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All You Need to Know About Fractional CO2 Laser for Acne Scars

May 21, 2021

Acne can form on your face when skin pores get clogged. Apart from making one feel insecure, acne can also be painful and leave stubborn scars and redness behind during the healing process. In this article, we will discuss the causes of acne scars and all you need to know about fractional CO2 laser for acne scars treatment.

What causes acne and how do acne scars form? 

Acne is a common disease that prevails in 90% of adolescents, and has the ability to persist to adulthood with psychological and social implications. Acne typically appears when hair follicle openings become blocked by over-secretion of oil and dead skin or bacteria accumulation in the pores. Acne scars, on the other hand, result from the inflammation of acne blemishes. In some cases, the contents of the blemishes spill into surrounding tissue that may cause deeper scars. They take on 2 main forms, either the scar develops when there is a loss of tissue, or when it is raised above the skin surface. They include:

Atrophic Scars

Located at areas with thicker skin, usually on the lower cheeks and jaw. Atrophic scars are further classified into ice pick, rolling and boxcar type. Ice pick indents are observed to have narrow and deep scars. Rolling scars are wider and can reach to the subcutaneous adipose (fat) tissue. Lastly, boxcar types have visible vertical edges which are wider than ice picks.

Visual representation of the different types of acne scars. Read more about the different types of acne scars here

Hypertrophic Scars

These lesions of scar tissue that rise off the surface of the skin are caused when collagen in that region is overproduced. They are usually located on the chest, shoulders and jawlines. Additionally, they tend to be itchy or painful. 

CO2 Laser for acne scars 

Laser treatments aim to minimize the scar appearance from acne outbreaks. It focuses light on the skin surface to disrupt the scar tissue while also encouraging new, healthy skin cells to grow and replace the scar tissue. One such type is the fractional carbon dioxide laser method. 

What does fractional CO2 laser do?

The CO2 laser is a non-invasive skin treatment that uses a laser made of CO2 to remove the outer layers of damaged skin and hence, acne scars. This particular laser system is the gold standard in acne scar treatment whereby it obtains better results with minimal thermal damage to the skin and also keeps the epidermis intact. Benefits of this method compared to other lasers include less tissue damage and edema, as well as faster recovery. 

How is the CO2 laser procedure done? 

The CO2 laser for acne scars is an ablative procedure, meaning it operates by breaking up the skin. The laser with a wavelength of 10,600nm penetrates deep into the skin. The epidermis (thin outer layer of the skin) is removed and dermis (underlying skin) is heated. This will then stimulate the body’s natural healing process and boost collagen fibre production, which ultimately results in the replacement of old, damaged cells. After the epidermis regrows, the treated skin will appear clearer, smoother and tighter. 

Who should avoid CO2 laser for acne scars? 

Generally, it is advisable for patients suffering from extensive breakouts, open wounds or facial infections to avoid the fractional CO2 laser for acne scars. It’s also worth noting complication preventions throughout the treatment process. Patients prone to poor wound healing or hypertrophic scarring should avoid aggressive skin resurfacing. 

How long does CO2 laser resurfacing take to heal? Is there any downtime? 

The period of recovery heavily depends on the severity of the condition, but the use of fractional technology has enabled healthy tissues to produce cells and proteins that will quickly aid in skin healing. Therefore, patients only have to undergo shorter recovery periods that last around 5 to 7 days. 

Is the CO2 laser for acne scars painful? 

The treatment is usually done with anesthesia so as to minimise any occurrences of discomfort. Most patients describe it as only a prickling sensation. The different types include topical anesthesia and numbing cream. Otherwise, painkillers and anti-itching medications may also be administered. 

How many CO2 laser treatments are needed?

The number of treatments for CO2 laser for acne scars mainly depends on the severity of the condition and the extent of the acne scars. Typically, patients undergo 1 to 3 sessions on average, which can be carried out at 4 to 6 weekly intervals.

Side effects of CO2 laser for acne scars

Since the fractional CO2 laser procedure encompasses heat, patients may experience redness or swelling in the treated area. In rare cases, studies show that the adverse side effects of laser methods include bacterial, fungal or herpetic infections, which are short-term. Long-term side effects may consist of prolonged erythema, post-inflammatory hyperpigmentation particularly in skin of color.

Adjunct Treatment for Acne Scars 

While the fractional CO2 laser is a first-line treatment for acne scarring, the potential for side effects from long-term, continuous treatment is an issue. Research has found that additive or adjunct treatments such as those with cosmeceuticals and radiofrequency, can be effective in the treatment of acne scars.

Cosmeceuticals that include the botanical ingredient Centella Asiatica can be beneficial when it comes to anti scarring. This phytochemical has anti-inflammatory and wound healing properties for cysts, scars, and sensitive skin. Centella asiatica contains compounds like asiaticoside for increasing strength of the new skin at the wound, and madecassoside for collagen formation and anti-inflammation, especially helpful for treating acne scars.

Cosmeceuticals for adjunct treatment wiith CO2 laser for acne scars

THE ELIXIR-V™ TOTAL RECOVERY SERUM formulated with Centella Asiatica for scar healing, is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.

In one study Mu et al highlighted that combining radiofrequency energy with fractional CO2 has the effect of a temperature increase in the dermis, the deeper layer of the skin. This temperature increase produces a firming and compacting effect in the skin. One 10 patient study found that this method of radiofrequency and fractional CO2 combination showed more improvement and faster healing with fewer side effects of pigmentary changes in the treatment group.

Radiofrequency alone has shown efficacy in acne scar treatment. The mechanism of action of thiis technique also complements that of laser resurfacing in fractional CO2 lasers.

The CollagenUp Facial Wand is an FDA approved home radiofrequency device which increases absorption and helps in skin cleansing and moisturizing in addition to photofacial light functions. Use this radiofrequency device at home in conjunction with CO2 laser for better results in your acne scar treatment routine.

Dr. Teo Wan Lin is an accredited dermatologist in Singapore who specialises in the diagnosis and treatment of acne, acne scars and other skin diseases. She is also the founder of cosmeceutical skincare line Dr.TWL Dermaceuticals, which develops evidence-based cosmeceutical actives for the adjunct treatment of eczema. She is also the author of Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare.

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Petrov A, Pljakovska V. Fractional Carbon Dioxide Laser in Treatment of Acne Scars. Open access Macedonian journal of medical sciences. Published March 15, 2016. Accessed May 20, 2021. 

Mu YZ, Jiang L, Yang H. The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars. Dermatol Ther. 2019;32(6):e13084. doi:10.1111/dth.13084

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