What Should I Know About Hypopigmentation Before a CO2 Laser Correction for Acne Scarring?

My dermatologist/surgeon wants to use CO2 laser for acne scarring. The scarring is not too extensive or extremely severe, but needs to be improved. I'm concerned mostly about hypopigmentation. I am a white male, 37, with fair to somewhat darker skin tone. I think my dermatologist called it a 2 out of 5? What should I know about the possible permanent change in skin color?

Doctor Answers 4

Fractional non-ablative Erbium laser resurfacing is more effective for acne scars

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CO2 laser resurfacing treats the surface of the skin and does carry a 10% risk of hypopigmentation and demarcation lines next to untreated areas.

Correction of acne scars requires the production of new collagen in the deep skin layers.

New fractional non-ablative 1540 Erbium laser resurfacing is much more effective at building new collagen in the deep skin layers, and thus is much more effective at correcting acne scars.

Non-ablative fractional 1540 Erbium laser resurfacing is also much safer, with minimal or no risk of hypopigmentation and a much more benign recovery. The skin is not ablated thus there is no open wound and no long recovery.

Modern results with non-ablative 1540 Erbium laser resurfacing for treating acne scars are excellent and this is my preferred method of laser resurfacing for acne scars.

Hypopigmentation has a low risk

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Hypopigmentation after CO2 laser skin resurfacing has a low risk. This is especially true if done in a fractionated manner and not one laser treatment under general anesthesia. The chances of getting hypopigmentation are low, but not zero. You should always take the risks into consideration before undergoing any procedure. Have a good conversation with your dermatologist about your concerns before making your final decision. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

Fraxel, co2

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Hypopigmentation is less likely to occur in Type 2 skin than in a darker pigment. The Fraxel 1540 laser-although called nonablative is mildly ablative but I have not seen any cases of permanent discoloration. The Pixel CO2laser has also drastically lowered the risk of discoloration which I have not seen to date but can occur. There is always a risk of skin color change but use of Hydroquinone and sunscreens may further lessen the risk.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Hypopigmentation after CO2 laser no longer an issue.

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The original CO2 lasers (15 years ago) did a nice job on wrinkles and acne scars but did cause loss of pigment in a large minority of patients.  The pigment loss generally did not appear for a year after the CO2 laser treatment.  This is no longer a problem with the fractional CO2 lasers.  The fractional lasers (Active FX, Fraxel and others) treat less than 100% of the surface area of the face leaving untouched cells that result in rapid healing and elimination of the hypopigmentation problems. 

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.6 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.