Fraxel Repair Vs. Pixel Laser - Which Works Better on Acne Scars?

Question

Hi,  I'm interested in getting some laser resurfacing done on my face and I'm thinking about going with the Pixel laser. How well does the pixel laser work on acne scarring? What's the recommended amount of times needed?  Does Pixel work better than Fraxel repair?

Joel Schlessinger, MD · Answer

In my opinion, acne scars are a very challenging problem and most patients do poorly with laser treatments.  Sometimes, just a visit to a good dermatologist can do more than any laser.  The biggest thing that I see when people come in for a laser consult is that they haven't gotten their acne under control.  Doing a laser without getting the underlying problem fixed is the worst thing that you can do.
Lasers work for a very limited type of acne scarring and usually provide no more than about 20 to 30% improvement at best.  Fillers, on the other hand, can provide some real improvement.  Make sure you are getting the right thing as 80% plus of patients who come to me for laser for acne scars end up doing something different (and loving it!).

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

Michael A. Persky, MD · Answer

Hi scubasteve,
I have had very good experience with treating my patients acne scarring with Fraxel re:pair.  I have not had any experience with Pixel, but from those who have, I have heard that it is not as effective as the re:pair.  Good luck and be well.
Dr. P

Daniel Shapiro, MD · Answer

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Jacob Freiman, MD, FACS · Answer

Both the CO2 and Pixel lasers are excellent modalities for acne scarring. I suggest seeing a dermatologist for ACTIVE acne but for the scars, see a plastic surgeon certified by the American Board of Plastic Surgery since reconstruction of scarring is our specialty and we can offer many modalities. Anyone offering less should not be dealing with the problem.

	If the pits are small and do not require excision, I prefer the Erbium (Pixel) laser since I can regulate the depth with precision and minimize surrounding thermal damage. Fillers are another option but beware; you will have to repeat them every 6 months.

Purvisha Patel, MD · Answer

The technology with both lasers is good. They are both ablative devices that poke microholes in the skin to wound/cause healing from the inside out. The treatment outcome depends on the settings used. In the right hands when done correctly you will likely get the results you desire with either device. Evaluate with your cosmetic physician which one would be better for you.

Jeffrey C. Poole, MD - Account Suspended · Answer

Acne scarring is a very difficult problem to treat, and generally requires mutiple different therapies for best results.  Currently, fractionated laser resurfacing is one of our most effective technologies for acne scarring.

	Both the Pixel CO2/Omnifit and the Fraxel Repair utilize the most potent resurfacing laser, the 10,600 CO2, combined with the safety of our current fractionated technology.  While the specifics of each laser differ a little, I think you should expect comparable results between the two.  A common treatment range is 1-4 treatments spaced 3-6 months apart-- with most patients doing best with 2-3 treatments.

	Actual treatments can vary greatly depending upon your severity of scarring, types of scars, skin type and tolerance for risk/benefit.  Be sure to consult with a physician you trust who is Board Certified in a field such as Dermatology or Plastic Surgery to discuss the treatment that is right for you.

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