Acne scar reduction - would C02 laser improve appearance of scars? (photos)

Question

I am of Indian ethinicity. Medium skin tone. I recently started to use salicylic acid in my routine and i have residual scarring from that. I want to know how bad is my scarring and how much improvement is possible with cp2 laser and other modalities in my case?

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

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. ​

Patrick Flaharty, MD FAACS · Answer

Your scarring is fairly mild and generally treated with less invasive procedures such as microneedling and fillers. A series of microneedling treatments (6) will stimulate new collagen production reducing the visible scarring. Six treatments separated by one month each would give you maximum improvement. Any residual depressed scars could be treated with microinjections of fillers to further smooth the skin.
Fully ablative CO2 laser is a very aggressive procedure with significant downtime and the risk of post inflammatory hyperpigmentation.  Given that the results from CO2 laser resurfacing may not be better than the previously mentioned protocol of microneedling and filler, and the downtime and risks are so much greater, we would not recommend CO2 laser as an initial treatment.

Acne scar reduction - would C02 laser improve appearance of scars? (photos)

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