Light and Laser Treatments for Acne Scars

Ruby Laser Treatment of Hyperpigmentation on Cheek

Light and Laser (L&L) treatments for acne scars use high-intensity light sources to treat skin damage caused by acne. Light and Laser treatments can be an excellent option for every type of acne scarring. Powerful ablative lasers can be used to break up scar tissue and repair damage from significant acne scars. Less invasive Light and Laser treatments are also available for mild acne scars and skin pigmentation problems. Below is our complete guide to Light and Laser Treatments for Acne Scars.

Alexandrite Lasers

Alexandrite Laser Hair Removal

Alexandrite Lasers are commonly used for laser hair removal and to treat areas of hyper-pigmentation on the skin (eg. melasma). Except for the treatment of hyper-pigmentation problems associated with acne scarring, Alexandrite Lasers are rarely used for the treatment of acne scars.

There is very little clinical research on the effectiveness of Alexandrite lasers in the treatment of active acne or acne scars. At the current time, Alexandrite Lasers are not considered to be an effective treatment for most types of acne scarring. Our discussion of Alexandrite Lasers and acne scars can be found here.

Carbon Dioxide (CO2) Lasers

C02 Laser Ablative Skin ResurfacingCarbon Dioxide (C02) Laser systems are ablative laser systems that are commonly used for laser resurfacing procedures on the face. CO2 Lasers are popular treatments for moderate to severe acne scars. The ability to penetrate into the supportive tissue underneath the skin surface makes CO2 Lasers a preferred choice for ablative laser resurfacing treatments, such as the repair of skin damage associated with moderate to severe acne scars.

Carbon Dioxide (CO2) lasers can be an effective treatment for many types of facial acne scars. In general, both physician and patient satisfaction with the results of CO2 Laser resurfacing are good. CO2 Lasers can be used for either complete resurfacing or fractional resurfacing procedures (eg. Fraxel). Complete resurfacing treats all of the tissue in a given area, while fractional resurfacing pixelates the laser beam and leaves small regions of untreated skin between the regions of treated skin. Fractional CO2 Laser treatments  are very popular because they tend to have fewer side effects and require shorter healing times than complete resurfacing. Our discussion of CO2 Lasers and acne scars can be found here.

Er:YAG Lasers

ErYAG Fractional Ablative Resurfacing of Acne ScarsAlong with CO2 Lasers, Er:YAG Lasers are the systems of choice for ablative laser skin resurfacing. Er:YAG Lasers are commonly used for treatments to repair skin damage, such as acne scars.

Er:YAG lasers are excellent options for repairing minor to moderate scarring and other superficial skin damage, but are considered to be less effective for the treatment of severe acne scars than CO2 Lasers. Because Er:YAG lasers primarily affect the surface of the skin, the recovery times are faster and the side effects are generally milder than more invasive laser resurfacing techniques, such as CO2 Laser resurfacing. Er:YAG Lasers are generally considered to be more effective for the treatment of acne scars than many other light and laser treatment modalities, including as Nd:YAG, Pulsed Dye Lasers (PDL) and Intense Pulsed Light (IPL). Our discussion of CO2 Lasers and acne scars can be found here.

Nd:YAG Lasers

Nd:YAG Laser Resurfacing of Acne ScarsNd:YAG Lasers are fairly common treatment of acne scars. Nd:YAG Lasers generally produce an infra-red laser beam (~1064 nm), but many dermatology clinics use tunable or Q-switched Nd: YAG laser platforms that allow the production of laser wavelengths down to 530 nm. Many dermatological Nd:YAG Laser systems combine an automated coolant spray that is administered simultaneously with the laser treatment. The coolant spray prevents the surface of the skin, the epidermis, from overheating and being damaged.

There are numerous clinical research studies on the utility of Nd:YAG Lasers for the treatment of acne scars. Overall, the scientific research indicates that Nd:YAG Lasers can help improve the appearance of acne scars. However, Nd:YAG Lasers tend to be less effective than CO2 lasers and Er:YAG lasers for the treatment of moderate to severe acne scars because Nd:YAG Lasers are less able to penetrate deeply into the skin. Our discussion of Nd:YAG Lasers and acne scars can be found here.

Pulsed Dye Lasers (PDL)

Pulsed Dye Laser Treatment of ErythemaPulsed Dye Lasers (PDL) are occasionally used for the treatment of both acne scars and active acne. Although they can be used for multiple applications, Pulsed Dye Lasers are not usually not first-choice for the treatment of active acne or acne scars. Dye Lasers get their name from the fact that they use a specialized liquid dye suspension, instead of a crystal, as the source of the laser beam.

Pulsed Dye Lasers are generally only used for the treatment of mild acne scars. PDLs are a viable treatment for spider veins, erythematous acne scars and other skin discolorations caused by damaged or dilated blood vessels. Improvements in acne scars following PDL treatment are usually modest and superficial.  On average, Pulsed Dye Laser treatment of acne and acne scars is reviewed as poor to moderate by patients after treatment. It is likely that PDLs are popular because they are a relatively inexpensive, versatile and common platform and not because they are highly efficacious for acne treatment. Our discussion of Pulsed Dye Lasers (PDLs) and acne scars can be found here.

Radio Frequency (RF) Therapy

RF Therapy for Acne Scars 1Radio Frequency (RF) therapy uses beams of radio waves to heat sub-cutaneous tissue. RF Therapy is most effective for the treatment of mild to moderate to acne scars. RF Therapy can help improve the smoothness of the surface of the skin by inducing the growth and remodeling of the underlying tissue that supports the skin (eg. the Extra-Cellular Matrix “ECM”). Because effective treatment of moderate-to-severe acne scars often requires more aggressive skin resurfacing treatments (eg. ablative treatments), RF Therapy tends to be ineffective for the treatment of severe acne scars.

RF Therapy is most widely used in treatments designed to improve skin laxity and diminish the appearance of cellulite.  RF Therapy systems produce intense beams of high frequency radio waves (generally around 5 MHz). RF Therapy has many dermatological and cosmetic applications. The intensity of the radio beams and their specific frequency are optimized for specific types of treatments. Our discussion of Radio Frequency (RF) Therapy and acne scars can be found here.

Red Light Phototherapy

Red Light PhototherapyRed Light Phototherapy is a treatment that involves exposing the skin to high intensity red light in the red spectrum. The purpose of the treatment is to reduce skin inflammation and accelerate healing. It is primarily used as a treatment for minor acne-scarring and to facilitate healing after an acne outbreak. Red Light Phototherapy is also occasionally used for the treatment of active acne symptoms.

Several research studies have reported that red light (600-900 nm) stimulates the growth of new skin tissue and the production of collagen. Although Red Light Phototherapy is not an effective scar treatment by itself, it can be combined with other types of scar treatments (eg. Laser Resurfacing, Microdermabrasion) to accelerate the healing process. Our discussion of Red Light Phototherapy and acne scars can be found here.

