Acne can be psychologically damaging for those afflicted by severe cases, and the life-long appearance of scars can be just as devastating. Lasers are a newer treatment modality for acne scarring. They can improve the appearance of permanent scarring, but they are not magic wands.
There are two main types of acne scars: atrophic (ice-pick, rolling, and boxcar scars) and hypertrophic (hypertrophic and keloid).
Acne scars develop due to changes in collagen caused by the inflammation from the acne lesions and their treatment of them.
There are several types of lasers for acne scars: ablative, non-ablative, fractionated ablative, fractionated non-ablative, radiofrequency microneedling, IPL/BBL, and LED.
Lasers for acne scars work by removing scar tissue buildup or remodeling the damaged collagen caused by acne and replacing it with new collagen.
Certain types of scars respond better to lasers than others. Severe and moderate acne scarring will be more challenging to treat than mild scarring. Read on to learn about the various types of acne scars and what lasers can help give you a healthful appearance.
Types of acne scars: what are they?
Acne scars are the visible results that appear after acne heals. Most acne will leave some type of acne scar based on the type. Inflammatory and cystic lesions leave the worst scars. There are three main types of acne scars that are discussed below.
1. Atrophic scarring
Atrophic acne scarring results from inflammation that destroys collagen, resulting in a loss of collagen and scars with a concave appearance. They include ice pick, rolling, and boxcar scars. Ice pick scars are deep, narrow scars, and rolling and boxcar scars are shallower. Rolling scars have sloped edges, and boxcar scars have sharp edges.
2. Hypertrophic scarring
Hypertrophic and keloid scars are formed by inflammation that causes extra collagen formation. Both types result in bumpy lesions on the skin that can be sore or painful. Hypertrophic scars are contained to the size of the acne lesion, while keloids extend beyond the borders of the lesion.
3. Post-inflammatory hyperpigmentation
This is not a true scar resulting in a change to collagen, but it is caused by inflammation that produces an excessive amount of melanin in the skin. This excess melanin will leave dark discoloration in the area of the acne lesion. This discoloration usually fades with time and is asymptomatic.
What is laser acne scar removal?
Lasers are sources of particular wavelengths of light. Specific wavelengths target different parts of the skin to affect improvement. The target for acne scars is collagen in the dermis (middle layer of the skin). These acne scar lasers work by stimulating new collagen production to replace the old damaged collagen created by acne.
This can be accomplished by physically removing parts of the skin (ablative) or by heating it (non-ablative) to stimulate collagen synthesis. In the case of post-inflammatory hyperpigmentation and/or post-inflammatory erythema, lasers target the dark pigment or redness to eliminate the discoloration without removing any skin.
Does laser acne scar removal work?
Acne scar removal is effective when used on the right scars. Shallow, atrophic rolling, and boxcar scars are the most amenable to laser treatments. However, no treatment will remove 100% of the scars, but lasers will give you noticeable improvement.
What lasers are used for acne scar removal?
Various lasers can be used to treat acne scars. The choice depends on many factors. These include the type of scar, how extensive the scarring is, skin type, medical conditions, medications, amount of downtime, postop care, and budget.
Ablative laser resurfacing
Ablative lasers remove layers of the skin to improve scars. The injury caused by removing layers of the skin stimulates the body to produce new, healthy collagen to replace the old, damaged collagen. The damaged collagen is what leads to scarring. The most common ablative lasers used are carbon dioxide (CO2) and erbium: YAG.
Non-ablative laser resurfacing
Non-ablative lasers do not remove a layer of skin tissue, but directly heat the collagen to stimulate remodeling. The remodeling will cause new collagen to grow and replace the damaged collagen. Pulsed-Dye Laser (PDL) and Nd: YAG is non-ablative lasers that help acne scars.
Fractionated laser treatment
Fractionated lasers can be ablative or non-ablative. They target tiny columns of skin instead of the entire skin to enact changes to collagen. Ablative fractionated lasers will drill tiny holes deep into the skin to cause replacement of the damaged collagen. Non-ablative fractionated lasers heat the collagen in tiny columns to cause it to remodel and repair the damaged collagen. Fraxel is the most well-known fractionated non-ablative laser for acne scars. CO2 and Erbium are available in ablative fractionated lasers as well as non-fractionated.
