Age 34, woman with old scarring - what laser doesn't cause fat loss?

Question

I'm a 34 year old woman with some old scarring and I want to do a laser that doesn't have the possibility of fat loss. Would Co2 be the only one that can address scars and not cause the loss?

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Nelson Lee Novick, MD · Answer

You have not provided any history or photos as to what kinds of scars you have. What I can say is a variety of simple, relatively inexpensive techniques are available to treat scars are available that have stood the test of decades of time for safety, efficacy in all skin types. For example, subcision can be used to elevate and smooth all kinds of indented scars (boxcar, rolling scars, post surgical or post-traumatic scars and chickenpox scars). TCA CROSS may be used to treat ice pick scars. Professionally performed microneedling can help to improve very superficial surface scars and texture and color irregularities. And none of the aforementioned have any issue with causing fat loss. I understand that Dr. Tik Tok and Dr. Instagram tout the supposed benefits of expensive fraxel laser or RF treatments, but, unfortunately, the reality is that these relatively expensive "bells and whistles" treatments have not stood the test of time and are actually backed far more by heavy marketing hype than any hard science. Make sure to consult with an experienced board certified cosmetic dermatologist with extensive scar therapy experience and not simply any venue hawking the supposedly "next big thing," faddish, "here today gone tomorrow" light or energy-based device. Best of luck.

Age 34, woman with old scarring - what laser doesn't cause fat loss?

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Age 34, woman with old scarring - what laser doesn't cause fat loss?

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