Laser Acne Scar Removal: Cost, Types, Side Effects

Laser

Unfortunately, moderate to severe acne leaves permanent scarring in the majority of cases. Lasers have taken on a very prominent role in treating acne scars. Understanding how this high-tech intervention can work for you is made easier by first gaining some knowledge of the laser systems that are used. Lasers for acne scar removal can be divided into two main types called ablative lasers and non-ablative lasers.

Ablative Laser Acne Scar Removal:

These lasers cause controlled damage to the upper layers of the skin (epidermis). This stimulates the body to “resurface” the skin by rebuilding the upper layers for a rejuvenated, smoother look. Ablative lasers induce something similar to a very bad sunburn.

Non-Ablative Laser Acne Scar Removal:

These lasers work beneath the surface, using heat and light energy to stimulate new collagen production. Collagen synthesis causes indented and sunken acne scars to better blend into the normal surrounding skin.

ablative and non-ablative laser scar removal
Ablative lasers (left) work on the upper skin layers. Non-Ablative systems work on deeper layers, leaving upper layers intact.

Both ablative lasers and non-ablative lasers can be used in two different ways. These are known as fractional and non-fractional.

Fractional Laser Acne Scar Removal:

Fractional lasers treat only specific areas of the skin in a grid-like fashion. All the areas in between the treated points are left untreated and unaffected.

fractional laser for laser acne scar removal
Fractional lasers treat specific points (red dots) in a grid-like fashion, leaving the skin in between untreated.

Non-Fractional Laser Acne Scar Removal:

These lasers simply treat the entire skin surface area.

non-fractional laser pattern
Non-fractional lasers treat the entire skin surface.

Here’s a summary of what’s been discussed so far:

Type Of LaserHow It Works
Ablative, Non-FractionalControlled burn to the entire upper skin surface
Ablative, FractionalControlled burn to specific grid-like spots
Non-Ablative, Non-FractionalPromotes collagen synthesis in the entire area
Non-Ablative, FractionalPromotes collagen synthesis to specific grid-like spots within the treatment area

Which Lasers Work Best?

For laser acne scar removal, how the different types of lasers mentioned above play a role depends on the type of atrophic acne scars you have, your skin tone, and your goals/tolerance in terms of recovery time.

Ablative, Non Fractional Lasers:

This treatment can be useful for rolling, boxcar, and some icepick acne scars.

Ablative Fractional Lasers:

These are more effective for treating rolling and boxcar atrophic acne scars than ice pick acne scars.

ablative fractional laser results for acne scars
Ablative, Fractional results for boxcar acne scars.

Non-Ablative Fractional Lasers

Boxcar and rolling atrophic acne scars seem to respond best to this type of laser, with ice pick scars responding less.

non-ablative fractional laser acne scar removal
Non-ablative, Fractional boxcar acne scar results.

Non-Ablative, Non-Fractional Lasers

Works for boxcar acne scars. This type of laser for acne scar removal is also effective in removing dark pigmentation associated with moderate to severe acne.

non-ablative, non fractional laser for acne
Non-ablative, Non-Fractional laser results for boxcar atrophic scars.

Hyperpigmentation:

Acne can leave the skin blemished with hyperpigmentation (dark spots), even after the acne itself has resolved. Pulsed dye lasers as well as Intense Pulsed Light (IPL) have been shown effective for diminishing hyperpigmentation associated with acne and acne scars.

Side Effects & Complications:

Complications of laser acne scar removal include:

  • swelling
  • redness
  • infection
  • acne break-outs
  • cold sore break-outs
  • oozing, crusting and scabbing (more common with ablative lasers)
  • permanent hyperpigmentation (more common with ablative lasers and in darker-skinned people)

Cost:

The American Society of Plastic Surgeons quotes average costs of laser skin resurfacing at $1,963 for ablative laser treatments and $1,201 for non-ablative. Final fees can be higher because of consultation fees, travel expenses, etc. Other factors that will influence costs are the body area to be treated, and the reputation of the practitioner you choose. For example, a small area on the chin will be less costly than an entire facial procedure. Also, treatment by a relatively inexperienced practitioner will generally cost less than that provided by a highly sought-after and well-known one.

Recovery For Laser Acne Scar Removal:

Recovery for non-ablative laser acne removal procedures is generally a lot quicker and easier. These procedures will feel like a mild sunburn. With ablative procedures, the treated area can feel like a severe sunburn, probably worse than any you’ve ever had. Recovery for ablative procedures is usually longer and more difficult, often taking weeks or even months. Practitioners will have their own after-care regimens based on their personal preferences. One very important after-care requirement is the use of sunscreen after healing for a full year. Use an SPF of at least 50 to minimize the chances of permanent hyperpigmentation, especially after ablative procedures.

Conclusion:

There are four main categories of lasers for acne scar removal. Each of these types of laser systems can play a role in the treatment of your acne scars. Which is best for you depends on the type of acne scars you have, your skin tone, and your goals with respect to recovery time.

Medical References:

Gupta, Atula et al. “Evidence-based Surgical Management of Post-acne Scarring in Skin of Color.” Journal of cutaneous and aesthetic surgery vol. 13,2 (2020): 124-141. doi:10.4103/JCAS.JCAS_154_19

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