Ruby Lasers

Ruby Laser TreatmentOnce quite common in medical and industrial applications, Ruby Lasers have declined in popularity with the development of modern laser systems. Ruby Lasers are rarely used in the treatment of acne scars, but there have been a handful of studies investigating their use in this context.

Ruby Lasers produce a laser beam that has a deep red color and a wavelength of ~694 nm.  Light in this wavelength is readily absorbed by the pigment melanin and many of the dyes used in tattoos. Ruby Lasers are occasionally used to some types of skin discoloration associated with acne scars. However, other types of laser treatments are more frequently used for this purpose (eg. IPL, PDL). Ruby Lasers are not considered to be an effective treatment for the damaged skin tissue associated with moderate to severe acne scarring. Our discussion of Ruby Lasers and acne scars can be found here.

Ruby Lasers

Ruby Laser Treatment

In 1960, the first operational laser was constructed. It was a ruby laser. Once quite common in medical and industrial, Ruby Lasers have declined in popularity with the development of modern laser systems. Ruby Lasers have been used extensively in medical applications (eg. tattoo and hair removal) and industrial applications (eg. diamond cutting and holography). Ruby Lasers are rarely used in the treatment of acne or acne scars, but there have been a handful of studies investigating the use of Ruby Lasers in the context of acne treatment.

How do Ruby Lasers Work?

Ruby Crystal
Ruby Crystal

Ruby Lasers produce a laser beam that has a deep red color and a wavelength of ~694 nm. Ruby Laser are solid-state lasers that have a synthetic ruby as the lasing medium. Ruby Lasers are one of the few solid state lasers that produce light in the middle of the visible spectrum. Light in this wavelength is readily absorbed by the pigment melanin and many of the dyes used in tattoos.

Ruby Laser Treatment of Hyperpigmentation on Cheek
Ruby Laser Treatment of Hyperpigmentation on Cheek

The energy in the laser beam from a Ruby Laser is absorbed tattoo dye or melanin pigment, which causes thermal damage to the surrounding cells. This causes the dye and pigment to be released, dispersed and eventually removed by body. This process can also be used to permanently damage the hair roots in their follicle. Ruby lasers are quite effective for laser hair removal, but they have been phased out of this application because they can cause more collateral damage then newer versions laser hair removal systems.

Ruby Lasers, Active Acne and Acne Scars.

Hypopigmentation after Ruby Laser Treatment (Nanni)
Hypopigmentation after Ruby Laser Treatment (Nanni)

Ruby Lasers are not commonly used for the treatment of either active acne or acne scars. Ruby Lasers are occasionally used to some types of skin discoloration associated with acne scars. However, other types of laser treatments are more frequently used for this purpose (eg. IPL, PDL). Ruby Lasers are not considered to be an effective treatment for the damaged skin tissue associated with moderate to severe acne scarring. For the repair of significant acne scars, ablative laser resurfacing technologies (eg. CO2, Er:YAG, Nd:YAG) are generally much more effective.

Many patients who have undergone laser hair removal with Ruby Lasers have reported a reduction in the severity of their acne following treatment. The exact cause of these reported improvements has not been thoroughly studied and it is not clear whether these reports are reliable. Ruby Lasers are not generally used as a treatment for active acne. Other Light and Laser systems (eg. Blue Light Phototherapy, PDT, Diode Lasers) are considered better treatments for active acne.

Effect of Ruby Laser on Sebaceous Glands (Manuskiatti)
Effect of Ruby Laser on Sebaceous Glands (Manuskiatti)

Unlike Diode Lasers, which can effectively target and damage the sebaceous glands, the deep red light produced by a Ruby Laser is poorly absorbed by the sebaceous gland, which lacks pigments like melanin. There has been limited clinical research investigating the efficacy of Ruby Lasers for acne treatment. However, the available research does provide some insight into the relationship between Ruby Laser treatment and acne. Researchers found that treatment with Ruby Lasers did tend to improve acne symptoms, but also increased the amount of sebum being secreted to the surface of the skin. Upon closer examination, they found that the size of the sebaceous gland was reduced, but it appeared to be producing more sebum. They hypothesized that this extra space created by removal of the hair shaft might allow the sebum to be secreted more freely, preventing the kinds of clogged pores and impacted follicles that can lead to inflammatory acne. This decreased resistance to secretion could lead to a smaller sebaceous gland. Despite this initial research, Ruby Lasers are not widely available as an laser acne treatment and their decreasing popularity in dermatology and cosmetic surgery make it unlikely that this will change.

How and where is Ruby Laser treatment administered?

Table of Side Effect Frequencies for NdYAG Ruby and Alexandrite Laser Treatment (Nanni)
Table of Side Effect Frequencies for NdYAG Ruby and Alexandrite Laser Treatment (Nanni)

Ruby Laser treatment is administered in laser hair and tattoo removal clinics, dermatologists offices and cosmetic surgery practices. Ruby Laser hair removal starts at approximately $100 dollars per session for a small treatment area and increases depending on the size and region of the treated area. Fractional laser platforms are available with Ruby Lasers.

Popular Ruby Laser Systems

EpiLaser, EpiPulse Ruby, Palomar E2000, RubyStar.

Ruby Laser Images

References

Laser hair removal affects sebaceous glands and sebum excretion: A pilot study. Manuskiatti, et al. 1999. 
Laser-assisted hair removal: Side effects of Qswitched Nd:YAG, long-pulsed ruby, and alexandrite lasers. Nanni, et al. 1999.
The Removal of Cutaneous Pigmented Lesions with the Q-switched Ruby Laser and the Q-switched Neodymium: Yttrium-Aluminum-Garnet Laser. Tse, et al. 1994.
Scar Sarcoidosis—Treatment With the Q-Switched Ruby Laser. Grema, et al. 2002.
Recalcitrant Scarring Follicular Disorders Treated by Laser‐Assisted Hair Removal: A Preliminary Report. Chui, et al. 1999.
Ruby Lasers @ Wikipedia
Ruby Laser Hair Removal @ Medic8

Radio Frequency (RF) Therapy

RF Microneedle Therapy for Acne Scars 1

Radio Frequency (RF) therapy uses beams of radio waves to heat sub-cutaneous tissue. RF Therapy is most widely used in treatments designed to improve skin laxity and diminish the appearance of cellulite. There are several different types of RF Therapy systems. High-power Radio Frequency platforms can also be used for ablative treatments. Certain types of RF Therapy are occasionally used for the treatment of active acne and acne scars.

How does Radio Frequency (RF) Therapy Work?

Duet RF Therapy System in Action
Duet RF Therapy System in Action

RF Therapy systems produce intense beams of high frequency radio waves (generally around 5 MHz). These beams of radio waves are absorbed by the target tissue, producing heat. Most RF therapy systems have a coolant system that sprays the surface of the treated area with cold gas. This prevents the surface from heating to the same degree of the internal tissue.

