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.  

Yes. My team & I will combine other treatments if deemed necessary. They include-

• TCA CROSS or paint to treat ice pick scars
• Subcision & surgery for deep rolling scars
• RF microneedling for medium to deep rolling scars
• Microneedling for hypertrophic scars with corticosteroid injections

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.

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. 

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. 

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. 

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. 

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. 

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.

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. 

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.

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. 

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.