In my experience the results of fractional laser therapy have been disappointing. I have personally achieved more consistent and gratifying results using a combination of subcision, fractional microneedling therapy (medical microneedling) or, when deemed appropriate the punctuated phenol peel for treating multiple atrophic acne scars, which appears to be the case here.
Subcision is a simple procedure that uses a needle-like cutting device that is slipped under the scar (under local anesthetic) and moved from side to side in order to break up the fibrous bands of scar tissue. This allows for the surface of the scar to float to the surface and also to promote new, more normal collagen synthesis to fill the potential space created. The result--a much more shallow scar and often significant visual improvement. A decided benefit to this approach is that the results are permanent, since the technique, as was pointed out, is predicated upon the person's own ability to produce new collagen in response to treatment.
When there is an unsightly surface texture to the scar, a series of medical microneedling treatments can be initiated. For relatively small scars, the DermaStamp can be used. This is a small instrument with a series of sterilized needles attached, which may be used, under local anesthesia, to disrupt the surface of the scar, allowing it to reform in a more uniform texture and sometimes color. Alternatively, large areas can be covered more easily and quickly with an automated device used for this purpose known as Dermapen. Occasionally, the area under scarring can be volumized and smoothed, prior to treatment, by the injection, in a fanlike fashion, of a volumizing agent with a high lifting force. This not only gives immediate improvement by stretching and making more superficial the overlying atrophic scars, but also makes the fractional microneedle therapy, easier to perform.
the Punctuated Phenol Peel technique may also be used. With this technique, also performed as a series of treatments, microdroplets of full strength phenol are placed along the scar--leaving intervening untreated spaces (a fractionated approach) from which healing may take more rapidly and with less risk for actually causing a scar.
Most often, I have found that subcision performed alone or combined with medical microneedling is capable of producing quite a gratifying aesthetic improvement.
Finally, some immediate overall improvement and smoothing of the scar might be achieved with the use of a volumizing filler, such as Radiesse or Radiesse combined with Voluma (not yet available in the U.S., although soon to be) injected immediately under the scar to diminish some of that sunken appearance.
Clearly consultation with a board certified aesthetic physician with extensive experience with all these treatment modalities is warranted.