Histological Changes Following Pixel RF Treatment (Halachmi)
Histological Changes Following Pixel RF Treatment (Halachmi)

RF Therapy has many dermatological and cosmetic applications. The intensity of the radio beams and their specific frequency are optimized for specific types of treatments. Low-power RF Therapy is used for to tighten skin and reduce the appearance of cellulite. This application works by inducing small amounts of thermal damage that then stimulate the production of new collagen, elastin and other components of the Extra-Cellular Matrix (ECM) that supports the skin.

RF Therapy can also be used with high-power radio beams. High-power RF therapies are used for ablative treatments, such as resection of cancerous or damaged tissue.

RF Therapy for the Treatment of Active Acne and Acne Scars.

RF Therapy of Acne Scars Before and After 4 Sessions (Ramesh)
RF Therapy of Acne Scars Before and After 4 Sessions (Ramesh)

RF Therapy is generally used for the treatment of acne scars. It is primarily used for the treatment of mild acne scars, and it is frequently combined with complementary scar treatments. RF Therapy has also been tested as a treatment for active acne, but this is an uncommon application of RF technology.

RF Treatment of Acne Scars Summary of Results (Ramesh)
RF Treatment of Acne Scars Summary of Results (Ramesh)

RF Therapy is most effective for the treatment of mild to moderate to acne scars. RF Therapy can help improve the smoothness of the surface of the skin by inducing the growth and remodeling of the underlying tissue that supports the skin (eg. the Extra-Cellular Matrix “ECM”). Dermatological applications of RF Therapy generally use low-power RF systems. These low-power RF systems are designed to cause small amounts of thermal damage and are considered non-ablative. Because effective treatment of moderate-to-severe acne scars often requires more aggressive skin resurfacing treatments (eg. ablative treatments), RF Therapy tends to be ineffective for the treatment of severe acne scars. For the treatment of moderate-to-severe acne scars, ablative laser treatments (eg. CO2, Er:YAG and Nd:YAG) are more frequently used.

RF Therapy for Active Acne Before and After 1 (Ruiz-Esparza)
RF Therapy for Active Acne Before and After 1 (Ruiz-Esparza)

RF Therapy has also been tested as a treatment for active acne. RF Therapy is rarely used for this application (and is not currently FDA-approved for this application at the time of this writing). However, some preliminary clinical research has indicated that RF therapy may be an effective treatment for active acne and some dermatologists are currently offering this treatment..

Improvement in Active Acne Symptoms After RF Therapy Summary of Results (Ruiz-Esparza)
Improvement in Active Acne Symptoms After RF Therapy Summary of Results (Ruiz-Esparza)

In the studies that have examined the efficacy of RF Therapy for the treatment of active acne, researchers have observed significant improvements in acne symptoms following treatment. However, it is important to note that relatively few clinical studies have been done on this topic, and many of those were funded by the manufacturer of the RF Therapy systems being tested. RF Therapy for acne is generally considered “off-label” and is not widely available. That may change if continued research supports the initial findings about the general efficacy of RF acne therapy.

In the treatment of active acne, RF Therapy may have two mechanisms of action that explain the observed benefits. First, the increased temperatures in the skin caused by RF Therapy may directly damage acne-causing bacteria (eg. P. acnes). The reduction in bacterial load following therapy could lead to a decrease in inflammation. Second, RF Therapy may decrease the size and activity of the sebaceous glands, causing a decrease in sebum production. Both of these effects could cause an improvement in acne symptoms.

How and Where is RF Therapy Administered?

RF Therapy for Acne Scars 1
RF Therapy for Acne Scars 1

RF Therapy is administered in many spas, dermatology offices, cosmetic surgery clinics and hospitals. RF Therapy is not widely available as an acne treatment.

The cost for RF Therapy can vary significantly depending on the application, area treated and system used. Generally speaking, RF Therapy tends to be fairly expensive. For example, treatments with Thermage (a popular RF therapy platform) generally cost over $2,000. Since RF therapy is not widely available as an acne treatment, there is little information available on the cost for that application.

RF Therapy should only be administered in a professional medical setting by trained professionals. Improper use of RF Therapy can permanently damage the tissue that supports the skin. This kind of damage can lead to permanent skin damage and scarring. Because RF Therapy targets the tissue underneath the skin, damage caused by improper use of this technology may not be immediately apparent after treatment.

Some RF Therapy platforms are capable of delivering fractionated (pixelated) radio beams. Fractionated RF systems tend to have fewer side effects, but can require additional treatments to achieve the same end result as complete (unfractionated) RF treatments.

Common RF therapy Systems

3DEEP Fractional, Aluma, Duet RF, eLIGHT, Exilis, INFINI, Intensif, Pixel RF, SecretRF, Sublative RF, Syneron Matrix RF, Thermage, VelaShape, Venus Freeze.

RF Therapy Images

References

Nonablative Radiofrequency for Active Acne Vulgaris: The use of Deep Dermal Heat in the Treatment of Moderate to Severe Active Acne Vulgaris (Thermotherapy): A Report of 22 Patients. Ruiz-Esparza, et al. 2003.
Nonablative Radiofrequency Treatment of Facial Laxity. Fisher, et al. 2005.
Laser Treatment of Acne Vulgaris. Jih, et al. 2007.
Procedural Treatments for Acne Vulgaris. Taub, et al. 2007.
Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. Prieto, et al. 2005.
A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: A pilot study. Halachmi, et al. 2010.
Novel technology in the treatment of acne scars: The matrix-tunable radiofrequency technology. Ramesh, et al. 2010.
Thermage Patient Reviews @ Realself
RF Therapy Skin Tightening @ Wikipedia

 

Nd:YAG Lasers

NdYAG Laser Acne Treatment 2

Originally invented in the 1960’s Nd:YAG lasers are among the most common and widely used class of laser.  Nd:YAG lasers are frequently used for the treatment of acne scars. In addition acne scar treatment and other cosmetic applications, Nd:YAG lasers are also routinely employed in eye surgeries, dentistry, cancer treatment and a variety of industrial uses. Nd:YAG lasers are not generally used for treatment of active acne.

How do Nd:YAG Lasers Work?

NdYAG Laser Treatment of Vericose Veins
NdYAG Laser Treatment of Vericose Veins

Nd:YAG Lasers are named for the crystal used as the lasing medium, Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG). Nd:YAG Lasers generally produce an infra-red laser (1064 nm), but most systems are adjustable, allowing the system to produce additional colors of laser beam (532, 940, 1120, 1230, 1320, and 1440 nm). Many dermatology clinics use tunable or Q-switched Nd: YAG laser platforms that allow the production of laser wavelengths down to 530 nm.

Improvement in Skin Roughness After Non Ablative NdYAG Treatment (Friedman)
improvement-in-skin-Improvement in Skin Roughness After Non Ablative NdYAG Treatment (Friedman)

Like other infra-red lasers (e.g. CO2 Lasers) the Nd:YAG Laser works primarily by heating the water molecules in the treatment area. When used at low power, infra-red lasers are used to stimulate cells by heating them up, but not enough to kill them. When used at high power, infra-red lasers can destroy (ablate) the target tissue very quickly. Ablative laser therapy with Nd:YAG Lasers is a popular technique to resurface the skin and treat acne scars by removing scar tissue.

