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

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thanks for your question and I am sorry you are frustrated with your Fraxel treatment. In addition to taking time for results to become apparent, most patients require a series of Fraxel treatments to achieve an optimal outcome. Acne scarring is a complex condition to treat that usually involves a combination of methods to obtain the best results. In my practice, we offer more than 45 lasers in addition to RF microneedling so we can customize treatments to the unique needs of each of our patients. Make sure you are working with a board-certified cosmetic dermatologist with extensive experience in scar revision to ensure your expectations are met.

A cosmetic dermatologist can assess your acne scars to see which treatments would be most appropriate for you.  Usually a combination of treatments works best and several sessions are necessary.  Please consult a cosmetic dermatologist who offers treatments including lasers, microneedling, TCA Cross and fillers.

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.