Does Palomar Laser Work Well on Acne Scars?

Question

Palomar lux 1540 non-ablative laser treatment has a 24-48 hrs downtime. Do you think it is a good choice for treating acne scars  such as ice pick and boxcar scars? Does it give the same results as Fraxel restore and repair?

Joel Schlessinger, MD · Answer

No laser, even the more invasive ones, will treat scars well. There can be some improvement, but I never encourage people to expect too much from lasers for acne scars in general. Additionally, it is important to remember that most clinicians recommend at least 4 treatments with this particular laser in order to achieve the most optimal results.

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

Daniel J. Givens, MD · Answer

For icepick scars, other techniques such as TCA CROSS may be more effective.  For rolling and boxcar scars, the 1540 is a great laser.  A series of 3+ treatments is often necessary for a noticeable improvement.

Laurie A. Casas, MD, FACS · Answer

Hello,The 1540 non-ablative Palomar fraxel laser is a good option for acne scars with minimal downtime. Pulses of light energy break down scar tissue, causing new tissue that is lighter in color and more even in texture to form in its place. New collagen develops, resulting in smoother looking skin. It works on any skin type, from very light to very dark skin. A simple procedure, it can take just 30 minutes per session; most people need three to five sessions for optimum results. Patients can usually resume their normal activities immediately following the session, making this a simple procedure to schedule. There is little to no downtime.For deeper scars, some patients need 1540 laser treatments in conjunction with filler. Good Luck.

Rebecca Fitzgerald, MD · Answer

Fractional lasers for acne scars will improve the surface of your skin by creating first a controlled "injury" which then causes a collagen response.
The theory (an reality) behind multiple sessions is that over time you have repeated collagen stimulation and improved skin smoothness.
As to which fractional lasers are best, sometimes it is a matter of market exposure. Palomar has some of the most extensive research and development but less marketing exposure.
In any case, no laser has yet proven to remove acne scars completely so recognize you will get improvement as opposed to removal of your scars.
Fraxel Restore is an erbium laser which superheats the treated columns of skin. Fraxel Repair is a CO2 laser which vaporizes the columns so you have a more intense recovery. Most scar patients opt for the less downtime (and expense) of the fractional NON-ablative lasers such as the Palomar 1540 or Fraxel Restore

Shelin Tkatch, MD, FRCSC · Answer

In our clinic we have had great results diminishing acne scars with the use of the Palomar 1540, delivered as a series of 3 treatments, micro needling delivered in a series of 3-6 treatments, and C02 ablative laser, delivered as a single treatment. Work with a provider who has expertise in a variety of treatment choices to help you choose the one most appropriate for your skin type, type of acne scarring, desired downtime, and budget. If your expectation is that you should see an improvement in your skin texture, rather then a complete absence of scarring, you will very likely be happy with your outcome.

Jennifer Ahdout, MD, FAAD · Answer

There is no magical laser to erase acne scars, rather we have tools to reduce their appearance. The Palomar Lux 1540 has the benefit of reduced and manageable downtime. You need a series of treatments, more like 4-6 sessions spaced 3 weeks apart. This modality works better for shallow scars, not the deeper ones.

Tal T. Roudner, MD, FACS · Answer

The Lux 1540 works for more shallow acne scars. It requires at least 4 treatments separated by at least 3 weeks apart. The results are more noticeable over period of 6 months after the last treatment and may require future treatments.

	The mechanism is by creating a pixilated column of coagulated (liquefied) soft tissue that is replaced by new fresh tissue that produces new collagen and elastin the main components of healthy skin.

	For Ice pick scars the best results are from surgical excision.