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Fractional CO2 Laser for Acne scars

Authors Dr. P.k.Talwar

During adolescence, acne or pimples are the commonest problem among teenagers. They appear due to clogging of sebaceous glands due to incresed secretions following hormonal disturbances. They may be labelled as black heads, white heads, comedones eyc. They may also present themselves in nodular, cystic or pustular forms. Larger acne may leave bigger scars. One should try to get their sizes reduced so that resultant scars are minimal. It can be done by different modalities. If medicines are ineffective, the size can be reduced by Intanse Pulse Light or Lasers. vascular lasers e.g. Pulse dye or KTP lasers mare very effective in it.

There is a need to evaluate these patients and there is need to do one or several of following procedures in order to offer cosmetic acceptable result. Neglect of acnes leave scars over the face. Inspite of best of treatment, some scarring may remain. A dermatologist is your best bet to no or minimal scarring. The acne scars may be in forms like pits, blemishes etc.

The procedures done to minimise post acne scars are many e.g :
  • AHA peels
  • TCA peel
  • Phenol peel
  • Dermabrasion
  • subcisions
  • Filling the pits by fillers like restylane, Juvederm,autologous fat etc.
  • Subdermal grafts
  • Excision of deep scars
  • Laser resurfacing by Erbium yag and CO2 lasers
  • Fractional CO2 treatment.

Chemical peels or dermabrasions were meant to remove outer layers of dermis thus de-saucerising the scar and effectively reducing the depth of acne scars. Miltiple sittings are required to achive planing of scars. Among Indian patients, post inflammatory hyperpigmentation is a worrysome problem, though fortunately I have not seen many patients developing it.

Surgical excision has been done by the author in 3-4 patients, during 25 years of experience, in very severe cases of acne scars.

Before popularisation of CO2 lase, the author used to do dermabrasion as a routine among most of his patients. The problems were two fold: First, the deeper removal of layers had a chance of hyperpigmentation and secondly,dermabraded skin used to become red and would take 3 months for skin to regain normal colour. The cheeks remained rosy for that long. While women could apply make up to hide it,men could not do that, hence unpopularity of the technique among men.

The resurfacing with CO2 laser had more or less same problem. because of long downtime. To overcome this problem, fractional CO2 laser was developed. In this technique, the laser pulse was delivered through multiple micro pulses interspersed with normal healthy skin , giving it form of "sieve". Healing occurs faster with this method due to interspersed healthy skin, and downtime comes to 5-7 days instead of 3 months.It also encouraged men to opt for it and became popular among them.Since advent of the fractional CO2 laser, the author has been doing mere and more of such treatment for men. There has been exponential increase in their numbers.

It is very useful in treating acne scars, fine lines dyschromias,sun damaged skin, naevue etc. it acts by not only ablating the tissue but also by remodelling and shrinkage of collagen.