Best Laser Resurfacing Treatment for Asian Skin?

It all depends on the level of scarring or fine lines. Textural changes do not need as much energy as deeper scars. All treatments have a risk of increasing Asian skin pigmentation and this can last for many months to more than a year, but usually is reduced with time and prescription creams.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

There are a number of modalities that can effectively treat Asian skin. I prefer the Sciton erbium laser. The key is to choose a treating physician who has the experience and expertise with Asian skin. 

Laser treatment can be effective in
rejuvenation the skin in asian patients, caution is required as this skin is
more at risk of reacting to the laser treatment:

The
risk of using powerful lasers on Asian skin types is an increased risk of
scarring and darkening of the skin during healing (termed hyperpigmentation).
The laser that is used should have the settings modified for Asian skin types
and a test area of skin may be advocated to look at the response to treatment.

Surgeon
with experience in treating Asian skin are important to avoid the risks of
scarring and hyperpigmentation.

The
type of laser used in skin resurfacing can selected to increased safety, including
the use of superficial Erbium laser and fractionated CO2 lasers.

The
use of topical medications before and after treatment have a role in improving
effectiveness and reducing reaction to laser. 

The laser is only as good as the doctor using it.  The most important part of choosing a procedure for a patient is to be evaluated by an experienced and knowledgeable dermatologist who discuss with the patient the areas of concern and what are the best options for treating those problems.  If it does turn out that resurfacing is the best option, then there are many things to consider such as:  How much downtime can you afford?  What is your pain tolerance?  Do you want to get the best bang for your buck and do fewer treatments which may involve greater downtime and more pain, or would you rather do a lot more less invasive treatments that hurt less and heal faster but may end up taking longer to finish and cost more?  If a doctor only has one laser, they can only offer you that one laser whereas a doctor who owns many lasers can provide you many more options.  Asian and ethnic skinned patients have to be particularly leary of resurfacing treatments because of their higher risk of complications so they should only consider doctors who have a lot of experience treating their particular skin type.  I talk to patients all the time who tell me they were told that Asians can't have laser treatments--I tell them that many doctors are not aware that there are physicians who specialize in treating Asian skin and it is true that most practitioners do not possess adequate knowledge or experience to treat Asian skin.  I have treated thousands of Asian patients with many different lasers without any complications.

Asian skin and other ethnic skin varieties are more likely to develop sun spots vs wrinkles. This is in contrast to caucasians. This predilection is related to varying degrees of skin color. People of color typically have different risks when it comes to anything done on their skin. They are more likely to get darker after any manipulation of their skin so you have to be very careful with ethnic skin.
In general, I approach Asian skin conservatively. Laser resurfacing can be done, but the settings have to be less aggressive. Active FX CO2 laser resurfacing is an excellent laser for Asians because you can tinker with the settings to fit the particular person and avoid complications and increased downtime. For Asians, I typically decrease the setting and stay on the less aggressive side and usually rely on repeated treatments to get the same results.
Consulting a Board Certified Facial Plastic Surgeon would be something that I would recommend. We specialize in the face and are highly qualified to help you with this.

Treating ethnic skin for scar, wrinkles or pigmentation issues is very demanding. You will want to work with either a dermatologist or plastic surgeon who has experience treating such skin types. You need to be extra concerned about the risk of burns and bad scar formation. In general, I always start with a low dose, test patch. I typically use a variety of topical medications to enhance the results and protect the skin. Remember, experience is far more important than the system!

The main risks of laser resurfacing Asian skin is the risk of post inflammatory hyperpigmentation (PIH) and eventual hypopigmentation.
CO2 lasers have a greater risk of post inflammatory hyperpigmentation and hypopigmentation than do Erbium lasers.
Flat beam lasers have more risk of PIH and hypopigmentation than do fractional lasers.
Ablative lasers generally have more risk of PIH and hypopigmentation than do non-ablative lasers.
Therefore, if you need laser resurfacing I would use low power settings on a non-ablative 1540 Erbium laser. Multiple treatments are required.
This laser resurfacing technique is usefull for acne scars and wrinkles and hyperpigmentation.