What’s the “best” laser for treating acne scarring?

Hello, I’ve been to about 4-5 different certified dermatologists for resurfacing/smoothing my rolling acne scars (which I’d classify as moderate, but some Derm's have said they're only mild), along with healing some post redness which resulted from earlier TCA-30 peels that were done to address the scars - and they've all recommended different procedures. I'm confused. Which treatment(s) would you blindly recommend (w/o examining my complexion)? So far the best option seems to be the following: -series of 3 "micro Needling" (Pen) performed in-conjunction (on the same day) w/ -a non-ablative "Fraxel 1550" laser for the texture-treatment; -followed w/a series of "V-beam" treatments at the end (after Texture treatments are done) to target the redness. Please let me know if you agree or if you'd change 'Any' /or 'All' these recommendations? The main issue I’m having is with the low chance of effectiveness I was given, which was a very broad range (20-70%) of being effective. If I’m trying to 'completely' smooth-out my skin (which is probably unrealistic), while also avoiding the complications of a harsh/ablative laser ~(C02), is the above treatment my best option? Thanks so much Dr.Irwin! -Michael, 35 PS: if you oppose Needling.. could you comment if you've ever performed it yourself, and if so what were your results for your patients? (particularly for Scarring issues). And what are the variables that would help someone achieve good results with Needling?

I know you were trying to avoid it, but the best way to treat acne scarring is the CO2 laser! There is more science, proof, and experience with this laser and acne scarring than any other laser. This is true for moderate to severe acne scarring. Usually, 1-3 treatments are needed. If the above is supplemented with a procedure called subcision before the laser, the results are improved even more. For more mild acne scarring, there is a lot of data on the Fraxel Restore (the 1550nm setting) done in a series of 2-4 treatments about 4-8 weeks apart.

Dos for treating acne scarring:

  • Schedule a fractionated CO2 or possibly a Fraxel 1550. These are not “harsh” lasers. They may have slightly more recovery time, but the results are worth it;
  • Go to a board certified, laser experienced dermatologist. We have much more experience with acne and acne scarring.
  • Take your time and do at least 2-3 consults before you decide on a doctor or a laser (here are my tips for getting a good laser treatment from a great doctor);
  • Usually, with 2-3 CO2 or Fraxel laser treatments, a 60-90% improvement is obtainable.
  • Follow any post care instructions exactly.

Don’ts for treating acne scarring:

  • Don’t bother with microneedling. It’s cheap, but the results are not reliable or consistent.  Complications can occur just like with lasers;
  • Don’t go a plastic surgeon for this. Most are not very experienced in treating acne or acne scarring;
  • Don’t get distracted by all the marketing. For this problem, stay with the science and the tried and true;

Yes, I and my staff have personally tried at least 4 different needling systems and were not impressed by any of them.

Dr. Mark Taylor, in Salt Lake City, is one of the best dermatologists in the country at treating acne scarring. Many of us who treat acne scarring frequently, have learned a lot from him.

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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

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