Would Fraxel CO2 laser be a helpful treatment for my acne dark spots/PIH on Type III-IV skin? (Photos)

Question

I’ve been struggling with dark spots since a preteen, and I have no idea what my skin looks like without all these dark spots on my face. I've tried VI chemical peels, BHA/AHA at home lighter chemical peels (Dr. Dennis Gross and Bliss Products) with only smoother skin, but not doing much for the scarring. I was also prescribed Azelaic Acid but it does more for the texture than my hyperpigmentation. At this point, I want to explore laser treatments, so if not Fraxel, then what would work?

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. Generally speaking, 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, PiXel8, Morpheus, Skinfinity, 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.

For darker skin types, it is important to avoid strong lasers such as CO2/Erbium and Fraxel as they can cause hyperpigmentation. Instead, scars in darker skin types can be improved with a combination of microneedling RF (Fractora, Intensif, Infini), Aerolase or Laser Genesis, microneedling with PRP, skin lightening, peels like Cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, and a proper skin care protocol (hydroquinone, vitamin c, kojic acid, azelaic acid, retinol)​. Sun protection is essential. I recommend getting a formal evaluation with a board-certified cosmetic dermatologist and acne scarring expert. Best, Dr. Emer​"

Anthony Farole, DMD · Answer

CO2 laser will be effective, especially for some of your lighter and larger pigmentation areas. It will also be effective for some of the smaller ones. In addition to the CO2 laser since it will not get rid of all of them I would suggest three treatments with RF Microneedling. That combination will give you the best overall combined result.

Would Fraxel CO2 laser be a helpful treatment for my acne dark spots/PIH on Type III-IV skin? (Photos)

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Would Fraxel CO2 laser be a helpful treatment for my acne dark spots/PIH on Type III-IV skin? (Photos)

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Everything you need to know about CO2 Laser

Our mission is to create a world where every investment in modern beauty is Worth It.