Laser Skin Resurfacing for Acne Scar Treatment

Laser skin resurfacing for acne scar treatment uses thermal or heat energy to manipulate the skin and improve the appearance of scarring. Laser skin resurfacing is also known as laser peel, lasabrasion and laser vaporization. The laser device sends out short, concentrated pulsating beams of light that produce heat energy. The beam of light removes the epidermis, or the outer layer of skin, as well as the acne scarring one layer at a time. At the same time, it heats the underlying skin (the dermis) to stimulate the production of new collagen fibers. As the body heals, it creates new skin that is smoother and firmer.

Am I a Good Candidate for Laser Skin Resurfacing for Acne Scar Treatment?

A GOOD CANDIDATE for laser skin resurfacing for acne scar treatment is:

• A patient who wishes to remove scars caused by acne
• A patient with light skin and shallow scars which means scars that can be stretched with the fingers
• Patients with elastic and non-oily skin

Those who are NOT GOOD CANDIDATES include:

• Patients with dark skin tones because they have a greater risk of hyperpigmentation (healing with a darker pigment)
• Patients with deep scars that may need more aggressive treatment
• Patients who are prone to scarring from minor cuts, immune disorders and those with active acne
• Patients who had skin color changes, scarring or thickened tissue from previous treatments
• Patients with skin disorders such as psoriasis or rosacea
• Any patient who has the herpes virus infection, which causes cold sores, since laser resurfacing can trigger a breakout or cause the condition to worsen

How is Laser Skin Resurfacing for Acne Scar Treatment Performed?

There are a variety of lasers used for laser skin resurfacing and two of the most common types include the carbon dioxide (CO2) laser, with its many variations, and the Erbium-YAG laser. Each type has a different wavelength, depth of penetration and use for certain skin resurfacing treatments and skin types:

• CO2 is readily offered to the public and provides the most predictable outcome. The CO2 laser works by vaporizing the skin cells damaged at the surface level. This type of treatment can be used for deeper, more pronounced skin irregularities. 
• Fractionated CO2 uses very short pulses of light energy known as ultrapulse. They are continuous light beams delivered using a scanning pattern to eradicate thin layers of skin with nominal heat damage.
• Erbium-YAG laser is more for superficial blemishes and treating patients with darker skin tones. It works by vaporizing the damaged cells at the surface level. This type of laser causes fewer side effects and less burning of the surrounding tissue. Therefore, the recovery time is generally shorter. Furthermore, this type of treatment is known to stimulate collagen as well as tighten and smooth the skin.

During the consultation, the doctor will select a laser based on the specific needs and preference of the patient. A series of skin treatments to help prepare the skin for a laser treatment may begin 6 weeks or more prior to the procedure. This is especially true for people who scar deeply, or people with specific skin types, to help minimize complications and gain the best results. Any patient who smokes should stop at least two weeks before, and after, the treatment since smoking can hinder healing. Certain medications like aspirin and ibuprofen, and supplements such as vitamin E, are to be avoided 10 days prior to the procedure since these can affect clotting. An antibiotic may be prescribed as a preventative measure for bacterial infections. Patients who are prone to cold sores may be prescribed an antiviral medication as well.

Laser skin resurfacing is an outpatient procedure and can take anywhere from 30 to 45 minutes to treat the whole face. Small areas may be treated with local anesthetic cream.  Prior to the treatment, the area will be cleansed and marked with a pen. Goggles are used to protect the eyes from damage by the laser. During the procedure, the laser will be passed over the skin while sending out pulses lasting less than a millisecond. The doctor will wipe the area with water, or a saltwater solution, between passes to cool the skin and remove the dead skin cells. The number of passes needed depends on how large the area is and the type of skin being treated. The patient can expect to feel some stinging, or a slight burning sensation, but there is usually little to no bleeding. After the treatment, the doctor will apply ointment and dressing to the treatment area.

Alternative Treatments

Alternative procedures include:

• Microdermabrasion is a similar treatment but it is not really designed to remove acne scars. It is more of a maintenance procedure to help exfoliate the skin to avoid acne outbreaks.
• A chemical peel uses chemicals to burn off the top layers of skin to remove scars. Patients with dark skin need to be careful since it can cause hyperpigmentation or hypopigmentation (lightening or darkening of the skin).
• Dermal fillers are a non-invasive means for improving acne scars and volume loss. However, dermal fillers are temporary and might need to be repeated several times a year to maintain the results

What is the Cost of Laser Skin Resurfacing for Acne Scar Treatment?

