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

Question

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?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Joshua L. Fox, MD · Answer

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.

Susan Van Dyke, MD · Answer

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.

Sirish Maddali, MD · Answer

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.

Brooke R. Seckel, MD, FACS (retired) · Answer

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.

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

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