FRACTIONAL LASER RESURFACING ACNE SCARS

What is fractional laser resurfacing & how does it treat acne scars?

Fractional laser resurfacing is one of the most technologically advanced methods to remove acne scarring. It works by stimulating collagen production as well as remodeling old scar tissue. This process is called neocollagenesis. Lasers are much more effective than traditional microneedling as they deliver precise & controlled heating of the dermis. Fractional lasers provide accuracy down to 1/100 of a millimeter.

Fractional lasers come in various wavelengths ranging from erbium, CO2 & other shorter wavelengths. Each wavelength has their pros & cons. This gives us unparalleled tunability to treat specific scar signatures in patients of all skin colors.

What types of acne scars are amenable to fractional laser resurfacing?

You should approach acne scars with directed treatments, namely to match your scar signature with specific treatments. Everyone has a specific scar signature, hence a tailored program will always give you the best results. Fractional laser can treat the following acne scar types-

• Shallow boxcar acne scars: These scars have defined borders & respond well to fractional laser resurfacing.

• Shallow rolling acne scars: Rolling scars have gentle undulating borders.

• Polymorphic scars: Are super common, they consist of mixed border types & depths.

• Enlarged pits, picks & pores: Respond well to CO2 lasers. 

Scar types that do not respond to fractional lasers include deep boxcar scars, ice-pick scarring, deep rolling scars, atrophic acne scars, post inflammatory hyperpigmentation (PIH) and red scars (PIE).

What types of fractional lasers do we employ?

Hybrid Alma laser: Most advanced laser system currently available. The Alma Hybrid laser is the newest generation of Hybrid lasers, providing unparalleled skin rejuvenation, erasing up to one decade of wrinkles, while gentle enough to treat even the most sensitive skin types for minimal downtime. Using two wavelengths in the one treatment session, this advanced technology is uniquely designed to treat the upper & lower aspects of skin in one pulse for:

•  Skin Resurfacing

•  Scars &  Acne Scars

•  Cystic & Active Acne

•  Fine Lines & Wrinkles

•  Sun Damage

•  Tone & Texture

•  Collagen Remodeling

•  Pigment Concerns

Alma Hybrid Laser is The Most Advanced Technology in Laser Resurfacing

In comparison to other fractional lasers that require getting weeks off work and the inability to go out in public without major attention drawn to yourself, Alma Hybrid is great in that you can be back to work within a couple of days. Discomfort is also minimal, with only slight dryness, redness, and peeling.

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A skin treatment that does it all! State-of-the-art precise technology takes the 3 most important qualities of skin treatment and offers it to anyone who desires clearer tighter skin.

• ABLATION for targeting dead tissue and cells and regenerating into healthier, fresher skin

• STIMULATION of new collagen and revitalization of the dermis and deeper layers of the skin

• DIRECT DELIVERY of essential skin care products to the source.

How long is the recovery following fractional laser resurfacing?

Recovery is directly related to the depth and density of fractional laser resurfacing. As a guide-

• Light resurfacing: 2-3 day recovery. Redness for 48-72 hours.

• Medium resurfacing: 2-4 day recovery. Redness for around two weeks.

• Heavy resurfacing: 4 to 7 day recovery. Redness for 4 weeks. For heavy resurfacing I normally use a healing ‘vascular laser’ at weeks 4-8 to markedly reduce redness.

Is laser resurfacing painful?

We are mindful of discomfort during & after your treatment. We ensure your comfort levels by-

• Applying a special formulation of super strong numbing gel prior to the procedure.

• The use of numbing blocks prior to laser.

• Inhalation of laughing gas.

• Use of oral or IV conscious sedation for more involved procedures.

A practice nurse will give you a call a few days before your procedure to discuss the optional pain relief prior to your procedure. We got you covered.

What does a typical procedure entail?

We perform all our procedures in accredited laser suites

• Step 1: Pre anesthetic documentation: includes documentation of scar types with photography. We use standardized photos prior to anesthetic.

• Step 2: Anesthetic. This takes care of any discomfort. We use numbing gel, blocks & in extensive cases sedation.

• Step 3: Mark-up. Scars are marked using angled or tangential lighting.

• Step 4: Treatment time 5-20 minutes, depending on the extent of scarring and the fractional laser employed.

• Step 6: Aftercare. Instructions will be given post laser to ensure your healing is uneventful.

• Step 7: Follow-up.

Why is the method more important than the type of fractional laser?