Effect of Non Ablative NdYAG on Acne Scars and Collagen Remodelling (Keller)
Effect of Non Ablative NdYAG on Acne Scars and Collagen Remodelling (Keller)

Laser beams with longer wavelengths are generally capable of penetrating deeper into skin and tissue. Infra-red lasers like Nd:YAG can be quite effective at repairing deep acne scars. Many dermatology laser systems combine an automated coolant spray that is administered simultaneously with the laser treatment. The coolant spray prevents the surface of the skin, the epidermis, from overheating and being damaged. When combined with an infra-red laser like Nd:YAG, this system allows the physician to treat the underlying tissue, while leaving the surface of the skin undamaged.

Nd:YAG Lasers, Active Acne and Acne Scars

Non Ablative NdYAG Treatment of Atrophic Acne Scars Before and After (Keller)
Non Ablative NdYAG Treatment of Atrophic Acne Scars Before and After (Keller)

Nd:YAG Lasers are commonly used as a treatment for acne scars. Nd:YAG Lasers are generally not used as a treatment for active acne. There are numerous clinical research studies on the utility of Nd:YAG Lasers for the treatment of acne scars. Overall, the scientific research indicates that Nd:YAG Lasers can help improve the appearance of acne scars. Along with CO2 and Er:YAG lasers, Nd:YAG lasers are some of the most popular and efficacious systems for treating acne scars.

Effect of NdYAG Laser Treatment on Active Acne and Sebum Production (Deng)
Effect of NdYAG Laser Treatment on Active Acne and Sebum Production (Deng)

There is also a small amount of research that indicates that Nd:YAG Laser treatment may be a helpful treatment for active acne for some people. However, improvements in acne symptoms following Nd:YAG treatment tend to be mild and temporary. Achieving good results requires frequent treatments, which can quickly get very expensive. In spite of this challenge, Nd:YAG treatment of active acne is positively reviewed by some patients.

How and Where are Nd:YAG Laser Treatments Administered?

DermaLase NdYAG Laser Platform
DermaLase NdYAG Laser Platform

Nd:YAG laser treatments are almost exclusively performed in a dermatology and cosmetic surgery clinics, along with hospitals. The cost of Nd:YAG laser treatment varies greatly by the type of application and the number of treatments required to achieve the desired result. Generally speaking, each individual treatment will cost at least $200 dollars. Some of the acne research studies used 8-10 individual treatments. This kind of Nd:YAG acne treatment program could easily cost $2000 dollars.

Ablative Nd:YAG Laser treatments that target acne scars may require fewer sessions and smaller treatment areas, which can hold down costs somewhat. Ablative laser therapy is somewhat invasive and can cause serious damage if done improperly. It is therefore very important to undergo any high-power or ablative laser treatment in a safe, licensed and professional environment.

Common Nd:YAG Laser Systems

Affinity QS, CoolTouch, DermaLase, Excel, Gemini, Genesis, GentleYAG, PhotoSilk, RevLite.

Nd:YAG Laser Images

References

A randomized, controlled, split-face clinical trial of 1320-nm Nd:YAG laser therapy in the treatment of acne vulgaris. Orringer, et al. 2007.
Fractional 1320 nm Nd : YAG laser in the treatment of acne vulgaris: a pilot study. Deng, et al. 2009.
Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Jordan, et al. 2000.
A Preliminary Study of Utilization of the 1320-nm Nd:YAG Laser for the Treatment of Acne Scarring. Sadick, et al. 2004.
Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser. Rogachefsky, et al. 2003.
Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. Lee. et al. 2006.
Comparison of a Long-Pulse Nd:YAG Laser and a Combined 585/1,064-nm Laser for the Treatment of Acne Scars: A Randomized Split-Face Clinical Study. Min, et al. 2009.
Comparison of a Pulsed Dye Laser and a Combined 585/1,064-nm Laser in the Treatment of Acne Vulgaris. Jung, et al. 2009.
Nonablative 1,064-nm Nd:YAG Laser for Treating Atrophic Facial Acne Scars: Histologic and Clinical Analysis. Keller, et al. 2007.
Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG Laser. Lipper, et al. 2006.
Patient Satisfaction and Reported Long-Term Therapeutic Efficacy Associated with 1,320 nm Nd:YAG Laser Treatment of Acne Scarring and Photoaging. Bhatia, et al. 2006.
Subcision and 1320-nm Nd:YAG Nonablative Laser Resurfacing for the Treatment of Acne Scars: A Simultaneous Split-Face Single Patient Trial. Fulchiero, et al. 2004.
Treatment of Atrophic Facial Acne Scars With the 1064-nm Q-Switched Nd:YAG Laser. Friedman, et al. 2004.
Nd:YAG laser @ Wikipedia
Physician Reviews of Nd:YAG Lasers @ MedicalSpaMD
Nd:YAG Laser Patient Reviews @ RealSelf

Er:YAG Lasers

Er:YAG Fractional Resurfacing on Cheek

Er:YAG and CO2 Lasers are the systems of choice for ablative laser skin resurfacing. Er:YAG Lasers are commonly used to repair skin damage, including acne scars and melasma (excess pigmentation). Er:YAG lasers are also routinely used to cut bone and tissue. They are used in laser dentistry and other surgical applications.

How do Er:YAG Lasers Work?

Resolution of Erythema After ErYAG Laser Resurfacing (Ko)
Resolution of Erythema After ErYAG Laser Resurfacing (Ko)

 Er:YAG Lasers utilize Erbium-doped Yttrium Aluminium Garnet as the lasing medium. Er:YAG Lasers generate a laser beam with a very long wavelength (~2940 nm). This wavelength is in the infra-red spectrum and is strongly absorbed by water. The longer wavelength of the Er:YAG laser beam helps it to penetrate deeply into the skin tissue.

ErYAG Ablative Skin Resurfacing
ErYAG Ablative Skin Resurfacing

Er:YAG Lasers work by ablating (vaporizing) the surface layer of the skin. Each pass with the Er:YAG laser removes approximately 10 micrometers of skin tissue (1/100th of a millimeter). This type of technology is the basis for the procedure known as a “laser peel”. Some systems are can be tuned to produce laser peels of varying depth.

ErYAG Laser Resurfacing at a Cellular Level (Jeong)
ErYAG Laser Resurfacing at a Cellular Level (Jeong)

Er:YAG Lasers primarily target the surface of the skin, and are not as effective as CO2 lasers at remodeling the collagen matrix underneath the skin. As a result, Er:YAG lasers are excellent options for repairing minor to moderate scarring and other superficial skin damage, but are less effective for severe scarring, especially pitted acne scars. Because Er:YAG lasers primarily affect the surface of the skin, the recovery times are faster and the side effects are generally milder than more invasive laser resurfacing techniques, such as CO2 Laser resurfacing.

