CO2 or Infini for acne scars, which one has a better result? (Photos)

Question

I have very serious acne scars and one side is even worse than the other. I was considering taking Infini but I was told that the CO2 would give me a better result because my acne scars are deep. The Infini treats shallow scars better. Is that true? I’ve had CO2 or something similar for 5 or 6 times. Sometimes it worked and sometimes it didn’t. I’ve never tried the Inifini before so I wanted to give it a try. Will I really get a better result with the CO2?

Jason Emer, MD · Answer

Acne scars need a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  Best, Dr. Emer.

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

Nelson Lee Novick, MD · Answer

Given the heavy advertising and the marketing out there, I am not surprised that you phrased your question as basically which device will be better for me, rather than which treatment or combination of treatments would be best for me. I have been writing for years cautioning readers about "bells and whistles," "next big thing" machines and products, like fraxels, radiofrequency devices, and PRP, which appear to be far more backed by device and product manufacturer supported marketing and advertising hype than any hard science. Subcision is an excellent means for elevating sunken (depressed, indented, atrophic) scars, but generally two to four treatment sessions are required per scar to achieve optimal improvement and done on multiple levels within the scars. Unfortunately, I need to emphasize that no scar older than three months, from any cause, including those from acne, can be completely eliminated with any current technology, although significant improvement is possible. Like you, the vast majority of people with acne scars typically have a combination of all the major types of acne scars, including boxcar scars, rolling scars, and pit scars. For best results, each type of scar requires its own treatment or combination of treatments.Less expensive tried and true treatments, on the other hand, such as "field subcision," for treating generalized facial atrophy;  individual subcisions wtih a biostimulatory filler (for deep rolling and boxcars);  TCA CROSS Technique for ice pick scars and very narrow boxcar scars; and medical microneedling for blending any residual, superficial color and texture problems that have followed these other treatments, have been shown to more consistently yield gratifying improvements. A series of superficial peels can help to fade and improve the postinflammatory pigmentary changes that may be present.  For more information on these, you may do an internet search under the above terms or check out the archives of RealSelf.com  Make sure that you do your due diligence in finding a good board certified aesthetic physician and not simply anyone or any place hawking its latest expensive fraxel or radiofrequency device purchase. Best of luck,

Jeff Rapaport, MD · Answer

In  my opinion, both infini and CO2 fractionated laser are excellent for medium depth superficial scars. We utilize both in the same session. To get the deeper and tethered scars, subcision and PRP is performed. I believe the infini provides more "lift" than the CO2 fractionated laser, but not as much as the subcision with PRP. Acne scars are treated based upon their type and therefore you need to see an acne scar expert who will determined which treatment is appropriate.

Kimberly Finder, MD · Answer

I've used fractionated CO2 laser for many years for acne scars and I've also used Infini RF in recent years. I'm very impressed with Infini RF. In my experience Infini RF is far superior. But Infini is more for the mid to deep dermis and I also use LaseMD thulium laser simultaneously for more superficial coverage and find that this combination is very effective.

William LoVerme, MD · Answer

In the past we proceeded from mechanical dermabrasion to CO2 laser for acne scars of the face. Infini or Radiofrequency microneedling has given us a whole new tool in treating acne scars. A combination approach is often best. CO2 laser can treat deeper scars but has significant healing time. Infini has much less or really no downtime and seems to treat the more shallow scars in a better way. Most people have a combination of scar types and therefore need a combination of treatments. If you have already had multiple CO2 treatments it may be time to try Infini.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Firstly, its about the Specialist and NOT the device. I can get good results with even an old erbium laser, or phenol peels, however in this day and age, we now know that combination treatments work best. I would personally perform subcsion as the primary modality, followed by Infini (or Co2), depending on the amount of fibrosis. If your dermis is thick, and fibrosis is prominent I would use CO2 or even Intensif as the solenoid of Infini will not penetrate the dermal layers. Scar revision is ALWAYS bespoke, and tailored to the patient. Its never about choosing between one or two devices. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 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, PRP 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 surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
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. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best,

Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

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