Acne scars remains one of the most challenging condition to treat. In short, there is no one single treatment that is best for everyone. That being said, I see many patients whom are extremely frustrated after trying treatments that are not effective for their type of acne.
The carbon dioxide (CO2) laser is an effective treatment for atrophic (slightly depressed) scars. In the recent years, it has been used less as others are trying “simpler” procedures with little or no downtime, although with far less benefit. In this study over 77% of participants reported at least mild improvement, while 40% of the participants noted moderate to significant improvement.
That being said, this is not the only treatment for this type of scarring. Dermabrasion and medium depth chemical peels (i.e. TCA – trichloroacetic acid) are good options as well. Short term options include fillers, such as Restylane.
Citation: Elcin G, Yalici-Armagan B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: Prospective clinical trial with short and long-term evaluation. 2017;32(9):2047-2054. doi:10.1007/s10103-017-2322-7.
It’s funny today. No matter what the condition, everyone thinks that a “laser” is available and is best. In most cases, this is not so, but in many cases, laser treatments are available.
There are many different types and causes of scars: traumatic, post-surgical, and acne scars to name a few. Well, there is not one treatment that is best for all types of scars. So, when it comes to scars, you need to have a lot of tools at your disposal in order to get the best result. For example, here is a list of treatments that I perform regularly for scars:
- CO2 laser ablation
- Dermabrasion (not to be confused with microdermabrasion)
- TCA peels
- IPL (intensed pulsed light)
- Topical treatments (i.e. silicone gel sheets, 5-FU), which can be combined with other treatment modalities
- Surgical scar revision
- Dermal and/or subdermal fillers
What is not on the list:
- Microdermabrasion – studies have shown that there is virtually no benefit unless one reaches the dermis( pinpoint bleeding), at which point it is a dermabrasion and not microdermabrasion. This modality can be combined with chemical peels, which does offer benefit.
- Microneedling – although there may be some benefit, the cost-benefit ratio is poor (high cost for minimal, if any, benefit). This is frequently recommended as there is minimal risk.
In short, the treatment of scars requires experience and skill. More and more frequently, I perform post-operative treatments to reduce the appearance of scars before they fully form (i.e. 10-14 days after facial surgery). But, most scars that are treated are from acne and/or trauma.