Type IV skin and acne scarring – which treatment is best??

Hello Dr. Irwin, I am skin type 4 and have deep acne scars on my face, I was reading so much about Fraxel-Restore as that is only available in my country and had almost made up my mind about going for it. When surprisingly my Dermatologist (She is the most trusted one, and easily the best this country has) told me that No, Fraxel will not help so much for your scars as much a Fractional CO2 laser would do, because my scars are very deep indeed. Now I know the difference is Fraxel Restore is Non-Ablative and the latter being Ablative. I have seen and read some Horror stories about people getting PIH (Post Inflammatory Hyperpigmentation) with Fractional CO2 laser, Especially with skin type 4-5. So should I be considering it in the first place. My Dermatologist who has almost now 30 years of experience has strictly said no for Fraxel as it would not help and I woulD unnecessarily end up spending lots of money on several Fraxel Restore sessions. She said I don’t think Fraxel will help you atall and that’s Period ! What do I do. I can go with Fractional C02, but I am most worried about PIH and my skin is very sensitive and I did a Glycolic Peel of 20% some years back and it gave a very bad PIH which still has not gone. But I was just thinking Glycolic Peel and Fractional CO2 are two different things maybe the Fractional CO2 it will not give me a PIH . But I don’t know any suggestions, advise ? Thanks

My apologies for the delay on this.  I think you wrote in November.  If you have deep acne scarring, I agree with your dermatologist.  You will get much more benefit with the fractional CO2.

This is where you need a very experienced laser dermatologist with a great laser center.   Your skin may need to be treated with certain regimen prior to the laser and a certain regimen after.  In addition to the skin care your doctor gives you, the pigmentation problem can usually be avoided if you absolutely stay out of the sun for a month or two after, use certain sunscreens (your derm will advise you), wear a wide brimmed hat and don’t take birth control or get pregnant for at least several months.   Dr. I

Dr. Brandith Irwin, MD

Ask me your skincare question!

Hi, I’m Dr. Irwin, and I believe that consumers need and deserve a medically trained and unbiased skincare advocate.

  • All our content is written and researched by myself and my trained staff.
  • My medical office in Seattle has experience treating thousands of patients.
  • This site is not affiliated or financially tied to any product line.
Ask Me Something
SkinTour Skincare
One of the best investments in your skin is your daily skincare. Why? Because you can prevent many problems with blotchy skin color, lack of glow, texture, some types of acne, and fine lines with good skincare products. You can also correct some of these problems with effective skincare products. Great skincare is often more expensive because quality ingredients are expensive. Some companies spend on research/development which benefits all of us and adds to the cost. Are they worth it? In general - yes!