Thank you for your question.
You’re a 27-year-old woman, half Filipino and half Caucasian with the history of acne
scars and you still have acne and you’ve undergone as you describe in your question
3 eMatrix treatments as well as 2 RF microneedling treatments and you state that you’ve had
very little change and improvement and so you’re asking if a more aggressive ablative
CO2 laser is appropriate for you.
Well certainly I can understand your frustration and I’ll give you a perspective based on
my experience with acne scars.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon and the use of lasers to help people with acne scars and actually
treating acne scars with a multiple different approach is significant part of my practice.
And I can certainly appreciate the challenges that your doctor face with your situation.
You see, the treatment of acne scars is very often a treatment of trial and observation
and then adjustment.
And when you look at what is the reason for acne scars, you understand what makes it challenging
to treat.
So the inflammation from cystic acne causes loss of tissues, loss of skin, loss of the
top layer, loss of the middle layer and even scar tissues underneath so you end up with
varieties of scars called ice-pick scars, boxcar scars and rolling scars.
And it is certainly there are plenty of successes with these technologies that you mentioned.
The eMatrix is a fractional CO2 laser and even the radio frequency, with the microneedling
device can cause some tightening.
Now in my practice, I actually also suggest to patients to also have a procedure called
subcision where I release the scar of the acne scars from the underlying tissues and
I’ll use platelet-rich plasma (PRP) in addition to try stimulate collagen and stimulate the
quality of the skin.
And one of the challenges is the skin is, by definition, somewhat dysfunctional and
so we use platelet-rich plasma (PRP).
And just to give you brief explanation, platelet-rich plasma (PRP) is derived from your own blood
and it’s a concentration of the wound healing and growth factors.
And when I use platelet-rich plasma (PRP), I’ll use hyaluronic acid filler to try and
build up the tissue underneath so that the scar tissue fills and then I’ll use varieties
of technology including fractional CO2 laser or erbium.
And yes, there are a lot of ways to combine these technologies.
So I think that one of the challenges your doctor has faced of course is that any young
person is prone to potentially hyperpigment or pigmentary changes.
They want to stay on the conservative side and be careful about managing the potential
for hyperpigmentation.
We have a particular laser made by a Fotona where we use erbium which actually minimizes
the amount of heat delivery which goes deeper under the tissues and that’s been a good
safe option for us in comparison to the amount heat delivery we get with our Mixto fractional
CO2 laser.
This is an art and there is going to be a lot of people applying their technologies
and methods in their own ways based on their experience.
So, I don’t think you can necessarily throw away the technology that was used to help
you but don’t go for something much more aggressive because there is a higher risk
with treatments that are more aggressive and you are probably in the zone that you can
do more without taking on that level of risk.
You’ll get a lot of suggestions by a lot of different people and unfortunately for
acne scar patients, they tend to bounce from doctor to doctor and get very frustrated.
And so I think that you should speak with your doctors that helped you with these original
procedures and ask about other options and see what they can offer you because there
can may be more than just the laser devices that they can help you with.
I always tell my patients with acne scars that you are not dealing with a situation
where you are not ever going to see scars again.
What you want to do is soften the appearance of the scars and try to minimize them as a
focal point of your face and it is a challenge with people who have cystic scars who feel
that everyone is looking at their scars and feel like really it affects their self-esteem
as a general experience with meeting a lot of these patients.
A lot of people, as they get older, tend to feel like they always have them and they accept
them and they’ll try to do something to improve them but I think there is individual
variation.
So, I would caution you about doing something much more aggressive.
You may want to get additional opinions but at the same time, have a dialogue with the
doctor or the doctors who helped you with the original procedures.
And so I can tell you that with fractional CO2 laser, you can go for minimal to very
aggressive and everything in between so you don’t have to worry about laser or the technologies
not being strong enough but there is information to be derived from your response and you should
probably take a look at your before and after pictures and you may find that there are likely
some improvements that may not be so dramatic to you but actually, at the physical, have
come about from these interventions.
So I hope that was helpful, I wish you the best of luck and thank you for your question!