The Laser Evolution

The first lasers used to treat skin conditions came on the scene about forty years ago. Their uses were limited and they often led to scarring. Over the last twenty years, the world of dermatological lasers has dramatically opened up.

Today there are many lasers that can be used for the treatment of various medical and cosmetic concerns. Lasers are used for tattoo removal, spider veins, pigmentation, anti-aging, and scars. Some laser treatments can be done on your lunch hour with no down time, and others need significant time for healing.

So, You Have Scarring

The appearance of scarring can be improved greatly with the use of lasers, whether your scars are from acne or something else. Ablative laser resurfacing is the choice for most traumatic or surgical scars while non-ablative lasers are the number one choice for acne scarring.

That being said, both kinds of lasers can be used for any kind of scarring depending on what kind of downtime you are willing to endure and what your budget is.

What’s the Difference?

Ablative Lasers

There are several lasers that fall under the “ablative laser” umbrella. Two of the most common are the CO2 laser (carbon dioxide) and the Er:YAG laser.  Ablative lasers remove the entire top layer of your skin (the epidermis) and heat the underlying dermis to stimulate collagen production.

Both CO2 and Erbium lasers can also be fractionated. Think of a pixelated image. Instead of the entire top layer of skin, only the little dots are removed leaving undamaged skin in between.  Results are still impressive, but healing time is minimized.

After Ablation

Ablative lasers are highly effective, often even after only one treatment. However, because of the significant amount of skin removed, healing times can be one to three weeks, depending on how aggressive your treatment was. You can also expect your treated skin to be pink for two to three months post-procedure.

Risk of side effects is higher for these kinds of lasers, as well. Hyperpigmentation, acne flares, cold sore activation, bacterial infections, and, rarely, scarring could happen. Your doctor will pre-treat you with an antiviral medication if you are at risk for cold sores, and some may give you antibiotics to minimize your risk of bacterial infection.

An important downside to ablative lasers is that most people of color are not good candidates for this treatment. Darker skins have a tendency to develop post-inflammatory hyperpigmentation, sometimes permanent.

Make sure to Discuss your options with your dermatologist. A traditional ablative laser is probably not the choice for you, but ask if your skin might be able to handle a fractionated ablative laser or if another kind of laser would be better for you.

Non-Ablative Lasers

Non-ablative lasers heat up layers of your skin to stimulate collagen growth. They do not remove any of your skin. Like the ablative lasers, they can be found in fractionated and non-fractionated forms. While a non-fractionated ablative laser would be the most aggressive treatment choice with the longest healing time, a fractionated non-ablative laser would be the gentlest treatment with the shortest  downtime.

Some examples of non-ablative lasers are Ng:YAG, microfractional mosaic (erbium glass), and pulsed-dye. Each of these lasers are effective at treating and minimizing the appearance of acne scars, and they each have specific benefits. 

For example, Nd:YAG lasers are the treatment of choice for hypertrophic or keloid scars. Erbium glass is effective at treating scars while improving skin tightness and texture at the same time. Pulsed-dye lasers are often used on atrophic (indented) acne scars and inflammatory acne.

After Non-Ablation

You can expect excellent results with all of these lasers with minimal to non-existent downtime. You may have some mild irritation or redness for a day or two. Some people experience acne and cold sore flares, just like with the ablative lasers. There is a small risk of post-inflammatory hyperpigmentation and scarring, as well.

The Downside

Because of the gentle, noninvasive nature of non-ablative lasers you may need multiple treatments to get the results you’re after. Results vary depending on many factors, and every individual will have a unique response. Maybe you’ll just need one treatment, but it isn’t uncommon to get a series of three or four before you see the appropriate level of change.

If you are a candidate for ablative lasers you will need to perform a cost benefit analysis to determine if you’d rather go through a long healing process one or two times or pay for three, four or more “easier” treatments. Both will give you great results, but time and money are important to consider when making your choice.

Before Your Laser

Whichever laser you choose to get, you will have to prepare before your treatment day. Your dermatologist may have a longer pre-care list for you, so it is always important to discuss these and any concerns with your doctor.

• BLOOD THINNERS

Usually you will need to stop taking aspirin and other blood thinning medications several days before your appointment. If you are on prescription blood thinners, you will have to get clearance from your prescribing physician to suspend taking your medication.

• EXFOLIANTS

You will have to stop using retinoids, benzoyl peroxide, salicylic acid, glycolic acid, and any other acne and anti-aging ingredients a week before treatment.

• PRESCRIPTIONS

If your provider prescribes prophylactic antiviral medication and/or antibiotics before your procedure you will need to take them as prescribed.

After Your Laser

Aftercare will be different depending on your provider’s instructions as well as what kind of laser was used.

Generally after a non-ablative laser you should wash your face with gentle cleansers, keep the skin well moisturized, diligently use sunscreen and avoid the sun. Your doctor may recommend specific products. 

Aftercare for an ablative laser is much more complex. You will receive extensive instructions from your care provider about how to best care for your skin. You may need to apply an ointment to your skin and clean your face in specific gentle ways. Sleeping on an incline and cold packs can help with swelling, and you might need to take some over the counter pain medication for discomfort. You will definitely need to avoid the sun at all cost while your fragile skin is healing.

Takeaway

There are a great many excellent laser treatments available if you are looking to improve your acne scarring. The one you choose depends on many factors that you and your dermatologist can discuss.