Is full-field erbium laser (Sciton) more effective than fractional C02 for boxcar and rolling acne scars?

Question

I've noticed doctors on YouTube who use a combination of full-field erbium with C02 fractional get much better results than using fractional lasers alone. Why is this combination of lasers not the norm for treating acne scars if it seems to be so much more effective? I've been to several dermatologic surgeons and they all recommend subcision with C02 fractional or Profractional. They don't mention the full-field option. Looking for some insight. Thanks!

Jeff Rapaport, MD · Answer

In my opinion, lasers do not lift scars. This is the reason that people are suggesting subcision or radiofrequency micro-needling to lift your scars. Lasers have the ability to soften the edges and tighten the skin however, if the scars are bound down or tethered they will not lift with a laser alone.

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.
 
As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Davin Lim, MBBS, FACD - Account Suspended · Answer

Agreed that for DEEPER scars that laser do not 'lift' these scars. For shallow scars - sure, erbium fully ablative laser in the correct depth and skin type can help. The objective is to raise scars with procedures such as subcision, TCA CROSS etc.. to the same shallow depth, then ablate with lasers. In your situation, I would attempt subcision first. If you live in CA, Dr Jason Emer is an expert in acne scars, so is Dr Chris Zachary. 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.

Is full-field erbium laser (Sciton) more effective than fractional C02 for boxcar and rolling acne scars?

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Is full-field erbium laser (Sciton) more effective than fractional C02 for boxcar and rolling acne scars?

Answers (3)

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Everything you need to know about CO2 Laser

Our mission is to create a world where every investment in modern beauty is Worth It.