Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery

Acne Scar treatment with punch grafts, Fraxel laser, and CO2 laser

[2010-02-17 15:38:39 - Tomo from South Jersey]: Dr. Ringpfeil, I had cystic acne as a teenager that left me with pitted scars as well as overall uneven skin texture. There seem to be so many options. I need your assistance in locating a surgeon who has a great deal of experience with punch grafting and subcission. I will then come to you for the laser treatment. Do you use the Fraxel type laser system? I greatly appreciate your help!
[2010-03-01 21:43:32 - Dr. Ringpfeil]: We perform punch grafts and subscision as needed several weeks prior to resurfacing by CO2 laser. In fact, I do not use Fraxel technology as it has not met expectations over the past 4 years since it entered the market even when 4-8 treatments were performed. The company that makes Fraxel has since developed a CO2-Fraxel combination system because Fraxel alone could not deliver results. However, we use the flagship of CO2 laser technology, the Ultra Pulse by Lumenis. Until today, the Ultra Pulse is still the most robust and versatile CO2 laser on the market, which is especially important for the outcome of scars.

CO2 Laser resurfacing following an erbium laser treatments

[2011-09-21 15:56:44 - sharon from Mainline]: I had erbium laser resurfacing almost 5 yrs ago. I was left with a lot of scars on my cheeks & a dent. Am I able to have co2 laser resurfacing to correct the damage & is it any less expensive just to have the cheeks done insted of the whole face? Thanks
[2011-09-21 18:08:13 - Dr. Ringpfeil]: It is not clear to me from your message whether the scars exists before the erbium treatment or after the treatment. I will present an answer to each interpretation. If scarring occurred after erbium laser resurfacing, CO2 laser resurfacing may not be able to correct the outcome and could potentially enhance the problem. Scarring is not expected after erbium laser treatment, CO2 laser treatment or superficial peels. If it occurred after a procedure that is per se non-scarring, you should be cautious about undergoing any other procedure. If you meant to say, you had laser resurfacing for scarring but were still left with scars after erbium laser treatment, then CO2 laser resurfacing should offer improvement. CO2 lasers are more powerful than erbium lasers, which translates to better results but longer downtime. However, there is no technology to date that can fully reverse scars. All methodologies that are currently in use strive to improve scars.

Punch graft for the treatment of chicken pox scars

[2011-09-29 09:04:15 - Sam from Philadelphia]: I have a deep large scar on my face from chicken pox. I would like to have it worked on, how effective is a punch graft and what are the risks?
[2011-10-03 13:22:06 - Dr. Ringpfeil]: Punch grafts are very effective but due to advances in CO2 laser treatments, they are not performed as often anymore. They are taken from behind the ears or another color matched site and are typically followed by laser resurfacing to blend them in. We have been able to elevate chicken pox scars by just CO2 laser alone. Evaluation is necessary to give the best treatment options for your scars as skin type, texture and color changes in the scar must be taken into consideration.

Can acne scar be treated with YAG laser1?

[2010-01-22 19:42:42 - Lyn from Philadelphia]: Do you use the Variable Pulse YAG Laser? And if not why not? Thanks for your input, it's overwelming how much info. is out there!
[2010-01-24 14:30:40 - Dr. Ringpfeil]: The Variable Pulse ND:YAG Laser is not appropriate for treatment of acne scars. I understand that the cosmetic technology available at this time must be overwhelming for a layperson. The choice of laser depends on the condition and skin type to be treated. It must also depend on the experience of the laser surgeon. Laser technology has made a tremendous impact on the ability to correct cosmetic concerns but is not without risks. A variable pulse Nd:YAG laser can be used for a host of conditions including hair reduction in all skin types, blood vessel treatment, redness reduction, skin rejuvenation, wrinkle correction and others. The downside of an Nd:YAG laser is its lack of specificity to treat some of the above conditions and most of the time, more efficient and specific lasers are used by advanced laser surgeons to achieve goals safely and quickly. A complimentary consultation with our aesthetician can help you better understand treatment options that are appropriate for you.

Should punch grafts performed before or after laser resurfacing?

[2010-06-01 06:15:17 - deborah K. from Villanova]: I have suffered with moderate to severe acne since my teenage years. I am now in the process of trying to remove as much of the scaring as possible. I did some research, and found that punch techniques should be done before skin resurfacing with a laser. However, the local doctor that I have seen wants to do an Erbium laser resurface before any punch excisions. He says that after the resurface,depending on the results, he can then do any punch excisions and spot treat again with the erbium laser.He says that doing it the other way could make some of the scaring worse. Do you agree?
[2010-06-01 13:50:03 - Dr. Ringpfeil]: Newer laser technology has been able to dramatically reduce the need for punch grafts, which in the past were often necessary to address deep ice pick acne scars. When indicated, punch grafts are typically done at least 4 weeks before the resurfacing procedure. They must be followed by resurfacing as they are otherwise quite obvious. Under certain circumstances, it may be reasonable to resurface acne scars first and then punch graft only the very few remaining deep lesions, followed by spot resurfacing.

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