Er:YAG Lasers, Active Acne and Acne Scars

ErYAG Laser Resurfacing (Jeong)
ErYAG Laser Resurfacing (Jeong)

Er:YAG Lasers are primarily used as a treatment for acne scars. They are rarely used for the treatment of active acne. Er:YAG Lasers have a good efficacy profile against mild to moderate acne scarring. Er:YAG Lasers are generally considered to be more effective for the treatment of acne scars purposes than many other light and laser treatment modalities, including as Nd:YAG, Pulsed Dye Lasers (PDL) and Intense Pulsed Light (IPL).

ErYAG Improvement of Acne Scarring for Different Regions of the Face (Tay)
ErYAG Improvement of Acne Scarring for Different Regions of the Face (Tay)

The (relatively) mild side effects of Er:YAG Lasers, combined with decent efficacy and generally positive patient response has made Er:YAG lasers a popular treatment option for superficial acne scars. The biggest limitation of Er:YAg lasers is their inability to effectively treat the extensive and deep scarring that is common in those who have suffered from severe inflammatory and cystic acne. For the treatment of moderate to severe acne scars, C02 Lasers generally provide better improvement. However, CO2 Lasers tend to generate more severe side effects and the recovery period can be significantly longer.

How and Where is Er:YAG Laser Treatment Administered?

Fractional Photothermolysis Cellular Image and Diagram (Geronemus)
Fractional Photothermolysis Cellular Image and Diagram (Geronemus)

Er:YAG treatment is administered in cosmetic surgery clinics, dermatology offices and hospitals. Er:YAG Laser treatment can be done as a complete or fractional ablation technique. Complete ablation treats all of the skin in a given region, but fractional treatment leaves small areas of untreated skin in between (like a checkerboard). Recovery times from fractional treatment tend to be substantially shorter than from complete ablation treatments.

The cost of Er:YAG treatment varies greatly depending on the area being treated, the number of passes (how many times they go over a particular area during a single treatment), the number of treatment sessions, and the general costs of laser surgery in your market. Generally speaking, the cost ranges from $200 to $700 dollars per treatment session for treatment of facial acne scars. In many cases, multiple treatments are necessary to achieve significant results. A complete Er:YAG treatment plan for facial acne scars often costs in excess of $2000.

Common Er:YAG Laser Systems

Alma Pixel, Contour TRL, Fotona, FRAXEL RE:STORE (fractional Er:YAG laser system), Sciton Profractional, Venus.

Er:YAG Laser Images

References

Resurfacing of Pitted Acne Facial Scars with a Long Pulsed Er:YAG Laser. Jeong, et al. 2001.
Resurfacing of Pitted Facial Acne Scars Using Er:YAG Laser with Ablation and Coagulation Mode. Jeong, et al. 2003.
Treatment of Atrophic Acne Scars with a Dual Mode Er:YAG Laser. Tanzi, et al. 2002.
Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study. Tay, et al. 2008.
Cutaneous Laser Resurfacing, Erbium-YAG @ Emedicine
Er:YAG laser @ Wikipedia

Alexandrite Lasers

Alexandrite Laser Hair Removal

Alexandrite Lasers are commonly used for laser hair removal and to treat areas of hyper-pigmentation on the skin (eg. melasma). Except for the treatment of hyper-pigmentation problems associated with acne scarring, Alexandrite Lasers are rarely used to treat active acne or acne scars.

How does Alexandrite Laser Treatment Work?

Alexandrite Illuminated with Different Light Sources
Alexandrite Illuminated with Different Light Sources

Alexandrite Lasers make use of the gemstone Alexandrite as the lasing medium. Alexandrite is a unique gemstone in that it changes color depending on the type of light that is illuminating it.

Alexandrite Lasers produce light with a wavelength of approximately 755 nm (Red/Infrared). Melanin, the primary pigment in skin and hair, absorbs energy strongly at this wavelength. As a result, the energy from Alexandrite Lasers is strongly absorbed by areas of tissue with high concentrations of melanin, such as the hair bulb and hyper-pigmented areas of skin. The absorption of the laser beam by the melanin damages the melanin-containing cells. This process is the basis of laser hair removal, which can damage the hair producing cells near the base of the hair shaft, and prevents future hair growth.

Is Alexandrite Laser Treatment an Effective Treatment for Acne?

There is very little clinical research on the effectiveness of Alexandrite lasers in the treatment of active acne. Alexandrite Lasers are usually not considered as an option for acne treatment. It is conceivable that they could be used to target the hair follicle, and in doing so, damage the sebaceous glands. But that is an untested concept, and is likely to remain that way. At the current time, Alexandrite Lasers are not considered to be an effective treatment for acne or most acne scarring.

How and Where is Alexandrite Laser Treatment Administered?

Candela GentleLase Laser System
Candela GentleLase Laser System

Alexandrite Laser treatments are offered at many dermatology offices, cosmetic surgery clinics and laser hair removal clinics.

Alexandrite Laser treatments for hair removal or melasma treatment are often significantly less expensive than laser skin resurfacing treatments and other aggressive laser therapies. There is a large range in cost, depending on the size of the treated area and the number of total treatments. One session of Alexandrite Laser treatment can start as low as $150 dollars and can rise to over a thousand dollars for a very large treatment area.

There have been numerous reports of permanent pigmentation and scarring side effects from poorly performed Alexandrite Laser treatment, Thus, it is important to have these procedures done in a professional and reputable environment.

Popular Alexandrite Laser Systems

Accolade, Apogee, DEKA MOTUS AX, Epilare, GentleLase, Noblex, Songic.

Alexandrite Laser Images

References

Laser Treatment of Pigmented Lesions. Goldberg. 1997.
Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face Design. Angsuwarangsee, et al. 2003.
Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite Laser. Alster, et al. 2004.
A Retrospective Study on the Efficacy and Complications of Q-Switched Alexandrite Laser in the Treatment of Acquired Bilateral Nevus of Ota-Like Macules. Ying-Ming, et al. 2001.
Alexandrite Laser Hair Removal @ Realself
Overview of Laser Hair Removal Treatment Options from Dr. Harvey Jay

Pulsed Dye Lasers (PDL)

Pulsed Dye Laser Treatment of Erythema

Pulsed Dye Lasers (PDL) are occasionally used for the treatment of both active acne symptoms and acne scars. Although they can be used for multiple applications, Pulsed Dye Lasers are not usually not first-choice for the treatment of active acne or acne scars.

How Does Pulsed Dye Laser Treatment Work?

Pulsed Dye Laser (PDL) Treatment
Pulsed Dye Laser (PDL) Treatment

Dye Lasers get their name from the fact that they use a specialized liquid dye suspension, instead of a crystal, as the source of the laser beam. Pulsed Dye Lasers (PDLs) are designed to deliver short bursts of light that last only a fraction of a second. Many Pulsed Dye Lasers can be adjusted (tuned) to create lasers of several different wavelengths (colors). For dermatology purposes, Pulsed Dye Lasers that produce laser beams at ~495 nm (green/yellow) are the most common.

