Thank you for your question.
You are stating in your question that for your acne scars, after you undergo CO2 laser
treatment, as you became aware that the laser treatment maybe up to 50% effective in improving
acne scars that you want to know when to follow-up the treatment with 1540nm laser and how long
after the laser can you do that.
Well, I can certainly share with you what I think the principles that are relevant with
this type of question.
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.
I have been using lasers since the early to mid 90s including the original CO2 ablative
lasers and it’s certainly a time in the world of laser treatment when we have so many
options.
When you have these many options, you also understand that there’s clearly no one single
best approach to any particular problem.
And acne scars are one of the most challenging problems to treat.
And what you have to think about is really looking at your situation through the lens
of someone who is going to be able to manage you from all aspects and not just treat you
with the laser.
And the reason is that to understand that most people who have acne scars have a combination
of scars.
So whether they have rolling scars, boxcar scars, ice pick scars, atrophic scars, facial
fat atrophy, there are a lot of things that are usually the case when you evaluate someone.
And so before you start with any laser, what I do is I look at the foundation basis of
what gives a person smooth looking skin.
People always look at their skin and think it’s all about trying to smooth out the
top layer.
But when you think about skin, you get a structure that’s about 2 millimeters in thickness
in the face.
You also have to think about volume below the skin.
So when you ask a question like this, I would hope that you’ve also had a discussion with
the physician about strategies.
For example, when I evaluate a patient with acne scars, I take photos with direct light
and I take photos with backlight.
With backlighting, it shows me areas which particularly cast a significant shadow.
And a lot of times, I find that the most significant shadows are cast because of volume loss.
So a lot of times what I’ll do is, even on a younger person, I’ll do something like
Structural Volumizing by placing a long lasting filler like Juvederm Ultra Plus and Juvederm
Voluma at the cheek level on the bone and that results in a kind of a restoration of
volume.
And when there’s restoration of volume, acne scars look smoother.
A lot of patients who come in who have experienced facial aging on top of acne scars, they really
appreciate that significant change probably more than anybody.
But the point of this is understanding that you have to work from the inside outward.
We would also combine other treatments as foundational ways to improve the skin’s
ability to respond.
So I would sometimes combine this with platelet-rich plasma (PRP) injection, micro needling with
platelet-rich plasma.
Basically, I try to minimize more aggressive ablative procedures before doing them so that
we get the skin healthy, we get the skin full and you may end up needing more conservative
treatment.
There’s a basic principle in wound healing and that is after you have an injury and that
includes the controlled injury of laser resurfacing, then there is a proliferative phase of generating
collagen that is essentially about a month or so.
And I think based on that concept, it might be safe for you to go ahead and do a non-ablative
procedure such as using this particular laser afterwards to try to stimulate collagen.
But I would caution you that there’s also a wound remodeling phase.
And I would tend to lean more on the conservative before trying to stimulate the skin to generate
more collagen because you can only generate so much.
A lot of times people are frustrated because they get a laser and another laser and another
laser.
A lot of times patients have come to me and their skin after so many different laser treatments
actually looks really thin.
And so we do what we refer to as tissue rehab where we’re using platelet-rich plasma derived
from your blood.
We sometimes combine this with Acellular matrix to help stimulate the fat cells and give the
skin some substance before treating it with another laser.
Interestingly, the world is coming full circle and a lot of the luminaries who have been
the biggest proponents for laser are now advocating PRP as well as microneedling.
So a little vindication is certainly something I’m enjoying.
Nonetheless, I really think you have to think through this process because you should have
a realistic understanding of outcome.
People, generally speaking, want to see significant improvement.
A lot of times acne scar patients get very frustrated because they don’t necessarily
see the improvement, they only see where there’s still loss.
And so it’s very important to have a good relationship with your doctor and have clarity
with what the outcomes will be and the timing.
You know, we have a lot of tools but you have to know when to use them and when to hold
back and wait.
And of course, ultimately, it’s my goal to try to do what is most effective with the
least amount of downtime and have a sense of what would really make the most impact.
You have to unfortunately accept that there’s no perfect solution for acne scars.
There are ways to treat and improve appearance but some things cannot be completely reversed.
So I hope that was helpful, I wish you the best of luck and thank you for your question.