Acne Scars, Fraxel Co2? (photo)

I have gone to a couple consultations and been told different options. The last place which I feel I trust told me I need two fraxel co2treatments. My issue is, is that I have zero idea of what to expect as an outcome. 20% 50% etc... I understand no one is the same, but I feel someone qualified in this can provide a range. I would also like to know what realistic risk the co2 laser could have on me. I provided pretty accurate photos. I appreciate any help I can get! Thank you

Doctor Answers 4

Individualized treatment for acne scars works best

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The treatment of acne scars works best when individualized for each patient based on the type of acne scars.  Rolling acne scars such as those on your right cheek and forehead respond well to a series of fractional (either ablative or non-ablative) laser treatments.  As Dr. Zimmerman said, I would expect a softening of those scars, maybe by 25-50% based on the number of treatments and treatment settings.  The most common risk of the procedure is temporary darkening of the skin.  I typically prescribe hydroquinone and a topical retinoid prior to the procedure and after the procedure to minimize this risk, but the most important thing is for my patients to be very strict about sun protection. 


Deeper scars that are more "ice-pick" or "boxcar" shaped tend to respond better to other forms of treatment. These are the types of scars you appear to have more on the left cheek.  One such treatment is called subcision, in which a physician passes a needle under the scar and breaks the scar tissue underneath, thereby untethering and lifting the scar.  Another treatment for these deep scars is to do small punch excisions of the scars where the scar is removed surgically and the small area is sutured together.  


By combining techniques, we are able to individualize treatments for each patient and optimize results. 

Centennial Dermatologic Surgeon

CO2 Laser Resurfacing For Acne Scarring

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The laser will emit high pulses of light targeting into the dermis to help eliminate damaged skin cells. The laser’s heat energy will peel off the top layer of skin and stimulate collagen growth where acne scarring occurred before. Then as the skin heals, new healthy skin will heal in its place.

Every patient is different and will have a different degree of improvement. What I tell my patients is this: with just one treatment they will see a dramatic difference. Yes, some patients need two treatments due to significant scarring and/or lines, but they will still have a lot of improvement with one treatment and even more dramatic with the second treatment. “Dr. D”

Acne scar treatment with co2 laser skin resurfacing

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have different types of acne scars, some of which will improve with laser resurfacing, and some of which will improve considerably less.  The lasers will not improve the depth of a peel to any significant degree, but will recontour the scar. It is hard to quantify, but two rounds of CO2 laser will improve your skin dramatically. 

Slow improvement with any treatment

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Acne scarring is very difficult to treat.  A % improvement is hard to estimate.  I usually tell patients in your case that 25% improvement is possible with a SERIES of fractionated laser treatments - whether CO2 or traditional fraxel (erbium:glass laser).  You should see improvement with each treatment but it is very hard to erase the scars completely.


I personalize each laser treatment.  For deep acne scars, we have to increase the laser intensity - that means more downtime but more effectiveness.  You should give yourself 7-10 days to recover with peeling and red skin after each treatment session.  You should wait at least a month or so between each treatment to allow the skin to heal.  The CO2 would be more effective but likely leave your skin with transient hyperpigmentation (darkening) that can take months to even out and may require fading creams.

Jay Zimmerman, MD
Walnut Creek Dermatologic Surgeon

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.