Which lasers and in what order for acne scarring & redness??

Hi! I have moderate acne scarring with some discoloration and a couple of ice-pick/boxcar scars. I also have some redness, mostly in the cheek area. I have a tendency to blush, usually because of temperature change, stress or alcohol, but sometimes for no apparent reason at all. I asked my doctor if I might have rosacea, but he didn't think so, he said I probably just have sensitive skin. I don't have any active acne (I use BHA 2% daily), but I do have black/whiteheads. My question is this: to reduce the scarring/discoloration, will the non-ablative Fraxel be enough? Or should I have subsicion before having laser treatment? And in order to reduce the redness, could I have some kind of IPL-treatment after the Fraxel? I'm confused about the order of treatments, and how long I should wait in between. I'm 30 years old, with no wrinkles or sun damage. Thank you for a very informative website! Regards, Elin

Thanks for writing Elin – these are good questions!   We are all individuals so your treatments need to be customized to you but here are some ideas and things to talk to your doctor about:

  • Redness. Generally, the Fraxel or fractionated CO2 lasers or subscision will aggravate redness slightly for 2-8 weeks.   If  the IPL treatments are done after, it’s helpful for  reducing the baseline redness and also any redness that remains from the Fraxel or fractionated CO2 laser treatments.  
  •  Intervals. The interval between treatments should be recommended by your doctor.  In our office we usually wait a full 6-12 weeks between Fraxel treatments and 3-6 months between fractionated CO2 treatments.  I prefer the longer time intervals because collagen builds slowly and sometimes just being patient reduces the total number of treatments needed (saves time and money) and also it allows more time to make sure there won’t be temporary problems like hyperpigmentation.   Remember to adjust treatment dates for your climate, vacations, and outdoor exposure in general.  About a month out of the sun is a common restriction.
  • Will the Fraxel be enough?  This depends on your skin type, depth of the scars and whether all over tighening or volume support is needed to get the best results.  Fraxel is best for mild to moderate rolling scars in people who are 20-45ish and don’t have much skin laxity. 
  • Subscision.  There is usually 7-10 days of down time due to bruising.  There ‘s about 5-7 days also with the Fraxel.   Sometimes, in our office, we will do the subscision right before the Fraxel treatment to minimize the downtime.   You may want to ask your doctor if this would be possible. 

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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