Can you have full laser resurfacing twice? (Photo)

Question

I’ve had numerous acne scar treatments over the last 15 years . Only ‘full’ ablative laser resurfacing and fillers/ skin boosters have helped . Fraxel laser , peels and microneedling didn’t help . Fraxel actually make my skin worse and gave me cystic acne again . The doctor who performed the laser resurfacing said it could only be done once , is that always true ?. How bad my skin looks is very dependent on the lighting and angle as you can see by the photos .

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photographs. A doctor who is very experienced with ablative lasers could perform a second treatment on you. Make sure the doctor discusses the risks, benefits and alternative laser devices available. Good luck,

Robert G. Aycock, MD, FACS · Answer

You can have more than one full ablative laser treatment. You just need to be sure that you allow enough time inbetween treatments to give your skin a break. It takes months for skin to rebuild and for you to notice the difference. Have a consultation with a board certified plastic surgeon and get an evaluation to see what type of laser and how intensive it needs to be.

Michele Zormeier, MD · Answer

Thank you for your question. 
For acne scarring, it is very common to undergo laser resurfacing more than once. Time between treatments should be at least 6-12 months to ensure healing. 
Active FX with Deep FX (called Total FX) may give greater improvements for acne scarring 
Bellafill is a more permanent filler that may be a good option for box car or rolling acne scars. Multi modality approach is usually necessary to give best results. 
Microneedling or sublative RF can sometimes add to the results after laser resurfacing but multiple treatments are needed. 
Please consult a local board certified facial plastic surgeon for more information and a comprehensive consultation to determine the best results for you and your skin type and depth of acne scarring.

Louis W. Apostolakis, MD · Answer

Hello,The term "laser resurfacing" is used quite loosely to mean so many different things.  Adding the word "ablative" still means very little by itself.  Ablative laser skin resurfacing ranges from little lunch time peels to major events that take months to heal.  The results you get at those two ends of the spectrum will be very different.  I will speak here to "full strength" ablative resurfacing.  At the higher power range, the laser removes most of the epidermis and creates a coagulation injury of the deeper dermis.  That coagulation injury triggers you skin to extensively repair and remodel itself, repairing old damage/wrinkles in the process.  The dermis is where the collagen and other structural components of your skin are located.  It is the dermis where wrinkles and scars are located.  The epidermis is just "along for the ride" as it covers the ups and downs of scars and wrinkles located in the dermis.  For a result that actually "fixes" scars and wrinkles you must get that deep dermal level treatment.  Also, realize that multiple low energy treatments will never equal a single high energy treatment.  Even 100 treatments at 25% energy wouldn't equal a single 100% energy treatment.  You must get well into the dermis to fix wrinkles and scars and repeatedly treating the more superficial skin never does anything to that deeper skin where the wrinkles/scars are located.Full strength ablative resurfacing is a procedure that can be repeated, though a careful examination of the patient between treatments is needed.  The deeper treatments can alter aspects of your skin that you don't want changed, like your pigment.  So you need to look for signs of changes you are trying to avoid before doing a second or third treatment.  You would typically wait at least a year between two treatments and it would be unlikely that you would ever do more than 3 in a lifetime.  As I look at your photos, I see very normal looking skin (aside from the acne scars) that appears to have tolerated your first treatment quite well.  So I think a second treatment all these years later is reasonable, but only an in person exam can say for certain.

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