The cost can vary depending on how many areas are being treated, the type of laser used, the skin condition of the patient and the type of anesthesia utilized by the doctor. Overall, the cost can range from $500 to $1000. Since skin resurfacing treatments often need several sessions, some doctors offer them in package deals for a cheaper price. The cost will also be higher if the patient is treating the full face rather than a smaller area. Laser resurfacing on the full face can range from $2000 to $6000.

Recovery and Downtime

Since laser skin resurfacing for acne scar treatment varies according to the type of laser used, and the size of the treatment area, the RECOVERY period varies as well:

• A gentle laser procedure, such as the erbium laser, can reduce a certain amount of imperfections with little downtime. Patients generally need about a week of recovery.
• A more invasive treatment, such as a CO2 laser, will promote a significant improvement but may require around 2 weeks of recovery and downtime. It takes time for the area to heal and a new layer of healthy skin to tone down to the appropriate shade.
• Recovery time varies from patient to patient depending on their overall health, lifestyle and how quickly their body heals. There will be several follow-up visits to the doctor so he or she can assess the skin’s regrowth and watch for signs of infection.

Patients can expect to see pinkness or redness in the treatment area with irritation similar to sunburn. Discomfort can be managed by pain medication and should be taken as directed. Swelling and itching is also common but is usually minor. Steroids may be prescribed to help bring down the swelling. Ice packs are also recommended during the first 48 hours to help with swelling and provide comfort. Patients should sleep on an extra pillow, with the head elevated, for the first few nights.

Deeper laser resurfacing may cause the skin to become raw and blister. The redness may turn brown and form crusting on the skin. The crusting generally peels off in about 5 to 7 days and should not be picked off. Picking at scabs can result in an infection and/or scarring. If ointment and bandages are applied, the patient will need to change the dressing and wash the skin four to five times a day to rid the skin of crusting and to avoid infection. Once the crusting is gone, the skin will appear pink in color. It may take several months for the discoloration to subside but the doctor will advise when oil-free makeup is safe to use for covering the discoloration.    

Results

The results can be seen after most of the swelling and discoloration has subsided. Patients who had a lighter treatment will see a smaller difference than someone who had a more aggressive skin rejuvenation treatment. Gentler laser treatments mean more laser sessions may be needed to achieve the desired results. Deep wrinkles and acne scars usually require several sessions to achieve optimal results. Additional sessions may begin as soon as eight weeks later or as long as one year later.

Laser skin resurfacing for acne scar treatment may not entirely remove deep acne scarring but the manipulation of the skin can provide better looking skin. Patients with lighter skin, who avoid sun exposure during recovery, tend to have the best results. It is important to avoid sun exposure, even after all the discoloration has gone, since the new skin is more prone to sunburn.

The complete results may take up to 18 months to be visible because the skin will continue to smoothen and tighten due to the increase in collagen production. While the effects can last for many years, the natural aging process will continue and cause wrinkles, sun spots and skin imperfections. Ongoing acne outbreaks can also cause additional scarring. A daily skin routine of sunblock, and a skin exfoliation regimen, can help maintain the results.

Limitations and Risks of Laser Skin Resurfacing for Acne Scar Treatment

When it comes to treatment LIMITATIONS:

• Laser skin resurfacing is limited to only improving mild or moderate acne scars. Patients with severe acne scars, or ice pick scars, may not see much improvement without multiple treatments.
• Laser skin resurfacing for acne scars is limited to treating acne on the facial region.
• Patients who have sunburn may be limited from having any treatment until the sunburn has subsided.   

Some of the more common RISKS include:

• Redness
• Swelling
• Crusting
• Itching
• Soreness
• Heat injury
• Lightening or darkening of the skin
• Activation of cold sores
• Infection
• Scars (rare risk)
• Small white bumps, known as Milia, can appear within the treated areas while healing but they can be easily corrected with a gentle cleansing using a washcloth.

Risk of Changes in Skin Color

Temporary color changes, such as the treated skin being darker than the surrounding skin, happen to some patients. Although the skin may fade with time, bleaching the skin can also help to lighten the region. Some patients end up with a loss of color in the treatment area around 6 to 12 months after the procedure. The lighter skin may be permanent and this is especially true if deep laser treatments were used. Patients with darker skin tones have a higher risk of permanent hyperpigmentation or hypopigmentation.

Consult With a Doctor

Since there are several different types of lasers, patients should consult with a board certified dermatologist that specializes in laser skin resurfacing for acne scar treatment in order to find out which type of laser is best suited for their particular needs. Furthermore, the doctor should be able to recommend how many treatments will be needed to meet the patient’s goals.

Written by Cosmetic Town Editorial Team - SP

Based on an exclusive interview with Coleen Crandell, MD in Endwell, NY