12 days post first Fraxel dual for facial acne scars. I see almost no difference to the scars. How many sessions does it take?

Really depends on your acne scar type. Fraxel is best for early mild scars with minimal atrophy. Acne scar revision comprises of many specialised procedures that are dependent on the skill sets of your Plastic Surgeon or Surgical Dermatologist. For the best results, one should target the acne scar type with an appropriate treatments METHOD. Using one or two devices is not optimal. Everyone has a unique pattern of acne scars- hence the best solution is a tailored one. Remember, scar revision is a medical procedure- much like the revision of inflammatory, traumatic and burn scars. It is not dependent on the clinic, branch, machine, or laser but by the skill and reputation of the surgeon. The surgeon MUST be skilled to deliver all forms of dermal fillers, and or autologous collagen- tissue matrix. The use of fillers, both on label and off label via needle and cannula techniques will usually give better results, and less downtime compared to lasers and energy devices. Scientific papers have recently confirmed the change in paradigm for acne scar revision. 



Take for example deep ice pick scars, and narrow box car scars. These are best treated with TCA CROSS and focused angled CO2 fractional laser in low density. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat graft, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 



In the vast majority of patients, different patterns of acne scars will be present. Monomorphic acne scarring (scars of the safe subtype) are extremely rare. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combinations that yields the best results. It is never about the device, it is about the specialist behind the equipment that will deliver the best outcomes. 

Global leaders in acne scar revision will always use manual methods to revise scars, and employ lasers and energy devices as instruments to assist. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.