Treatment for Scarred or Enlarged Pores?

Question

Hello there, I have underwent fractional CO2 laser resurfacing about a month ago and I'm getting pretty good results for textured scarring. However, there are some distinct scarred or enlarge pores that are not seeing much improvement (including some icepicks I suppose, but I'm not overly concerned with those). Mainly on my CHEEKS and on my NOSE. TCA cross is probably not an immediate option since it doesn't seem to be offered in Minneapolis. What are my other possible options? Thank you

James Bonaparte, MD, MSc, FRCSC · Answer

This is certainly a difficult problem, but there are options. 

	Some people require multiple ablative laser treatments. You can do a combination of Fractionated and confluent treatments as well. Basically, this means you can use the laser to produce little microcolumes of skin damage into the deeper tissues while you also use the laser to remove a superficial layer of skin, thus a fusion of the two techniques. I've had good results with this, depending on your skin type and colour of course. Pearl Fusion is one laser that can do this and is thought to be better as it is a YSGG laser, which is thought to be in between the Er:YAG and CO2 Laser. As I mentioned, I've had great results with this device.  

	Deeper peels can help as well as can the TCA cross you mentioned. But, I'm not sure they would offer much more of an advantage over the laser on its own. I would however, think that regular chemical peels would help maintain a nice even texture and ensure you prevent new scars from developing. 

	Some people even have the scars excised surgical in order to realign tissue and remove the worst areas. This is certainly not the best option, but can be very effective in the right hands.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jacqueline Calkin, MD · Answer

Hello,

	Sometimes the simplest treatments are very helpful.  If TCA is not an option, ask your dermatologist about punch excision of the ice pick scars prior to further ablative or non ablative resurfacing.  Enlarged pores, depending on their size, will continue to improe with repeat treatments, but if very dilated can be best treated like an icepick scar, with excision.

Michael H. Swann, MD · Answer

Enlarged pores are quite different than scars, but both can be improved by fractionated laser technologies.  TCA Cross technique is useful, particularly for ice-pick scars as it can remodel them into boxcar type acne scars.  For scars, using fractionated CO2 gives reliable and reproducible results when used in series.  Non-ablative fractionated technologies such as Fraxel 1550 can also give decent results, but erbium nor non-ablative will give CO2 results in the same number of treatments.  I would begin by considering 2-3 fractionated CO2 treatments (depending on settings and degree of scarring), which may give the best results.  Compare that to 4-6 fractionated Erbium treatments which would give you 70% of the end result of fractionated CO2.  Also consider a series of 8-10 non-ablative treatments which would give you 50% of the end result of fractionated CO2.  Keep in mind that fractionated CO2 is more to go through (more discomfort and downtime) compared to the other modalities.  Fractionated CO2 by a well-trained physician gives you great results!

Treatment for Scarred or Enlarged Pores?

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Answer: Treating Enlarged Pores

Answer: Treating Enlarged Pores

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Treatment for Scarred or Enlarged Pores?

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Answer: Treating Enlarged Pores

Answer: Treating Enlarged Pores

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