The most popular dermatology application for Pulsed Dye Lasers is for the removal of birthmarks and other hyper-pigmented marks on the skin. Low power Pulsed Dye lasers are also used to improve the appearance of wrinkles by stimulating regrowth of the tissue immediately underneath the skin.

Pulsed Dye Lasers can be used for two ablative and non-ablative treatments. Ablative treatments (ablative means to be removed or vaporized at very high temperature) utilize longer laser pulses and/or high light intensity to thermally damage or destroy the target tissue. Certain molecules, like oxyhemoglobin (found in red blood cells), preferentially absorb energy from Pulsed Dye Lasers. This feature makes Pulsed Dye Lasers a viable treatment for spider veins, erythematous acne scars and other skin discolorations caused by damaged or dilated blood vessels.

Ablative laser treatments destroy the target tissue, which is then replaced by new, healthier tissue. Researchers are experimenting with using ablative laser treatment to target and destroy the sebaceous glands, whose hyperactivity can contribute to acne symptoms. However, longer wavelength laser sources, like diode and CO2 lasers are generally preferred over Pulsed Dye Lasers for many dermatology applications.

The more common application of Pulsed Dye Lasers is for non-ablative treatments. These treatments are intended to stimulate tissue growth or to target specific molecules like porphyrins. Although most commonly used to improve skin tone and correct small wrinkles, Pulsed Dye Lasers are also used to improve the appearance of mild acne scars.

Pulsed Dye Lasers and Active Acne

Chart Showing Good Efficacy of PDL Treatment of Active Acne (Jung)
Chart Showing Good Efficacy of PDL Treatment of Active Acne (Jung)

There are a handful of clinical research studies that found Pulsed Dye Lasers may be effective for treating active acne infections. There are also a few studies that found PDLs were not effective treatments for active acne. This disagreement is likely because there are several different kinds of PDLs, and the treatments being researched are not all the same for every study.

Chart Showing Poor Efficacy of PDL for Treatment of Activ Acne (Orringer)
Chart Showing Poor Efficacy of PDL for Treatment of Activ Acne (Orringer)

Pulsed Dye Lasers can be used as part of Photodynamic Therapy (PDT), which is a treatment that targets sebaceous glands and acne-causing P. acnes bacteria. Photodynamic Therapy works better with adjustable PDLs that are capable of producing a laser with a wavelength near 415 nm (ultraviolet), instead of the more common 595 nm (green/yellow). However, PDLs are rarely used for PDT because there are more accessible (and less expensive) light sources available for this treatment.

PDL Acne Treatment Before and After (Harto)
PDL Acne Treatment Before and After
(Harto)

PDLs are also being studied as a way to selectively ablate the sebaceous gland, which then inhibits sebum production and reduces acne symptoms. While the research indicates using PDLs is a a viable approach, there are alternative lasers (eg. Diode Lasers) with longer wavelengths that are better suited for this application.

Pulsed Dye Lasers can also be used to directly kill acne-causing bacteria. The acne-causing Propionibacterium acnes bacterium produces a special molecule called porphyrin. When porphyrin is exposed to high intensity light at a wavelength around 420 nm (ultraviolet/blue) it generates free radical molecules which can kill the bacterium.  This process is called Blue Light Photherapy. Pulsed Dye Lasers are available that can generate high intensity light in this spectrum. However, other high-intensity sources of blue light (eg. LEDs) are substantially less expensive than PDL and are generally used for this type of acne treatment.

Pulsed Dye Lasers and Acne Scars

Treatment of Acne Scars with PDL (Alster)
Treatment of Acne Scars with PDL (Alster)

The most common application of Pulsed Dye Lasers is for the treatment of acne scars. Both ablative and non-ablative PDL treatments are available for treating acne scars. Pulsed Dye Lasers are generally only used for the treatment of mild acne scars. Improvements in acne scars following PDL treatment are usually modest and superficial. The Pulsed Dye Laser platform is not well suited to correct severe acne scarring. This is because most PDL systems do not penetrate deeply enough into the skin tissue to correct significant acne scar damage.

On average, Pulsed Dye Laser treatment of acne and acne scars is reviewed as poor to moderate by patients after treatment. It is likely that PDLs are popular because they are a relatively inexpensive, versatile and common platform and not because they are highly efficacious for acne treatment.

How and Where is Pulsed Dye Laser Treatment Administered?

Candela Vbeam Laser System
Candela Vbeam Laser System

Pulsed Dye Laser treatment is usually administered at a dermatology or cosmetic surgery clinic. PDL systems can also be found at some spas specializing in light and laser therapy. As with almost all laser-based treatments, there is the potential to cause permanent damage and PDL treatment should only be administered by a trained and certified professional.

Pulsed Dye Laser treatments generally cost between $200 and $600 per session. In almost all cases, multiple sessions are required. Research studies on the use of PDL systems for the treatment of active acne for acne found that optimum results required at least four treatments. In addition, PDL-based treatment of active acne usually only provides temporary relief, and acne symptoms eventually return.

Overall, a complete PDL treatment plan for active acne usually starts around a thousand dollars, and goes up from there. PDL treatments are comparable in cost to many other laser treatments, but their mediocre efficacy make them a relatively poor value. The cost and the number of visits required for PDL-based treatment of acne scars varies considerably, depending on the specific application, the amount of damage and the size of the affected region.

Popular Pulsed dye laser (PDL) Systems

C-Beam, Cobra, Cynergy, Navigator, N-Lite, PhotoGenica, Regenlite, Vbeam.

Pulsed Dye Laser Images

References

Laser Treatment of Acne Vulgaris. Jih, et al. 2007.
Investigation of the Mechanism of Action of Nonablative Pulsed Dye Laser Therapy in Photorejuvenation and Inflammatory Acne Vulgaris. Seaton, et al. 2006.
Treatment of Acne Vulgaris With a Pulsed Dye Laser: A Randomized Controlled Trial. Orringer, et al. 2004.
Improvement of Facial Acne Scars by the 585 nm Flashlamp-Pumped Pulsed Dye Laser. Alster, et al. 1996.
Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. Lee, et al. 2008.
Dye Lasers @ Wikipedia
Pulsed Dye Laser Patient Reviews @ Realself.com

Red Light Phototherapy

Red Light Phototherapy

Red Light Phototherapy is a treatment that involves exposing the skin to high intensity red light in the red spectrum. The purpose of the treatment is to reduce skin inflammation and accelerate healing. It is primarily used as a treatment for minor acne-scarring and to facilitate healing after an acne outbreak. Red Light Phototherapy is also occasionally used for the treatment of active acne symptoms.

How Does Red Light Phototherapy Work?

Clinical Red Light Phototherapy Machine
Clinical Red Light Phototherapy Machine

Red Light Phototherapy is most commonly used for photo-rejuvenation procedures. Several research studies have reported that red light (600-900 nm) stimulates the growth of new skin tissue and the production of collagen. Additionally, high intensity Red Light Phototherapy appears to assist in the resolution of inflammation, redness and other types of uneven skin tone. Scientists have some ideas about how red light might cause these changes in skin tissue, but the exact mechanism (or mechanisms) are not well understood. Nonetheless, the results from clinical research studies of Red Light Phototherapy have been generally positive. Although these study results may overstate the benefit of Red Light Phototherapy, the treatment is becoming more popular.

