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Admin DXD profile picture
Admin DXD
VIP
from Singapore asked a question

Is the fractional radiofrequency, CO2 laser or erbium laser more effective for deep acne scars?

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Acne & Scars Aesthetic Medicine

Hi doctors,

I am looking at options for acne scars treatment. Personally, I have very deep acne scars, ranging from boxcar, rolling to ice-pick scars.

I would like to know the difference between the ablative fractional radio frequency and co2 or erbium lasers and the effectiveness of the treatments, as I have heard that co2 lasers may not be able to go as deep as fractional radio frequency does.

Please advise. Thank you!

DOCTOR’S ANSWER (3)

Hi J,

With regards to your question:

  1. Fractional CO2 lasers generally penetrates deeper than Erbium lasers
  2. Fractional CO2 lasers also generally penetrates deeper than Fractional RF devices EXCEPT Microneedle RF machines that can reach a depth of 3.5mm (only in some machines) which in this case will have a greater penetration depth as compared to Fractional CO2 machines.

Fractional CO2 lasers also generate more heat than Erbium lasers and as such have better collagen synthesis etc but this also confers a higher risk of heat-related side effects namely Post-Inflammation Hyperpigmentation (PIH) , redness and longer downtime.

As the other doctors have mentioned, this is where Fractional RF machines have a safer side effect profile with a lower risk of PIH.

That being said, one would also have to consider the type of acne scars you have as different scars are treated differently and not all scars respond well to machine-led treatments.

In conclusion, all these devices have their pros and cons, and can deliver good results when executed to its full potential.

Hope that helps.

All the best!

Consult Doctor
0 1110 views 0 Doctors agree 24 Jan 2018

Dear J,

The current options for ablative treatment of acne scars would be mostly limited to :

  1. Fractional Co2 laser
  2. Fractional Erbium laser
  3. Fractional RF

I would say that for easy understanding, fractional Co2 has the best results because it is able to penetrate deeper into the skin. However, it’s a double edged sword and has much higher chances of side effects like PIH ( Post-Inflammatory Hyperpigmentation) and Hypopigmentation.

Fractional Erbium and Fractional RF were developed precisely because of the higher chances of those side effects, and thus they do not penetrate as deep or ablate as strongly. However, they still give a good result with much lower chances of side effects.

Thus, your idea that fractional RF goes deeper than fractional CO2 is likely not true, based on the above principles.

To help you decide, mainly you need to think through the following factors :

  1. Are you still having active acne? If yes, you will need treatment for that first. There’s no point treating the scars if you are still having active acne. It’s like trying to fill a bucket of water to the brim but the bottom has a hole continuously leaking. You need to plug the hole first. There are many options and if your keen to find out more, you can send another question on DXD.
  2. How much downtime can you afford? The deeper the laser, the longer the downtime and the more conscientious you need to be with your post-laser recovery. You’ll need to apply more recovery products as well.
  3. Are you willing to take the risks of PIH / Hypopigmentation ? This is more pronounced if you have darker skin type. There’s always risks with every medical treatment.
  4. Cost

Hope that helps!

Consult Doctor
0 1110 views 0 Doctors agree 24 Jan 2018

Hey J,

In a nutshell:

  1. Fractional CO2 gives the best improvement but is frequently not tolerated in out context because of prolonged downtime and high risk of side effects such as PIH.
  2. Fractional radio frequency (RF) was invented for this purpose – much safer profile for Asian skin and supposedly less effective.
  3. However, because it is safer to use Fractional RF at a higher power setting, some doctors actually get better results than the CO2 (which would be undesirable or unsafe to use at higher setting)
  4. There are two forms of Fractional Erbium – the Erbium Yag and Erbium Glass. The Yag laser is ablative whereas the Glass laser is non ablative.
  5. The fractional Erbium Glass laser was shown on a clinical study to have better results than the Fractional RF for scarring. Similarly, it is also much safer for Asian skin types and offers even less downtime.

Hope this was helpful!

Consult Doctor
0 1110 views 0 Doctors agree 24 Jan 2018
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