Fractional Laser Resurfacing Acne Scars At A Glance
- Best Results2-5 sessions
- Treatment Recovery1-4 days
- Procedure Time15-30 minutes
- Skin SpecialistDavin Lim. Dermatology nurse.
- Duration of ResultsPermanent
- AnaestheticNumbing & blocks
- Back to Work 1-5 days
- Cost$$- $$$+
Fractional laser resurfacing acne scars
Fractional laser resurfacing can improve most types of acne scars. 2-5 sessions spaced 4-8 weeks apart is a typical program. My team and I employ 10 different types of fractional lasers in order to match the scar type, your skin color & projected recovery. This gives you the best possible results whilst reducing side effects and recovery time.
FactsFacts on Fractional Laser Resurfacing for Acne Scars
- Matching the correct fractional laser for your scar & skin type will give the best results
- We have over 13 types of fractional lasers ranging from CO2 to Fraxel lasers
- Fractional lasers are useful for shallow scars
- Fractional lasers are often combined with subcision, TCA CROSS & dermal fillers
- Recovery ranges from 1 to 7 days, depending on settings
- CO2 lasers provide the best results
- Non-ablative hybrid lasers have the least downtime
- Lasers are safe in all skin types
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. My team & I run over 13 different types of fractional lasers. 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?
My team & I work with 13 different types of fractional lasers. Why? Because we view lasers as tools of the trade. For the best results, we tailor treatments based on factors such as scar depth, morphology, downtime & skin color. Here is a quick overview on some of our fractional lasers we employ-
- Ultrapulse CO2 fractional laser: Super powerful, reserved for deep scars.
- Hybrid Alma laser: Most advanced laser system currently available.
- CORE CO2 Candela laser: Super fine laser for darker skin types.
- Mixto Laser: Great all rounder.
- eCO2 fractional laser: The best for darker skin types.
- Fraxel Dual 1550 laser: Better than microneedling.
- Fraxel CO2 RePair laser: We don’t use it anymore. Far better CO2 lasers.
- Erbium ProFractional laser: Great for deep scars in dark skin types.
- MCL/Juliet erbium fractional laser: All rounder for scars.
- C&B non-ablative laser: Polishing fractional laser for pits & pores.
- Fractional Picoway laser: great for post acne marks.
- Fractional Picosure Focus Pro: great for pits & pick scars.
- Fractional Spectra laser: good overall laser to reduce post acne marks.
The laser portfolio at Cutis Dermatology is the largest in the Southern Hemisphere. We are the research and development center for several laser companies. Check our social media to see what lasers are acquired as we update our devices on a monthly basis.
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?
My team & I 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 at Cutis Dermatology.
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.
View our Treatment Gallery
Is Fraxel laser a good laser for acne scarring?
No. Fraxel is an AWESOME laser for skin rejuvenation, pore size reduction & as a sun spot treatment. It is underwhelming in the context of acne scar revision. It is not that it does not work, the argument is that there are many other lasers that give far superior results. These include hybrid lasers, erbium & high power small spot CO2 lasers.
Can other scar treatments be combined with fractional laser resurfacing?
Yes. My team & I will combine other treatments if deemed necessary. They include-
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.
How much does it cost to undertake fractional laser resurfacing?
We are mindful of the costs of resurfacing, hence why we run a dermatologist laser list & a nurse directed list. The latter is more cost effective. As a guide;
- Level 2 resurfacing (shallow): $590-$990*
- Level 3 resurfacing (deeper): $690- $1290*
- Fractional lasers combined with TCA/blunt subcision: $790- $990*
My fees vary depending on complexity. I very rarely perform fractional laser alone as most of my patients have moderate to severe scars that often require surgery/subcision at the same time as resurfacing.
*Variation of costs depends on the complexity & area of scarring. For example; the cheaper quote applies to small areas of resurfacing, whilst the higher quote for more extensive areas.
We do not ‘upsell’ laser treatments, meaning you will be treated with the best laser that suits your scar pattern. The cost variation is quoted on a senior nurse run list, this quote is approximately ½ to ⅓ of my fees, should you want me to perform the laser.
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-
Who performs this procedure- me or my nurses?
My team & I perform fractional laser resurfacing. For mild to moderate cases, my senior nurses perform this procedure. This is designed to provide you with timely treatments that are cost effective. Alison & Katie have worked with me for the past 6 & 8 years respectively & have assisted me in well over 1500 cases.
For complex cases, I will be performing the procedure. Very rarely do I only do fractional laser resurfacing as I often combine this with surgical procedures such as sharp subcision or as the final pass after fully ablative laser resurfacing.
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.
*For active cases of acne, I will give you the option of seeing one of my colleagues at Cutis Dermatology. My procedural team will work with the medical dermatology team to ensure that effective treatments are undertaken to treat, & in most cases place your acne in complete remission.
Davin’s Viewpoint On Fractional Laser Resurfacing
The concept of fractional lasers is to treat portions of skin, known as the density. For example a density of 35% means that 65% of your skin is NOT treated. This allows for much faster healing times. In darker skin types it also means less chances of skin color changes (or more accurately, a quicker resolution of post laser skin darkening).
My team & I operate with over 10 different types of fractional lasers. This gives us the ability to tailor treatments based upon your history, examination, ethnicity & recovery. We often double up on fractional devices in the one procedure. For example we may use a super powerful CO2 laser, followed by a fine dot CO2 laser. The latter gives us penetration to reach deep scars, whilst a fine CO2 delivered superficially treats shallow scars with less downtime than a big spot fractional laser. It is these small details that provide finesse for every treatment.
Hybrid lasers are the way of the future. These lasers combine two wavelengths of fractional beams, delivered sequentially, individually or stacked in the one laser entry point. We have extensive experience in the operation of all hybrid devices (as of 2023). Hybrid lasers include the Alma Hybrid CO2/1570, the YouLaser MT & the Sciton HALO.
HALO is the weakest by far & is the least suited for acne scar treatments primarily due to the lack of penetration (erbium component has 15 times less penetration compared to the big brother ProFractional). Sciton HALO is marketed as a low downtime device ideally suited for skin rejuvenation, however for scar revision, the ProFractional is infinitely better for this job.
YouLaser MT has the most technologically advanced interface, even though it is one of the older generation. The downside is that it is underpowered at 30 watts. Adjusting the pulse duration & stacking sequence, it does have the potential to go deeper, albeit a high rate of PIH.
Hybrid by Alma is our latest acquisition. It has both ablative & non-ablative components with a super intuitive interface that allows fine adjustments. This laser can treat mild to moderate acne scars in all skin types as we can fine tune the delivery of CO2 & the non-ablative 1570.
Fraxel has the most market presence as the parent company re-invests the royalties charged for consumables back into advertising. There has not been an update in the Fraxel Dual for close to 13 years, despite the requirement for a more powerful & faster system. It is not that this laser system is a bad one for acne scar treatment, the argument is that there are much better systems that cost less to perform than Fraxel resurfacing.
Join the conversation
Join Dr Davin Lim on Instagram to stay up to date