Acne scars are a common but frustrating problem for many adolescents and adults. The goal of acne scar treatment is to reduce the appearance of these permanent lesions by either softening their color or flattening them out.
Typically, acne is caused by changes in the lining of hair follicles that make the follicles stick together. The lining swells, causing a clogged hair follicle. Bacteria that normally live on the skin and hair grow inside this swollen follicle and cause inflammation. Inflammation from acne can cause small lesions called pustules as well as larger, painful cysts that sometimes leave scars when they heal.
Acne Scars and Laser Treatment
Acne scars are estimated to affect more than 90% of patients with acne, and there are many different lasers available for treatment. These include ablative CO2 resurfacing lasers, which produce new collagen formation, and nonablative lasers, which work by increasing collagen production via stimulation of the fibroblast.
Acne scar treatment consists of 5-25 laser sessions with an average cost per session ranging from $200 to $500 depending on location and region. Laser therapy can be used alone or in conjunction with other procedures such as subcision, dermabrasion, or fillers.
Scar improvement can be compared to an untreated control area based on change in appearance on standardized clinical photographs. A number of studies have shown that laser therapy is effective for post-acne scarring, although there are no FDA guidelines regarding its use.
The treatment does not reduce the number of scars, but diminishes their size and depth. It also makes surrounding pores less visible.
Materials and Methods
Acne scar treatments is a common practice in dermatology clinics. There are many variables that make acne scars difficult to treat, including the type and depth of scarring, skin color, consistency of the patient’s tissue, presence or absence of sebaceous glands within the scar, and patient expectations.
Multiple modalities for acne scars are available, including chemical peels, skin fillers, new pulsed-dye laser technology and ablative lasers.
Ablative lasers remove some of the surface of the skin in an attempt to smooth out scars. These include CO2 lasers, erbium:YAG (yttrium-aluminum-garnet) lasers, and a combination of CO2 and erbium:YAG lasers. Ablative lasers are known for causing significant postoperative erythema (redness).
In addition to these risks, ablative laser resurfacing is also not indicated for patients with darker skin types due to the potential for scarring or dyspigmentation.
Newer lasers, such as the pulsed-dye laser (PDL), target blood vessels within acne scars while leaving surrounding tissues unharmed. The best candidates for this treatment are patients with fair skin and dark hair because more energy is required to treat patients with darker skin.
Redness and swelling are the most common postoperative side effects, although this is often mild. This treatment can cause severe erythema in patients with darker skin types; therefore, it is not recommended for those individuals.
Fractional laser therapy uses a nonablative laser to create microthermal zones within acne scars that stimulate collagen production. This modality is indicated for all skin types, although the treatment areas are limited to the upper portions of the face because lower facial regions are associated with increased incidence of adverse effects.
Side effects include mild to moderate crusting and swelling that typically resolve within 1 week after therapy.
The costs of laser treatments for acne scars vary depending on the severity and type:
- Non-ablative: $500-$1,000 per treatment session more than 5 sessions may be needed to see results.
- Ablative: $1000-$10,000 about 10-20 days recovery time between each treatment more than 5 sessions may be needed to see results.
Lasers are an effective treatment option for post-acne scarring. However, there is no single laser that provides the best outcomes for all types of scars. This may be due to variability in study designs (laser type, laser fluence, number of passes). Efficacy can be improved by optimizing the parameters for each patient.
Laser treatment is a reasonable treatment option in combination with other traditional acne scar revision treatments such as subcision or dermabrasion. The high cost of these procedures may limit their use in some clinical settings.