Collagen Production in Skin After Red Light Phototherapy (Weiss)
Collagen Production in Skin After Red Light Phototherapy (Weiss)

Researchers of Red Light Phototherapy have reported that the treatment induces the production and remodeling of collagen and elastin fibers. Collagen and elastin are protein based fibers that form an interconnected matrix (Extra-Cellular Matrix, ECM) that provides structural support and elasticity to the skin. A healthy ECM is one where the fibers form a three dimensional, interconnected structure that is capable of stretching and compressing in all directions. When skin is damaged or ages, the density and organization of the collagen and elastin matrix tends to deteriorate. Increasing the production of healthy collagen and elastin in the skin is one of the primary goals in skin rejuvenation procedures.

Proposed Mechanism of Action of Red Light Phototherapy (Zhang)
Proposed Mechanism of Action of Red Light Phototherapy (Zhang)

Researchers have also reported that specific wavelengths of light in the red spectrum appear to stimulate certain cellular functions. The majority of the research on the subject suggests that Red Light Phototherapy activates cellular processes that lead to a decrease in inflammation, improved healing of skin tissue and collagen production. Additionally, Red Light Phototherapy may inhibit the pathway that leads to apoptosis (cell death). Individual cellular components, mainly enzymes, have been shown to absorb light in the red spectrum. The most well studied of these red light absorbing enzymes is cytochrome c oxidase, an essential component of mitochondria, which are the power sources of a cell. The absorption of photons (light) by cytochrome c oxidase apparently increases the metabolic activity in a cell, which may explain the accelerated rate of healing observed after Red Light Phototherapy.

Red Light Phototherapy, Active Acne and Acne Scars

Red Light Phototherapy Treatment of Acne Before and After 1 (Na)
Red Light Phototherapy  Before and After  (Na)

Results from several clinical research studies indicate that Red Light Phototherapy can be partially effective as a treatment for active acne symptoms. However, the improvement in active acne symptoms in response to Red Light Phototherapy is likely to incomplete and temporary. For example, one study that evaluated Red Light Phototherapy found that treatment caused a small decrease in inflammation, but did not reduce the levels of acne-causing P. acnes bacteria or the production of sebum by sebaceous glands. This indicates that Red Light Phototherapy may be helpful by decreasing inflammation, but does not address some of the more fundamental causes of acne.

Red Light Phototherapy Erythema Treatment
Red Light Phototherapy Erythema Treatment

Red Light Phototherapy is also used in the treatment for acne scars. Although it is not an effective scar treatment by itself, it can be combined with other types of scar treatments (eg. Laser Resurfacing, Microdermabrasion) to accelerate the healing process. Red Light Phototherapy alone may be somewhat effective for the treatment of Erythema. Erythema is a common type of skin discoloration that can occur during or after acne outbreaks. It is generally caused by damaged or dilated capillaries near the skin surface. Red Light Phototherapy may help treat this condition by stimulating the repair of the damaged tissue. Other popular treatments for erythema include the use of lasers to ablate (destroy) the offending capillaries.

 

How and Where is Red Light Phototherapy Administered?

Red Light Phototherapy of Acne - Summary of Results (Na)
Red Light Phototherapy of Acne – Summary of Results (Na)

Most Red Light Phototherapy procedures use large panels of LED lights to create a high intensity source of a specific color (wavelength) of red light. Depending on the treatment, the precise wavelength of the light used can range from 600 nm (orange/red) to 850 nm (infra-red). Achieving therapeutic benefits from Red Light Phototherapy appears to require a high intensity light source.

Red Light Phototherapy 2
Red Light Phototherapy

Red Light Phototherapy using LED based light systems usually costs between 30 and 200 dollars per session when administered in a spa or clinic.  Home use Red Light Phototherapy systems are also available for purchase on the internet. Home use phototherapy systems range between 20 and 700 dollars, with large variations in the size, intensity and quality of the various systems. Small, inexpensive home use phototherapy systems are unlikely to be capable of generating the intensity of light that is required for the therapeutic benefits reported in the clinical research studies. It is important to recognize that light therapy requires frequent (even daily) treatment for significant improvement in acne symptoms. Treatment can also be time consuming, requiring up to 45 minutes per session.
Red Light Phototherapy is often used in conjunction with Blue Light Phototherapy or as part of a photo dynamic therapy (PDT) or intense pulsed light (IPL) system.

Red Light Phototherapy Images

References

LED Phototherapy @ RealSelf
Influence of 5-Aminolevulinic Acid and Red Light on Collagen Metabolism of Human Dermal Fibroblasts. Karrer, et al. 2003.
cDNA MicroarrayAnalysis of Gene Expression Pro¢les in Human Fibroblast Cells Irradiated with Red Light. Zhang, et al. 2003.
Clinical Trial of a Novel Non-Thermal LED Array for Reversal of Photoaging: Clinical, Histologic, and Surface Profilometric Results. Weiss, et al. 2005.
Effect of NASA Light-Emitting Diode Irradiation on Wound Healing. Whelan, et al. 2001.
Single Low-dose Red Light is as Efficacious as Methylaminolevulinate–Photodynamic Therapy for Treatment of Acne: Clinical Assessment and Fluorescence Monitoring. Hörfelt, et al. 2009.
A prospective, randomized, placebo-controlled, double-blinded, and split-face clinical study on LED phototherapy for skin rejuvenation: Clinical, profilometric, histologic, ultrastructural, and biochemical evaluations and comparison of three different treatment settings. Lee, et al. 2007.
Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Papageorgiou, et al. 2000.
Non‐invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris. Zane, et al. 2008.
Red Light Phototherapy Alone Is Effective for Acne Vulgaris: Randomized, Single‐Blinded Clinical Trial. Na, et al. 2007.

C02 Lasers

C02 Laser Ablative Skin Resurfacing

Carbon Dioxide (C02) Laser systems are ablative laser systems that are commonly used for laser resurfacing procedures. CO2 Lasers are popular treatments for moderate to severe acne scars. C02 Lasers are capable of penetrating deep into the skin and underlying tissue. C02 Lasers are available at higher fluences (power) than many other laser systems used in dermatology and cosmetic surgery.

How Do CO2 Lasers Work?

Fractional C02 Laser Treatment in Progress
Fractional C02 Laser Treatment in Progress

Carbon Dioxide (CO2) Lasers use a gas mixture that contains about 20% carbon dioxide as the lasing medium. C02 lasers generate an intense laser beam in the far infra-red spectrum (~10,000 nm). Energy from a CO2 Laser beam is strongly absorbed by water. Because cells are composed mainly of water, they are quickly heated or ablated (vaporized) by CO2 laser treatment.