Acne scars should be treated according to their merits. Not all scars require fractional lasers. In some cases, simple TCA peels or microneedling can outperform even the most technologically advanced systems. Some scar types are best treated with other lasers. This includes vascular lasers for red scars, pico lasers for brown scars, & ablative lasers for deeper scarring. In other cases, surgical techniques are indicated. It is about the method, & not the laser itself.

How many treatments will I need?

Typically 2-5 depending on:

• Your severity of acne scarring including your scar signature & depth.

• Your end goals & expectations.

• Skin type or color.

• Recovery time permitted.

• Control of acne.

• Type of laser employed & settings

• Your immune system responses to resurfacing .

*Control of acne should be absolute when undertaking scar treatments. Any form of inflammation, however small, reduces your immune response to remodel acne scars.

Is fractional laser safe in darker skin types / ethnic skin?

Yes, provided the correct fractional laser & settings are used. This is especially important when treating Indian, Sri Lankan, & Islander skin types. Small spot short pulse duration CO2 & erbium lasers are employed for this task, in addition to non-ablative fractional lasers.

For darker skin types, an additional 1-3 sessions are required as the density of laser requires adjustment to reduce the timeline of post-inflammatory hyperpigmentation.

Can fractional lasers treat atrophic acne scars?

Fractional lasers can improve low volume atrophic scars that lack collagen. These are termed low volume atrophy.Lasers are underwhelming in treating large volume atrophic scars due to loss of fat.

Larger volume atrophic scars are best treated with soft tissue fillers. Fillers, in the context of acne scar revision can-

• Support the overlying scar tissue

• Correct scar specific volume loss of both fat & collagen

• Provide volumetric displacement & traction of skin. This is especially important in mature patients who have an age related depletion in fat & collagen.

• Filler timing is flexible; they can be employed during, after or before laser resurfacing. For fillers on the same day as laser, laser settings must be conservative.

What is the difference between non-ablative & ablative fractional lasers?

Non-ablative fractional lasers include Fraxel & Pearl, whilst fractional lasers include eCO2, Ultrapulse, ProFractional,  CORE, Mixto, & Deka. A third category of Hybrid fillers are now available. They include YouLaser MT, HALO & Alma Hybrid.

Fractional ablative lasers (& Hybrid lasers) are infinitely better than non-ablative lasers in the context of acne scar remodeling.

What is the difference between fully ablative & fractional laser resurfacing?

Fully ablative lasers treat the entire surface area of skin; namely 100%. Fractional lasers cover a percentage of surface area, most commonly between 3% to 70%. This percentage is controlled by the operator & tailored according to the job.

• Advantages of fully ablative lasers: able to plane down superficial acne scars in one session. Faster to perform than fractional lasers.

• Disadvantages of fully ablative lasers: prolonged recovery time of 1-2 weeks, redness that may last 3 months, post inflammatory hyperpigmentation common in darker skin types.

What is the difference between microneedling and fractional laser resurfacing?

Microneedling is an entry level treatment for acne scars. Most cases can be conducted at home (for needles less than 0.3 mm). Lasers are designed to treat more severe acne scars, or for patients who want faster & better results, albeit a slightly longer recovery time.

Microneedling does not heat the skin, whilst lasers provide collagen remodeling as temperatures in the dermis reach 68.5 degrees. Heating upregulates HSP or heat shock protein, in turn stimulates collagen production.

What are the potential side effects of fractional lasers?

Fractional lasers are super safe with a more forgiving safety profile in comparison to fully ablative CO2 & erbium lasers. There are potentially more side effects with CO2 lasers as compared to non-ablative/Fraxel lasers. The flipside? Much better results.

• Side effects include-

• Skin darkening is known as post inflammatory hyperpigmentation. This is more common with ablative fractional lasers. Darker skin types are more prone to color changes.

• Prolonged redness, again more common with high density CO2 lasers.

• Infection.

• Prolonged healing.

Why is control of acne the most important factor that is within your control?

Background acne, no matter how small, plays an important role in your immune system’s ability to remodel scar tissue & generate collagen. An analogy is working out to build muscle. Say for example, you want to build up your quads. You can train as much as you like, but if you have a small tear (inflammation), your body will never build muscle. It is more interested in repairing the inflammation. Exactly the same for acne scar revision. If there is background acne, your skin’s effort is to reduce inflammation & not build collagen.

It doesn’t matter how you control acne during the process of revision. My team & I are cool with any method- from Accutane, through to diet, natural remedies, antihormones, & even fluffy skin care- just as long as you don’t have acne.