Deeper Laser Treatments for Acne Scars?

I have worked with the Profractional laser for quite some time, and have kept up with innovative uses across the country. In my office, my skin care nurses provide superficial depth treatments to 300 microns, and I perform those that go deeper.
Acne scarring is difficult, because it involves deep dermal elements. Multiple users, including myself, have been increasing the depth of Profxnl treatments to remodel the scarring. Empiric evidence have suggested at least 500 microns, and even up to 700 microns in thicker skin regions like the cheek or chin, in order to be effective. Temple skin is treated a bit less aggressively. I still counsel patients that two to three treatments must be expected. With those treatment parameters, the results have been impressive, even after prior skin resurfacing like C02 or conventional erbium. We also pretreat the skin with a 20 micron microlaser peel just before the profxnl treatment in order to improve the standardization of depth, and minimize the profxnl pattern while healing. Density setting is always 11 %, and coag is usually 1.
I don't feel it's appropriate for an aethetician to use the laser in this range. Find a physician in one of the core disciplines of derm, facial plastics, plastics, or oculoplastic surgery to perform this treatment.
Bleaching cream is recommended, and in my practice with your skin type would be deemed imperative.
Good luck.

Anytime a patient will undergo a deep laser profractional treatment, or even a microlaser peel we always like to pretreat the patients skin.  Anytime we have a darker skintype it is mandatory to pretreat with a bleaching agent 4-6 weeks prior to their laser procedure. This not only helps prevent any burning to the barrier layer of the skin, but it also helps diminish any pigmentation issues if that's what the  patient was trying to treat. It may even help the healing processes post laser. For you being a skintype four, the esthetician is being very cautious with her settings but she can probably increase it to 300, and may do spot treatments for the deeper scars.  

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

To address Acne scars, the depth of treatment needs to be about 800 mincrons. To tolerate this, (as it can be painful), you would need to have some oral pain relievers as well as some nerve blocks. these are not typically done by an esthetician. Bleching cream pre-treatement and post treatment is always a good idea for any client with pigmented skin.

You may have a darker skintype based on your reported ethnic backgorund and a bleaching cream would be prudent. As for the depths I do not think you should press your esthetician any further. You will likely carry a higher risk than others with side effects and you need to be treated by someone comfortable with your skin type and the laser being used. If the esthetician is working under a doctor then discuss your concerns with the doctor (assuming they are board certified in a skin specialty such as dermatology, plastic surgery, facial plastic surgery etc ) Otherwise, you may be wasting your time and money if your acne scars are deep and your settings are not.

To answer your question, yes, you need to go much deeper than that. Most Specialists will be able to assist you, especially those who have experience in treating darker skin type. I usually laser 2-3 darker skin types (type 3 and above) on a weekly basis. The deeper you go the better the results. I personally will go down to 600-800 or even 1000, but keep coverage at less than 11%, no coag. You may darken, but like you said using HQ or lightening creams can help. I would do treatments 3 months apart. Hope this helps, Dr Davin LimLaser and Cosmetic DermatologistBrisbane, Australia

I agree with your instincts, deeper treatments are required to improve acne scarring. Although you may have surface irregularities in the texture of the skin, the scarring process occurs within the deeper dermal zones. The beauty of the Profractional Laser is that treatments can be delivered safely to the deep dermal tissue. I don't believe 175 micron depth at 8% coverage is taking full advantage of the equipment and not likely to maximize the benefit. Perhaps those parameters were chosen to test your reaction, but if tolerated, you'll benefit from deeper treatments in the future.
I'd also urge you, however fair your skin, to pre-treat with hydroquinone, or other agent to block pigmentation. Your background would predict a tendency to pigment with skin injury.....do you tan at all in the sun?....are your eyes brown? I might bypass the pre-treatment phase on a blond patient with blue eyes, if both her/his patients were blond with blue eyes as well, but not otherwise. We like to treat aggressively, but take all precautions to avoid the complications that aggressive scar treatment might cause.