Ask Dr. Pane: Can subcision with CO2 fractional improve my acne scars?

The Question

At Atlantic Coast Aesthetics, we know some of the most meaningful and impactful cosmetic procedures correct the ravages of real medical issues which can have lifelong impact. One of these, acne, is seen as a rite of passage, an irritating but unavoidable part of the process of becoming an adult. For many people, acne is a relatively minor annoyance. For some, it can become a life-altering, even disfiguring burden, affecting their appearance, self-confidence and their entire world. ACA has tools and techniques for helping ease the ravages of acne which work well for many people, and one of these is the topic of this week’s Ask Dr. Pane segment, from one of our Twitter followers. The patient asks, ”Can subcision with CO2 fractional [laser] improve my acne scars?”

The Answer

In this case, the patient did not send photographs, so it is difficult to know exactly how these scars have manifested in this patient. Because of this, Dr. Pane will limit his answer to generalities, with the understanding that an in-patient clinical consultation and evaluation is always the gold standard for determining the “ideal” treatment protocol.

 

 

 

 

 

 

 

Regarding laser treatments, Dr. Pane says they are really the best option for correcting acne scarring without invasive surgery. A laser which uses carbon dioxide gas is applied to the skin to help strip away damaged tissue and reveal the healthier skin beneath the surface. This can be done in two ways:

Fractional CO2 laser treatments are only applied to certain points on the skin. This type of laser treatment has the advantage of less pinkness, downtime and peeling. However, as Dr. Pane explains, because fractional CO2 or “fraxal” treatments only target specific areas, it’s a bit like a Swiss cheese where the laser is only applied to the holes. Because of its selective nature, fraxal treatments are often done on a 4-6 week timetable between treatments, and individuals may require 6-8 or more to achieve the full benefit, which means many patients who choose this method may be undergoing treatment for the better part of a year.

Full CO2 laser treatments, in contrast, are applied to the full area in a single sitting session. It works the same way, but is not selectively applied. Because the lasers are covering a larger area at one time, the patient often gets the full benefit after a single treatment. The drawback to this is, of course, that the patient is getting the full treatment all at once, which can lead to increased skin sensitivity, pinkness or redness, pain and peeling in the treatment area. Patients undergoing full CO2 laser treatment can expect to undergo at least a week of downtime and need to stay out of the sun until the pinkness has fully resolved, in addition to following any other aftercare protocols issued by clinical staff.

Subcision, where the skin around a depressed acne scar is actually cut down, hence the name, is sometimes an option on its own or in conjunction with CO2 laser treatments. However, subcision is not generally as good an option for treating acne scarring because such scars tend to be uneven, with a number of different profiles from recessed to raised. When this is done, Dr. Pane says he ideally likes to couple the subcision with fat transfer to lift up the skin immediately under the scar, helping to minimize its appearance.

As with any other kind of scar, acne scars cannot be fully eliminated. This is why scar treatment is called “remediation” or “revision” instead of “removal.” It is possible to minimize their appearance to a point, but they will never fully go away. Dr. Pane says patients should expect an ideal improvement in scar appearance of around 50%, but this number may increase or decrease based on a number of factors including patient’s age, skin type, environmental and habitual factors and other issues. These factors can be best and most accurately assessed during an in-person clinical evaluation, to ascertain the impact and determine how best to proceed, as well as helping the patient set realistic expectations for the outcome.

If you have a question about any aspect of cosmetic surgery, Dr. Pane and the staff of Atlantic Coast Aesthetics are always happy to discuss the areas of interest or concern to you. Simply follow us on Twitter, Instagram, Facebook and LinkedIn; call us at (561) 422-4116; and/or email us through our website’s Contact page. Your question might even be the focus of an upcoming Ask Dr. Pane segment, helping us to inform and educate others who share your interests with real talk and honest answers to your questions. Remember, at ACA we believe the only bad question is the one you don’t ask!