Fractional CO2 Laser Resurfacing Closeup and Histology (Gotkin)
Fractional CO2 Laser Resurfacing Closeup and Histology (Gotkin)

The ability to penetrate into the supportive tissue underneath the skin surface makes CO2 Lasers a preferred choice for ablative laser resurfacing treatments, such as the repair of skin damage associated with moderate to severe acne scars. The C02 laser penetrates more deeply than the Er:YAG laser (which is another popular laser system for acne scar treatment), and CO2 Lasers are the preferred modality for deep-seated acne scars. CO2 Lasers directly destroy (ablate) scar tissue, which allows new healthy tissue to regrow in the treated area. The process of laser ablation of tissue is called photothermolysis.

CO2 Lasers and Acne Scars

Fractional CO2 Acne Scar Treatment Before and After 2 (Cho)
Fractional CO2 Acne Scar Treatment Before and After 2 (Cho)

Carbon Dioxide (CO2) lasers can be an effective treatment for many types of facial acne scars. In general, both physician and patient satisfaction with the results of CO2 Laser resurfacing are good. For patients with moderate to severe acne scarring, multiple treatments are often necessary to achieve maximum improvement in the appearance of the skin. This is especially true for acne scars around the temple and the middle of the cheeks because these regions tend to respond less favorably to laser resurfacing than other areas of the face.

Improvement in Acne Scars in Different Regions of the Face After C02 Laser Treatment - Ratings by Patients and Physicians (Trimas)
Improvement in Acne Scars in Different Regions of the Face After C02 Laser Treatment – Ratings by Patients and Physicians (Trimas)

Ablative CO2 Laser resurfacing treatments are among the most popular and effective methods for repairing acne scars. Treatment is applied to the entire scarred area. In addition to ablating scar tissue and encouraging the regrowth of healthy skin tissue, CO2 Lasers can be used to shape large acne scars in order to reduce their appearance.  CO2 Lasers can be used to ablate the edges and ridges of large scars, which creates a gentler slope and minimizes the apparent depth of the scar. CO2 Laser systems allow for more precise control of the treated area than many other skin resurfacing technologies (eg. Microdermabrasion and Chemical Peels).  CO2 Laser resurfacing can also tighten the skin by inducing the contraction of the dermal collagen, which causes scars to appear flatter and less noticeable.

Complete vs Fractional CO2 Laser Resurfacing

Ablative vs Nonablative Laser Resurfacing Diagram
Ablative vs Nonablative Laser Resurfacing Diagram

CO2 Lasers can be used for either complete resurfacing or fractional resurfacing. Complete resurfacing treats all of the tissue in a given area, while fractional resurfacing pixelates the laser beam and leaves small regions of untreated skin between the regions of treated skin.

Frequency of Side Effects After Fractional CO2 Laser Resurfacing (Gotkin)
Frequency of Side Effects After Fractional CO2 Laser Resurfacing (Gotkin)

Fractional CO2 laser treatments (eg. Fraxel) are very popular because they tend to have fewer side effects and require shorter healing times than complete resurfacing. Possible side effects of CO2 Laser resurfacing include complications such as edema, prolonged erythema, scarring and hyperpigmentation. Both complete and fractional CO2 treatments have risks of these side effects, although they are substantially higher with complete resurfacing. Patients with darker skin tones appear to be at higher risk of certain types of of side effects (eg. hyper- and hypo- pigmentation) after CO2 resurfacing.

Another advantage of fractional CO2 treatment is that it is safer for higher-power (more aggressive) treatment protocols that ablate tissue to greater depths. This can be helpful for the treatment of deep-seated acne scars.

Fractional CO2 Treatment of Facial Acne Scars Before and After (Walgrave)
Fractional CO2 Treatment of Facial Acne Scars Before and After (Walgrave)

According to many clinical research studies, the effectiveness of fractional CO2 laser resurfacing for acne scar treatment is comparable to traditional complete resurfacing. Many fractional CO2 Laser systems are now commercially available, and complete CO2 resurfacing is no longer a common procedure in most places. Although they are safer, fractional CO2 systems generally require significantly more treatment sessions than complete CO2 resurfacing to achieve the same level of improvement.

How and Where is CO2 Laser Treatment Administered?

Potential Side Effects of Fractional CO2 Resurfacing - Erythema and Scarring (Fife)
Potential Side Effects of Fractional CO2 Resurfacing – Erythema and Scarring (Fife)

CO2 Lasers are agressive laser resurfacing technologies that can cause significant and permament skin damage if used improperly. They may also require the use of anesthetics. Because of this, CO2 resurfacing procedures are generally only available in a specialized clinical settings.

CO2 Laser treatment of acne scars is a complicated procedure that tends to be substantially more expensive than many other types of Light and Laser Treatments used for acne or acne scars. In general, CO2 Laser resurfacing of the face tends to cost between $750 and $2500 per session. Effective fractional CO2 treatment of acne scars generally requires 2-6 sessions depending on the specific treatment area, types of acne scars and their severity.

Popular CO2 Laser Systems

Active FX, Affirm CO2, Deep FX, Fraxel Re:pair, Juvia CO2 Fractional, Mixto SX, Mosaic, Pixel CO2 OMNIFIT, Sharplan, SmartXide, Ultra-30 Plus, Ultrapulse.

CO2 Laser Resurfacing Images

References

CO2 Laser Resurfacing Patient Reviews @ RealSelf
CO2 Lasers @ Wikipedia
A clinical and histologic comparison of electrosurgical and carbon dioxide laser peels. Acland, et al. 2001.
A Prospective Survey of Patient Experiences After Laser Skin Resurfacing. Batra, et al. 2003.
Ablative Skin Resurfacing With a Novel Microablative CO2 Laser. Gotkin, et al. 2009.
Carbon Dioxide Laser Abrasion. Trimas, et al. 2000.
Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars. Kim. 2008.
CO2 Laser Physics and Tissue Interactions in Skin. Fulton, et al. 1999.
Complications of Fractional CO2 Laser Resurfacing: Four Cases. Fife, et al. 2009.
Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. Manuskiatti, et al. 2009.
Evaluation of a Novel Fractional Resurfacing Device for Treatment of Acne Scarring. Walgrave, et al. 2009.
Fractional photothermolysis—an update. Allemann, et al. 2010.
Laser Punch-Out for Acne Scars. Koo, et al. 2001.
Laser Resurfacing: Usual and Unusual Complications. Rendon-Pellerano, et al. 1999.
Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Jordan, et al. 2000.
Long-Term Efficacy of a Fractional Resurfacing Device. Ortiz, et al. 2010.
Successful Treatment of Acneiform Scarring With CO2 Ablative Fractional Resurfacing. Chapas, et al. 2008.
The Efficacy and Safety of 10,600-nm Carbon Dioxide Fractional Laser for Acne Scars in Asian Patients. Cho, et al. 2009.
The principle of a three-staged operation in the surgery of acne scars. Whang, et al. 1999.
The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars. Alster, et al. 2007.