Results of Tradional CO2 Laser for Acne Scar?

I have many acne scars and opted to Deepfx and subcision However, the results are not very satisfactory I wonder if tradional CO2 will give me more Also, sometimes, I came across other patients after full face CO2 their skin texture is quite different and look bizzare Is that the side effects of the full face laser?

Doctor Answers 3

Acne Scar Treatment

  First, please know that acne scars are difficult to treat and often must be treated more than once. Deep FX with subcision is an excellent approach but the results will vary depending on how aggressive the Deep FX settings are.

  I have treated thousands of patients with the traditional CO2 and more recently with fractional CO2. In my hands, there is no doubt that traditional CO2 was/is more effective.

  The biggest problem was loss of pigment. That is the reason for development of fractionated CO2. In some patients, the skin will look shiny in photos shortly after resurfacing because peach fuzz which dampens the flash has been burned off. This effect is only seen in photos and goes away as the peach fuzz regrows.

Austin Dermatologic Surgeon
4.7 out of 5 stars 3 reviews

Results of Tradional CO2 Laser for Acne Scar?

The question you pose focuses on failed acne scar improvement after fractional co2 laser resurfacing. Ablative lasers like Co2 have historically been one of the top platforms for acne scar improvement. The move towards fracrtional technologies has significantly improved many of the common issues with fully ablative technologies of yester-year, namely loss of pigmentation and the "plastic" look that you have found artificial. Now with fractional lasers, we  only treat a certain percentage of the skin, and the reliance is on the skin healing between the small ablative holes these devices make into the skin. For scarring however, this fractional approach may not be enough to improve scarring, hence the need for other options.


I do not agree that moving from ablative to non-ablative fractional lasers will do anything in this situation. The first option i would explore is performing more fractional treatments, up to 3 in a 9-12 month period. I would try and get about 17% coverage on each treatment, with about coverage down to 1500 microns. After the third treatment, we then look at other options if the scars persist. The next technology we have seen very good results with is Ulthera. As a complement to fractional Co2, I have seen very good improvements with acne scarring, especially when one covers the area on the 5-0 plus protocol down to 4000 microns.

If the lasers and Ulthera do not work, we then talk about subcision, but performed in a different way. I use the 1064 SMART LIPO system at 10-12 watts and do a compelte subcutanous undermining of the Acne scarred area, and get the surface temperature up to 40 degrees C. Once this is done, we then inject PRP (platelet rich plasma) into the skin where the Smart Lipo was done. We then leave the skin for about 3-6 months and as a back-up procedure it works well. Hope this helps.

Farhan Taghizadeh, MD
Phoenix Facial Plastic Surgeon
4.0 out of 5 stars 23 reviews

CO2 laser for Acne Scars

Laser resurfacing is one of the best ways to treat acne scarring. Whether to use a traditional CO2, a Fractional CO2, or a non-ablative Fractional laser (Erbium) depends on the patient and their type of scars.

Example of CO2 laser is Lumenis TotalFX (activeFX, deepFX)

Example of Erbium laser is Fraxel Restore

One traditional CO2 treatment may give better results than 1 Fractional CO2. But, the down-time and risks are much more significant. Also, with the TotalFX, you have the option of "tailoring" the treatment so that in really bad areas, you can do a "traditional CO2" and a fractional CO2 in less problem areas.

I have found that a series of 4-6 Fraxel Restore treatments may give equal or even better results than one CO2 treatment.

So, for many of my patients, I will offer the option of an initial series of 4 Fraxel Restore treatments. We then evaluate the results, and decide on whether we want to move to one or more Fractional CO2 treatments. I also have several patients who are undergoing a series of Deep FX treatments. They are getting good results, but the downtime with each treatment is about one week, so it takes a lot of dedication to go this route.  

Finally, If you have considerable pigment in your skin, it might not be safe to use a CO2 laser. It could risk white discoloration to the skin. Find a doctor with a lot of experience and one that has all the tools to treat acne scarring well.

Jennifer Reichel, MD
Seattle Dermatologist
4.5 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.