Laser Resurfacing
for Facial Acne Scarring

Atrophic acne scars are pitted scars that occur when fibrous tissue replaces healthy tissue damaged by acne and not enough replacement collagen is formed.

Several treatment options are available for this type of facial acne scarring, depending, on the type and severity of the scarring. One of the options available is laser resurfacing, which can be done with ablative or non-ablative lasers.

These procedures work by utilizing a specialized, high-energy form of light that passes through the skin and is absorbed by the water in the dermis, just beneath the outer surface of the skin. The laser is able to remove very minute portions of skin and/or stimulate collagen growth resulting in improved facial contours and textures.

Ablative Lasers
Ablative laser resurfacing uses a high-energy beam of light to vaporize very small areas of skin with pinpoint control. In addition, the skin below the surface is very briefly heated, which stimulates new collagen growth that, together, develops a new, smoother layer of skin once healed. The most common type of ablative lasers are carbon dioxide (CO2) and erbium. This may be a good treatment option for deeper rolling scars and boxcar scars that are more prominently visible.1 While everyone responds to a laser differently, one of the earliest studies documented the ongoing improvement after CO2 resurfacing. Sixty subjects had continued improvement for 18 months, meaning the final result was not observed until that time.2

As with any cosmetic procedure, there are limitations to ablative resurfacing that should be discussed with a doctor. It usually takes one week or longer to recover from a resurfacing treatment, and the healing process can trigger “fever blisters” (reactivation of herpes simplex virus) and acne flare-ups. In rare cases, the scar can actually get worse or harden.3 Laser resurfacing also causes redness (erythema) that may last several weeks. Additionally, hyperpigmentation can occur, especially in darker skin types (see skin types), along with pain, crusting, as well as itching or stinging for 12 to 72 hours after the procedure. In general, patients should expect to remain out of sight for at least 7 days after a laser resurfacing before returning to public life.

Ablative resurfacing may not be appropriate for all acne scar cases, specifically for patients with an active infection, a history of keloids or hypertrophic scarring or those who have used isotretinoin to treat acne within the last 12 months.

Non-Ablative Lasers
A similar, but less intensive treatment option is non-ablative laser resurfacing. This type of treatment works by reducing the depth of scars by stimulating the collagen below the surface; however, this process does not remove or vaporize any tissue. Non-ablative laser treatment is best for superficial rolling and boxcar scars that are widely distributed across a person’s complexion.

Because non-ablative lasers are less invasive, results are typically less dramatic than with ablative lasers.1 Non-ablative resurfacing usually takes several sessions to achieve the maximal result (three to five treatments), with optimal results usually occurring three to 6 months after the final session.

Non-ablative treatment can result in complications such as swelling, redness, and crusting of the affected area, and the possibility of an acne breakout and hyperpigmentation although these risks are far lower than with ablative laser procedures. In general, patients are able to appear in public much sooner after a non-ablative laser treatment, just 1 or 2 days for some types of treatment.

Fractional Lasers
Fractional laser resurfacing can be ablative or non-ablative, with the difference being that fractional treatment involves treating very small points in the skin evenly distributed across the face. The pattern is microscopic, and essentially invisible to the naked eye. This leaves much of the skin surface intact or untreated, allowing more rapid healing. Most fractional lasers are either carbon dioxide or erbium.

Patients who opt for the fractional laser procedure will have the best results when multiple treatments are used. Possible side effects are similar to non-fractional laser resurfacing procedures, including redness, swelling, dryness, fever blisters, acne flares, hyperpigmentation and darkening or crusting of the skin However, with fractional treatments, the overall degree of side effects and length of healing is improved compared to non-fractional treatment.

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NOTE: Always consult with a medical professional to make sure you have a proper diagnosis and plan of action to safely achieve healthy skin.

1 Sobanko, Alster. Management of Acne Scarring, Part I. Am J Clin Dermatol 2012; 13 (5): 319-330.

2 Walia S, Alster TS. Prolonged clinical and histological effects from CO2 laser resurfacing of atrophic acne scars. Dermatol Surg 1999; 25:926-30.

3 Goodman GJ. Management of post acne scarring. Am J Clin Dermatol 2000 Jan-Feb: 1 (1).

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