenic. Your skin will heal eventually and will look better than before.

Michele S. Green, MD · Answer

I am so sorry that your acne scars appear worse than before.  I would definitely consult an expert in acne and acne scars.  Perhaps you can start with an oral acne medication to reduce the inflammation. I prefer the eMatrix laser for acne scars and Asian skin.  Please keep us posted.  Best, Dr. Green

Neil Sadick, MD · Answer

its hard from the pics to advise, for example how long after the treatment where these pictures taken. did you apply anything to your face after the treatment, like aquaphor?
fraxel induces local damage and stimulates microinflammation during the healing process so its not surprising to see the skin flare. Please go back to your doctor, he/she may be able to give you some medication to reduce the acne flare. Use a topical that is non allergenic. Your skin will heal eventually and will look better than before. Good luck!

Why have my pores and acne scars gotten worse after my 2nd Fraxel session? (Photos)

Answers (5)

Answer: Acne Scars and Fraxel

Answer: Acne Scars and Fraxel

Answer: Post Fraxel acne flare

Answer: Post Fraxel acne flare

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Why have my pores and acne scars gotten worse after my 2nd Fraxel session? (Photos)

Answers (5)

Answer: Acne Scars and Fraxel

Answer: Acne Scars and Fraxel

Answer: Post Fraxel acne flare

Answer: Post Fraxel acne flare

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Recommended reading

Everything you need to know about Fraxel Laser

Our mission is to create a world where every investment in modern beauty is Worth It.