Acne Scars

Fractional delivery systems for the CO2 laser emerged in an attempt to achieve the clinical results obtained with resurfacing lasers and dermabrasion.

It transpires that these systems can often achieve better results because the depth of dermal ablation can be up to several mm, particularly with the powerful Ultrapulse Encore™ systems (DeepFX™ and recently ScaarFX™) while a reservoir of viable adjacent skin is maintained.

Additionally the capacity for collagen remodelling appears to be enhanced following release of heat shock proteins and subsequent induction of an ordered fibroblastic response with compact, newly formed collagen throughout the dermis and studies in peer reviewed individuals have shown that ablative fractional lasers offer an improvement range of 26-85% compared to 26-50% for non-ablative fractional resurfacing.

Overall however, acne scarring is remarkably responsive to fractional resurfacing with great benefit to patients and little risk of any significant side effects.

Acne scarring is however always a challenge to treat despite a multiplicity of techniques including micro-excision subcision, punch graft elevation and intralesional medication. It is never possible to fully return skin to the pre-morbid state and patients must have realistic expectations about treatment.

That said the more recent fractional laser systems, both ablative and non-ablative, have achieved some remarkable outcomes. Softer ‘rolling’ scars do better with laser treatments although a sharp shouldered ‘ice pick’ and ‘boxcar’ scars can be softened by direct/collimated or focussed laser treatments prior to ‘full field’ fractional resurfacing.

In hypertrophic/low grade keloid scars deep fractional microthermal zones at low density can afford a conduit for transdermal delivery of medication, particularly under occlusion. Interestingly, hypopigmentation has been observed to improve in many instances with fractional resurfacing and in the case of persistent erythema, this can be addressed with the pulsed dye laser which has been shown to induce TGF-B2 messenger RNA which can promote collagen synthesis.

Prevention and treatment of many different scar types have been reported for the pulsed dye laser. Elimination of erythema and vessels is more efficient with purpuric settings and PDL may also have the benefit of improving any component of inflammatory acne.

For more information about this condition, please contact the Solais team below...