Acne Scarring: A Review of

Available Therapeutic Lasers

Cohen et al
Lasers in Surgery and Medicine
48:95–115 (2016)
 Laser ttt of Acne Scars
• Traditional ablative lasers: CO2 and Er lasers
• Traditional non-ablative lasers: neodymium, diode,
alexandrite, PDLand IPL, as well as both ablative,
and nonablative fractional laser systems.
• Aim: provide a framework for understanding the
various types of lasers available to treat acne scars
and review the primary literature pertaining to the
efficacy, safety, and advantages of each type
 Acne Scars
• Rolling scars are relatively shallow, curved depressions.
• Ice pick scars are conical depressions with borders that
converge onto a single point in the deep dermis or SC
tissue.
• Boxcar scars have edges that descend vertically and are
classified as shallow or deep.
Ablative Lasers
 Non-Ablative Lasers
• Aim to resurface skin through thermal
induction of collagen remodeling in the
dermis by targeting water as its primary
chromophore without destroying the
overlying epidermis
• Target water less specifically and demonstrate
variable amounts of absorption by
hemoglobin and melanin.
 Non-Ablative Lasers: Nd: YAG

Long pulsed primarily used to target lower extremity blood vessels and HF
1,064nm effectiv e when combined with 585 PDL in a study (40%
Nd:YAG improvementt after 3 ttts
Non-Ablative Lasers
Non-Ablative Lasers: Erythema
 IPL
• filters isolating light within the range of 560–
650nm show similar action to PDL but slightly
less efficacy. No purpura but more painful.
• Some degree of benefit in atrophic acne scars
using longer wavelenghts.
• Combined with Fr CO2: 37 patients (FST III–
IV), with both active acne and acne scars
treated with 4–6 IPL sessions (590 nm filter)
followed by two Fr CO2. signinicant
improvement in 44% of cases.
Fractional Non-Ablative Lasers
 Fractional Ablative Lasers

• Originally used for rejuvenation

Fr YSGG •20 patients (FST IV) two sessions . after 3 months, 70% of
2,790 patients showed 50 to 89% improvement, and rest had 40–50%
improvement.. No PIH or scars, erythema 5 days. + no bleeding.
Miscellaneous Devices: Plasma Kinetic Device
• Radiofrequency energy to convert nitrogen gas
into a material known as “plasma,” which is then
applied to the skin through a hand-held device.
• The result is ablation of the epidermis, along
with thermally induced changes in the dermis,
similar to the effect of ablative lasers.
• Non-viable epidermis remains on the skin for
several days after the procedure before sloughing
off and acts as a bandage and facilitates healing.
• Few studies, 20% improvement single ttt; 3
sessions needed to achieve satisfactory results in
another
 Conclusion
• Ablative treatments, such as theCO2 and Er:YAG
lasers, are most efficacious for atrophic scars but
use limited by prolonged recovery & side effects.
• Ablative fractional lasers may offer the best
compromise between efficacy and adverse
effects.
• Promising non-ablative options include: 1,550nm
and Fr 1,540nm or the novel 755nm picosecond
pulse duration laser.
• 585nm and 595nm PDLs and IPL can be utilized
for hypertrophic scars or scars with erythema.
 Conclusion
Patient goals and expectations regarding :
– treatment timeline,
– number of treatment sessions,
– length of recovery,
– and projected outcomes
should be clearly discussed in order to optimize
treatment experience and patient satisfaction.
 Ablative
10,600 nm CO2 Laser : 1 session; 75% imp
2,940 nm ER: YAG Laser: 1 session 4-5 passes 69% imp
755nm Alex
1,320nm Nd:YAG picosecond Fr CO2 10,600
5-6 ttt ; 50% imp 6 ttt; 50% imp 2-3 ttt; 26-50% imp
depth 66% imp
Short pulsed 1,450nm Diode 10 & 20 Fl, 10% vs 20% density:
1,064nm Nd:YAG 5 ttt; 30% imp
no diff; 1 vs 3 months no diff
NON ABLATIVE
8 ttt; 20-30% imp
only in FST I&II
FRACTIONAL
Scarring on neck & eyelids.
585, 595nm PDL
LASERS FrABLATIVE
Q switched
& 532nmKTP
1,064nm Er:YAG 2,940
Nd:YAG Erythematous or
5 ttt; 80% imp
5 ttt ;40% imp hypertrophic
scars only LASERS
Bleeding; Less down time
Long pulsed
Fr 1,550nm Er Doped
1,064nm Fr YSGG 2,790
Nd:YAG+PDL 3 ttt; 50-70% imp
2 ttt; 50% imp
3 ttt; 40% imp 1,540nm Er:glass
No bleeding, Less downtime
3ttt; 51% imp
THANK YOU