Are Ablative or Fractional lasers better for deep acne scars? (photo)Acne & Scars Skin, Hair & Nails
For atrophic and box car scars, if downtime is not of a concern, is it better to have FULLY ABLATIVE lasers treatment rather than FRACTIONAL lasers treatment (either by Erbium/CO2 lasers) since ablative usually has better results in 1 treatment as compared to 3 sessions of Fractional laser treatments? What is the difference between Erbium Vs Fractional CO2 Lasers? Please advise with thanks!
You are right in that ablative lasers usually have better results per treatment session. An Asian study by South Korean doctors did a comparison of lasers for acne scar treatments and found that the non-ablative (i.e fractional laser) treatment groups had a slightly lower improvement score and required a greater number of treatments compared to the ablative laser treatment groups.
However, patients who had the ablative laser had a prolonged recovery period and higher risk of complications. Complications of ablative laser include hyperpigmentation, hypopigmentation, skin infections, prolonged redness and laser burns. It is for this reason that many doctors may advise you to start off with a fractional laser instead. The study also concluded that 3 consecutive fractional lasers are as effective as a single treatment of ablative laser. This may be a good trade off, for a much lower risk of complications, especially in Asian skin, which is prone to developing hyperpigmentation.
Hope this helps in your decision!
Dr. Joanna Chan
Source: Comparison of four different lasers for acne scars: Resurfacing and fractional lasers. JPRAS Jan 2016.
Fully ablative lasers are excellent for treating acne scars provided you are not concerned about looking after weepy crusted skin for a couple of weeks (ie massive downtime), and you have Caucasian skin where the minimal melanin content also means there is no hyperpigmentation of the skin after healing. For Asian skin, I would not recommend it as patients usually feel quite traumatised by the recovery period and will look darker for a couple of months.
Fractional ablative CO2 laser is my go to laser for acne scars like yours. It delivers the laser deep into the skin to stimulate new collagen formation, and improving the scars. For the deeper scars, we can perform TCA CROSS or punch excision first, before resurfacing with the fractional CO2 laser for optimal results.
Hope this helps you plan a good solution for your acne scars!
Dr Stephanie Ho, Dermatologist
If downtime is not an issue, yes several overseas doctors would advise doing Ablative laser therapy to improve the scarring issue. The only downside are the increase in downtime, risk of pigmentary changes (hypo pigmentation or hyper pigmentation concerns). You will probably need to consent and understand these risks better before undergoing the therapy. Also make sure you are NOT on high dose isotretinoin prior to the treatment.
Erbium has reduced risks of hyper pigmentation changes especially in darker skinned patients, while Co2 has a higher risk. The penetration of the lasers (Co2 > Erbium) will also impact on the improvement seen.
Please see your doctor and discuss the options available. Experience with the machines would be important.
Lastly, you may want to consider TCA Cross for your scars.
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