Thank you for your question.
You submitted your question without a photo but
basically you’re asking, why are doctors often recommending a combination of full field
Erbium laser treatment with a fractional CO2 laser treatment for acne scars.
And essentially, you’re trying to understand what the rationale is and whether or not the
CO2 laser is necessary.
Well, I can certain share with you how I approach my patients who have acne scars.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Lasers for skin resurfacing is something that I was very fortunate to be a part of from
the very beginning in the early 90s with the original very aggressive ablative CO2 lasers.
And understanding the evolution of needs and outcomes is ultimately what has resulted in
types of combination strategies and I’ll explain it more basically what transpired.
When we were doing the original CO2 lasers, we were basically inducing a full facial second
degree burn.
And that meant managing the patient like a burn patient as you would in a hospital.
And it involved a long healing process, dressing changes and other things and of course with
that came risks and challenges and complications.
So it’s almost like the the desirability of doing that dropped precipitously.
And then around 1998 or so, the Erbium laser was introduced and we decided of course it
was better to allow people for faster healing time and maybe not deliver as much thermal
energy and try to get improvement and lower the risks of complications.
Well, move the clock forward, we have fractionated forms of both Erbium laser and CO2 laser.
I would say that ultimately, if we were talking about using purely a laser strategy, you’re
mostly talking about dealing with basically a sub type of scar known as boxcar scars.
And essentially what you’re trying to do is you’re trying to blend the transitions
between the normal skin and the scarred skin.
What is essentially the intention is that with the Erbium laser, you are resurfacing
a lot of the skin and without delivering thermal energy in a great amount.
And then for the deeper scars, you’re delivering CO2 energy which delivers thermal energy to
induce a more robust collagen response.
Now in addition to that, I commonly also use microneedling, I use platelet-rich plasma,
I also do subcision.
There’s a lot of different ways to help maximize the outcome.
And the goal is to minimize the healing time and healing process.
As of late also, appreciating that, a lot of times people with acne scars don’t appreciate
how much fat volume loss they also have.
And so a lot of times, the most dramatic improvement for acne scars may be no laser at all but
rather the use of injectable fillers at a structural level.
So for example, very commonly, if you look at someone’s face, although people who have
acne scars are bothered by the scars when they look at themselves, basically you’re
looking at a triangle.
Basically you’re looking at the eyes and then the point of the bottom or the point
of the triangle is the chin.
Within that area, includes the midface and the cheek.
A lot of times people who have depressed scars in that area, in the cheek area, filler does
a really nice job in adding volume and softening the appearance of those scars.
In addition, when it comes to the strategy of improving these scars, sometimes it’s
a slow approach where we do maybe a limited amount of fractional lasers or you may do
a combination of subcision and PRP and try to condition the skin and improve the skin
quality and then do the lasers.
People with acne scars are often very frustrated that they jump from one doctor to another,
one medispa to another trying to find the right laser and right combination.
And of course, the industry doesn’t help itself by simply keeping on promoting the
latest and greatest lasers every other day.
So there’s a strategy that your doctors who you are consulting always have in mind.
And it takes a certain amount of evaluation and understanding.
One of the things that help people understand that the significance of their acne scarring
is through an examination technique called backlighting.
And we look at the scars with backlighting, essentially, you kind of get a sense of what
the deepest layers are.
And when you think about laser, you’re dealing with just the skin at the thickest around
2 millimeters.
So when you look with back lighting, you see a significant indentation.
Well clearly, there’s an opportunity to build under the skin and that’s where injectable
fillers and PRP can also play a role.
Essentially, the goal is to maximize the outcome and minimize the downtime.
And so understanding that your doctor is trying to use probably that strategy to minimize
that amount of significant thermal energy to get the best result as well as minimize
your downtime.
So I hope that was helpful, I wish you the best of luck and thank you for your question.