What's best treatment for acne scarring? Thinking about CO2 but scared of pigmentation (Photo)

I have been treating acne scars for decades. Dermapen would not have been expected to be particularly effective, since microneedling is best for treating superficial, surface texture and color irregularities and is not useful, as you found out the hard way, as a monotherapy for deeper acne scars. PRP is a relatively expensive and heavily marketed & hyped modality, but the hard science to support its routine use is unfortunately lacking. So, no surprise that this modality was not really effective for you. C02 laser, like dermabrasion, runs the risk, especially in skin of color (SOC), for the post treatment development of pigmentary (both hyper or hypopigmentation) problems that can be long-standing or even permanent. Subcision, on the other hand, is a treatment technique that I have personally been using since 1994, for elevating and smoothing boxcar and rolling scars, that has a proven safety and efficay record overall and in SOC. TCA CROSS, another relatively inexpensive and simple technique, with an over two decade record of safety and efficacy for the treatment of ice pick scars, likewise is appropriate for treating SOC. So, it would be wise to consult an experienced, board certified cosmetic dermatologist and exercise a healthy dose of skepticism about being offered any more "bells and whistles" energy or light-based devices or faddish treatments. Best of luck.

Hi Royasami!
You would be a great candidate for the CO2 laser +/- subscission for your acne scarring! But, due to your more olive skin tone, it would be absolutely essential to be on several weeks of pre-treatment (prior to the laser) with prescription-strength topicals like hydroquinone and retinol to minimize the potential for hyperpigmentation after the procedure. You should also go to someone who is not only board-certified, but who has also done a fellowship in lasers so that your doctor is well-versed in the appropriate laser settings to use to yield the most effective results in terms of minimizing your acne scarring (while also minimizing the potential for complications).
Hope this helps!
Dr. Kiripolsky

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