Are Ablative or Fractional lasers better for deep acne scars? (photo)

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 a 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.

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 (i.e. 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 improve 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.

If downtime is not an issue, yes several overseas doctors would advise doing Ablative laser therapy to improve the scarring issue. The only downside is the increase in downtime, risk of pigmentary changes (hypopigmentation or hyperpigmentation 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 hyperpigmentation 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.