I have PIE - Would CO2 laser help reduce acne or would peels and microneedling be more effective? (photos)

Question

Currently struggling with leftovers from my acne. My derm recommended be CO2 laser but here at realself many doctors say it is bad for people that have PIE. Therefore, I would like to ask if this is the right procedure or if peels or microneedling would be more effective for me.

Nelson Lee Novick, MD · Answer

C02 laser treatments, much like dermabrasion, is a relatively expensive, aggressive treatment, that works by more deeply abrading off the top layers of the skin, and hence poses a real risk for the development of scars and for the subsequent development of hyper or hypopigmentation problems, particularly in individuals with skin of color. Other simpler, less expensive procedures, such as subcision for elevating and smoothing indented scars and TCA CROSS for ice pick scars each has a several decades' long proven track record of safety and efficacy in all skin types. You would be wise to exercise a great deal of "buyer beware" caution when being hawked all kinds of "bells and whistles" lasers and other gizmos whose hard science to support their use lags woefully behind the heavy marketing and social media hype to promote them. You would be wise to consult with a board certified cosmetic dermatologist who can help you both to control acne breakouts, as well as treat any scarring that has already occurred. Hope this helps and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

I have PIE - Would CO2 laser help reduce acne or would peels and microneedling be more effective? (photos)

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