My doctor recommended CO2 laser for my acne scars - advice? (Photos)

Question

My Dr recommended me CO2 for these scars I have already taken 3 subcision and 9 rf micro needling session kindly recommend me these are taken in angel light

Nelson Lee Novick, MD · Answer

I have successfully been employing subcisions, both individual and Field Subcisions, for treating acne scars for nearly thirty years. The kind of extensive acne scar-related cheek atrophy seen in the photos would NOT be expected to do much to improve the overall appearance. So, no surprises at the lack of success with this approach. A Field Subcision, properly performed, that treats the entire cheek is much more likely to yield the desired overall improvement in the overlying scars. 
Microneedling, which I have been performing for nearly a quarter of a century, is best reserved as a "polishing" step for treating any residual, superficial color and textural abnormalities, AFTER more appropriate acne scar treatments have addressed the major problems. It is not a particularly useful primary treatment for acne scars, as you have unfortunately found out the hard way. What's more, when microneedling is employed, manual microneedling, instead of RF microneedling, avoids the added expense and added risks of the RF approach.
CO2 laser, much like old-style dermabrasion, is simply an aggressive, ablative, destructive process of essentially skin sanding that typically engenders significant post-treatment downtime and has risks for scar. And besides, it does nothing for restoring the atrophic volume loss responsible for the sunken cheeks.
You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist acne scar treatment specialist before wasting more time and more money. Hope this helps and best of luck.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Yes, CO2 laser treatments can be effective for improving the appearance of acne scars. This type of laser works by targeting the deeper layers of the skin, promoting collagen remodeling and encouraging skin renewal. After multiple RF microneedling treatments, which can also enhance skin texture, adding CO2 laser can further refine results, particularly for deeper scars. The treatment can help smooth out the skin surface and improve overall tone. I hope this helps and best of luck!

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

Anna Chacon, MD, FAAD · Answer

Hello,

Thank you for sharing your concerns and photos. CO2 laser treatment can be an effective option for improving the appearance of acne scars, especially for those who have not achieved the desired results with other treatments like subcision and RF microneedling.

CO2 lasers work by creating controlled micro-injuries to the skin, which stimulates the body's natural healing processes and encourages collagen production. This can lead to smoother and more even skin texture over time.

Here are a few considerations and steps you might want to take:

Consultation with a Specialist: Ensure that the CO2 laser treatment is performed by a board-certified dermatologist or a highly experienced laser specialist. Given your history of multiple treatments, a thorough assessment by a specialist is crucial to tailor the treatment to your specific skin type and scar characteristics.

Pre-Treatment Preparation: Follow any pre-treatment guidelines provided by your doctor, which may include avoiding sun exposure, discontinuing certain skincare products, and possibly using topical preparations to prime your skin.

Post-Treatment Care: Adhering to post-treatment care is vital for optimal healing and results. This typically includes avoiding sun exposure, using gentle skincare products, and following any specific instructions from your doctor to minimize the risk of complications.

Realistic Expectations: While CO2 laser can significantly improve acne scars, it's important to have realistic expectations. Multiple sessions may be required to achieve the best results, and the degree of improvement can vary.

Risks and Downtime: Be aware of potential side effects, such as redness, swelling, and downtime associated with CO2 laser treatments. Discuss these with your doctor to ensure you are fully informed before proceeding.

Given your treatment history and the nature of your scars, CO2 laser could be a beneficial next step. However, personal evaluation by a specialist is essential to determine the most appropriate and effective treatment plan for you.

Best of luck with your treatment journey!

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