• Laser Resurfacing

    Acne Scarring

Non-ablative Fractional Laser Resurfacing (FraxelTM)

This type of laser is a fractional laser. Fractional non-ablative lasers work by creating columns of photothermally coagulated skin. These columns are called Micro Thermal Zones (MTZ). The amount of channels created on the skin can be increased by increasing the fractional density. The depth of the channels can be changed by increasing the laser energy used. Caution and experience must be used as use of very high densities and depth can create scarring and permanent damage to the skin rather than improve it. The MTZ/columns undergo a process of new collagen formation. This increases the overall collagen density within the scar affected skin. This improves acne scarring as atrophic acne scars are caused by destruction of skin collagen by inflammatory acne. Non ablative fractional laser is a milder and safer form of acne scarring treatment compared to ablative fractional laser treatment. It also has a quicker recovery time compared to most ablative fractional laser treatment.

Fractional non-ablative laser resurfacing is more effective than microneedling, radiofrequency microneedling and peels BUT less effective than fractional ablative laser resurfacing. It is a safer alternative to ablative and fractional ablative resurfacing in darker skin types (eg. Oriental, Asian, Afro-Caribbean) as it is less likely to result in pigmentation side effects.

Please see Dr Hussein’s lecture on Lasers and Scarring to better understand laser treatment of acne scarring.

Ablative Fractional Laser resurfacing (with fractional CO2 or fractional Erbium YAG laser)

This is a more aggressive type of fractional laser. In this type of treatment columns of skin tissue are actually physically vaporised into the skin. This creates tiny holes/channels on the skin that are on average 0.2-0.3mm in width and variable depth. The depth of channels is dictated by the energy used to create it. This energy is limited by the power of the laser used. Because a physical channel is created within skin a greater degree of tissue regeneration and collagen remodelling occurs in response. The inflammatory response is greater in extent and more long lived due to the greater degree of injury to the skin caused by the laser. Greater inflammatory response and duration gives a greater degree of collagen synthesis and remodelling.

The improvements in acne scarring seen with fractional ablative laser resurfacing are greater than fractional non-ablative laser resurfacing. Recovery times and risk of side effects with this method are greater than those in fractional non-ablative laser resurfacing. Risk of pigmentation side effects in darker skin types is also greater and so it must be used in experienced hands.

Please see Dr Hussein’s lecture on Lasers and Scarring to better understand laser treatment of acne scarring.

Combined Fully Ablative and Fractional ablative laser resurfacing (CO2 and Erbium YAG)

There are only a handful of cutaneous laser surgeons (less than 5) that are experienced enough to safely perform this procedure in the UK. Dr Hussein is one of them. This is the most aggressive type of laser treatment that can be performed for the treatment of acne scarring. It involves the use of fractional ablative laser to first individually treat scars throughout the full depth of the scar. It is then followed by a fully ablative CO2 laser or Erbium YAG laser treatment that will give the greatest degree of surface skin remodelling. It is a procedure that carries a higher risk of infection, pigmentation side effects and scarring. However, it has an excellent safety record if performed in experienced hands. As Dr Hussein specialises in cutaneous laser surgery he performs a large number of these types of cases and thus has considerable experience of this technique.

The advantage of this type of treatment is that it gives the greatest degree of improvement in one treatment session compared to any other acne scarring treatment modality. A strict aftercare regiment and prophylactic medications are taken in the recovery phase following treatment. After 10 days recovery time it is usual that patients can return to work. A degree of foundation may be required to conceal redness that may last for several weeks post treatment. However, most patients find this an acceptable price to pay for the degree of improvement they get from this treatment.

It is possible to treat darker skin types with this type of treatment. Dr Hussein may reduce the settings he uses when treating darker skin types. The risk of darkening the skin is high. However, this will usually fade aster 2-3 months and is an acceptable consequence for most patients.

Please see Dr Hussein’s lecture on Lasers and Scarring to better understand laser treatment of acne scarring.