Radiofrequency (RF) microneedling combines microneedling with RF technology. Microneedling utilizes a device with numerous tiny needles that will puncture the skin. These punctures cause micro-injuries to the skin that will cause new collagen to form. RF uses energy to stimulate new collagen production. By combining the two, there is enhanced improvement in scars. Genius, Vivace, and Morpheus are probably the most well-known RF microneedling devices.
Intense-Pulsed Light laser (IPL) and Broad-Band Light (BBL) can help improve hyperpigmentation from acne lesions, also known as post-inflammatory hyperpigmentation, by using a wavelength of light that targets the melanin in the skin. These help with evening skin tone and fading post-inflammatory hyperpigmentation. IPL/BBL is best used in patients with lighter skin tones. These lasers can also target hemoglobin in the blood, leading to an improvement in redness caused by acne.
Another option is the Light Emitting Diode (LED) technology, which uses different colors of light to target different problems with the skin. Red light can target collagen and help improve acne scars.
Also, the Pulsed-Dye Laser (PDL) can help fade the redness associated with acne scars because it targets the red hemoglobin pigment in the blood, resulting in an even, natural skin tone.
What does the procedure look like?
Depending on the laser used and the size of the area treated, the procedure can take 30 minutes to over an hour. After cleansing the face, the area is numbed with local or topical anesthesia. Oral sedatives, IV sedation, and even general anesthesia can be used for extensive scarring requiring full-face ablative laser treatments.
After the treatment is complete, post-op care instructions are given. Proper cleansing, moisturizing, and sun protection are a must after laser treatments. Ablative treatment will require wound care to the area for up to 2–3 weeks. Oral medication may be prescribed to prevent bacterial infection or outbreak of herpes. Strict adherence to post-procedure protocols will lessen the rate of complications.
What is the recovery period after laser treatments for acne scars?
Ablative lasers take longer to recover because the skin is being removed and needs time to heal. It can take up to 2–3 weeks for the skin tissue to undergo the natural healing process and several months for the residual redness to subside. Even fractionated ablative lasers can take 1–2 weeks to heal, depending on the depth of the treatment. Residual redness can take weeks to subside as well.
Non-ablative laser treatments require less time to recover because there are no wounds created and no healing process. The skin redness and swelling will fade over the next 1–2 weeks. Recovery from fractionated non-ablative laser treatment is even faster, with only a few days of redness.
How much is laser treatment for acne scars?
The cost of laser acne scar removal treatment depends on the type of laser used, the area treated, and where you are located. Ablative non-fractionated laser treatments are usually the most expensive. It is best to consult with a board-certified dermatologist or plastic surgeon first to discuss which laser would be best for you and what the costs are.
Laser treatment for acne scars can greatly improve their appearance, but will never make them disappear completely. Correct expectations are critical for any procedure, especially laser for scars. Always consult with your doctor first to discuss your options and treatment goals.
How many laser sessions do you need for acne scars?
Several laser sessions may be required. The number of laser sessions for acne scars depends on the extent of the scarring, laser settings, and the laser being used. Usually, ablative non-fractionated lasers only require one treatment because it is a more aggressive laser treatment that removes layers of scarred tissue in one session. Non-ablative and fractionated lasers require several treatments to create healthy tissue.
What are the side effects of laser scar removal?
These depend on the laser being used for the acne scars. Redness, swelling, itching, and stinging can occur with all lasers. Bleeding, bruising, infection, scarring, pain, prolonged redness, and change in the pigment of your skin can occur with ablative laser treatments. Fractionated ablative lasers hold less risk than non-fractionated ones and have an overall quicker healing time.
How painful is laser acne scar removal?
There is some discomfort associated with laser acne scar removal. Ablative non-fractionated treatments carry the most risk of pain, but your doctor will give you something to help with the pain after surgery. The other types of lasers usually do not require any post-op pain management. During any of the laser procedures, there is very little discomfort because you are numbed with some form of anesthesia.
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