Most clinics will only promote lasers or treatments such as RadioFrequency that they own as ‘the best cure for acne scars.’ This is far from the truth. As a group of Specialists we have access to all forms of fractional treatments ranging from skin needling, thru to Profractoinal Erbium by Scition, CO2 Fractional, Fraxel, eMatrix RadioFrequency, and ePrime RF Needling.
The burning question remains- what is the best laser? The answer is-‘ it depends most importantly on the skill level of the Specialist assessing your scars. Scar treatment should always be based upon careful examination and planning, and treatments targeted accordingly.’
Sometimes the answer does not lie with a laser- examples include TCA CROSS for deep ice-pick scars. This procedure, in the setting of treating ice pick scars and deep pores is more effective than the most powerful CO2 lasers, cost less, and has a quicker recovery. Subscion for tethered scars is another example of targeted approaches to acne scars.
OK, now to ask what I think is the best treatment, we have to explore the scenario of that individual situations. Here are some examples-
- eMatrix Radiofrequency is an excellent treatment for early scar or for treating scars whilst patients are undergoing acne treatment. Radiofrequency is not better at remodelling collagen compared to CO2 Fractional laser- full stop. Do I use RadioFrequency? Absolutely, however its best use is implemented in the Acne Free RF program
- Fraxel 1550 for acne scars. This has been marketed in the US as the acne scar treatment of choice for beauty salons, spas, and cosmetic GPs, but is it as good as CO2 Fractional? In my opinion – no. Fraxel however has an excellent brand name, and is safe in all skin types. This laser is a ‘no brainer press a button to treat laser.’ So, if safety is your priority over results in a cosmetic salon, Fraxel is great- it still delivers results in most cases.
- Scition Profactional erbium laser - this is still my choice for deep rolling acne scars in darker skin types. Why? Because erbium has less thermal damage than CO2 and the risks of PIH or skin darkening is less. I use the maximal settings at a depth of 1.5 mm.
- ePrime Skin Needling Radiofrequency - in theory this should work well for rolling and atrophic acne scars in darker skin types. Essentially it delivers very powerful radiofrequency deep into the dermal layers of the skin. The downside of this treatment is the downtime of over one week. Do I use it? Yes, but only for ethnic skin type with primarily atrophic and rolling scars.
- Skin Needling - Not as effective as lasers. Does it work? Yes! Are lasers much better? Absolutely. When do I advocate skin needling? Skin needling such as Dermapen provides an entry level to scar revision for patients who cannot afford fractional lasers. (However high fluence eMatrix is about the same price as needling and works a lot better!) Skin needling- we leave it to the beauticians and cosmetic clinics, but still offer this service as entry-level treatments. Remember- you are better off undertaking a course of eMatrix than Dermapen needling if cost is an issue.
- CO2 CORE - saving the best for last. This is THE best laser for treating atrophic, rolling and mixed scars. We use the maximal settings in all skin types, including dark and ethnic skin with absolute safety. This laser stimulates and remodels collagen like there is no tomorrow. CO2 Fractional laser is by far the best laser for acne scars- providing you know what you are doing. It is the most powerful laser in our arsenal and it does the job well.
In summary I perform all forms of fractional lasering, however will tailor treatments to individuals, and not merely advising a form of treatment because it is the only one I offer…
Dr Davin Lim
Laser and aesthetic dermatologist