Which is a more effective treatment for acne scars: fractional CO2 laser vs PRP?

In this video, I discuss the difference between fractional CO2 laser and PRP. I talk about how each treatment works and what effect you can expect from them. In summary, a combination of the two treatments will give synergistic effect as PRP boosts the result of the fractional CO2 laser.   🪄 fractional CO2 laser + PRP (platelet-rich plasma) 🎯 for improvement of acne & surgical scars ⏱ 60 minutes…

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Boxcar acne scars are relatively easy to treat. It just takes time. Two rate limiting factors here- patient’s skin type, & scars on convex areas of the cheeks. This was a 9 month job . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers. #TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👀👉This Patient: Was treated with mainly CO2 laser as adjunctive to TCA. Chase deep enough and you can knock out some melanocytes. PIH can be expected, however was not the case in this patient (I used short PD CO2, she is also brilliant at photoprotection). Erythema will decrease in 3-6 weeks. No downtime lasers like Pico (for pores & pigmentation), or simple vascular lasers can reduce colour change & assist with #neocollagenesis . Possibly one more gentle fractional laser in a few months time will take care of the residual shallow scars. At that depth, simple #microneedling or RFM can also be an option . . 📸Action: For simple scars like these, see my nursing team @cliniccutis. Alison, Katie or Marisa are well versed in these non-surgical treatments💯 . .. 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 @drdavinlim @cliniccutis Brisbane #chemicalpeels #TCA #TCACROSS#acnescars #acnescarrevision#acnescartreatment#brisbanedermatologist #brisbaneskin#acnescarsnomore #acnescarsbegone#ogscareraser #scareraser#phenolpeels #acnescarlaser #davinlim (at Melbourne, Victoria, Australia) https://www.instagram.com/p/CJuCdpzDXsO/?igshid=1x5nnq5s6ivp7

Acne Scar Revision: Subcision + Fractional Radiofrequency Microneedling

https://youtu.be/jUiDLpdG54s In revising old acne scars, a proper evaluation must be made to ascertain the type of scars the patient has. Aside from this, one should also take into consideration the patient’s skin type and lifestyle. Remember that each patient and unique… and so is their treatment. There are many combinations of procedures that can be done but everything should always be…

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Chase scars deeply & dyspigmentation can ensure. Simple focal deep chemical peels can raise up deeper scars prior to laser resurfacing . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers. #TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👀👉This Patient: Was treated with minimal sessions. Given the downtime of COVID mid year I employed fully ablative resurfacing during the second session. Note the HYPOPIGMENTATION given her skin type 3. Chase deep enough and you can knock out some melanocytes. This should settle. Persistent cases can be rx with nuvb, excimer 308, Latiesse, focal psoralen, MC transfer or simple tacrolimus . . 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 @drdavinlim @cliniccutis Brisbane #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #brisbanedermatologist #brisbaneskin #acnescarsnomore #acnescarsbegone #ogscareraser #scareraser #phenolpeels #acnescarlaser (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CHoIzCFDrSn/?igshid=2wnokhodm4a1

Chase scars deeply & dyspigmentation can ensure. Simple focal deep chemical peels can raise up deeper scars prior to laser resurfacing. I used both 88% phenol-croton oil & TCA in this case . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers. #TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results (recent paper showed marginal advantage to phenol, no so in this patient) . . 👉👀This Patient: Was treated with two types of deep focal peels. Responded marginally better to TCA cf phenol. Treating age related changes will always help acne scars. In some cases it involves improving skin laxity, in others it is dermal fillers for volume displacement . . 💯Scar support: Vital to understand. Do not be scarcentric if other factors come into play, address all factors= results. Volume replacement provides counter traction . . 😎Dr Davin Lim, Brisbane Dermatologist @drdavinlim @cliniccutis Brisbane 🇦🇺 #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #brisbanedermatologist #brisbaneskin #acnescarsnomore #acnescarsbegone #ogscareraser #scareraser #phenolpeels (at Cutis Clinic) https://www.instagram.com/p/CHgSxHQDoGe/?igshid=1sqreevugas59

Treat all aspects not just scars. Volume loss & laxity play an important role in scar management💯 . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers, pico comes into mind. TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results. Lasers are seldom the only answer for scars (unless monomorphic superficial scars) . . 🙄👉This Patient: Was treated with TCA peels, lasers, & a wee bit of dermal filler. Fillers replace volume. Fillers support the overlying scars, fillers redrape the skin. Volume loss increases with age . . 👩‍🦳Ageing & acne scars: Probably the most difficult concept I have to deal with daily. Scars worsen with age due to loss of support. Treat the support, you indirectly improve acne scars. Fillers don’t last forever, nothing does. Options are HA fillers, collagen stimulation fillers, or fat transfer. Pros & cons beyond discussed in previous & future posts . . 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #acnescarsnomore #scareraser OG #acnescarsbegone for good… #skinbrisbane (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CGYN0pzj7GX/?igshid=15qfh3ewgrzcf

Simple focal deep chemical peels can treat bridging acne scars as it destroys both epidermal sides; the inferior area of the bridge & the base itself. Certainly an alternative to excision . 🔬👉Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers, pico comes into mind. TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👉This Patient: Was treated with TCA followed by ablative laser resurfacing. Skin Type 3+ so hypopigmentation will take a few more months to settle . . ⚠️Caution: Saucer scars, midline & polymorphic acne scars . . 🎬Action: For mild cases of scarring, my nurses @cliniccutis (Katie, Marisa & Alison) have been extensively trained in the application of TCA to open pores & deep acne scars, in addition to laser resurfacing & RF #microneedling with #lutronic Genius RFM . . 🔪💉🔫👍🏻👊What I do: I treat severe acne scars primarily with surgical subcision, excision & fully ablative lasers or complex atrophic - hypertrophic scars. Please book in with my clinical nurses if you have cosmetic issues such as enlarged pores or objectively mild acne scars. Trying to keep my waiting times down, Ta!!!🙏🏼🙏🏼🙏🏼 . . 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 @drdavinlim @cliniccutis #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #brisbanedermatologist #brisbaneskin #acnescarsnomore #acnescarsbegone #ogscareraser #scareraser (at Cutis Clinic) https://www.instagram.com/p/CFvSvzcD3nW/?igshid=1x6fx4h984y5m

Simple focal deep chemical peels can treat bridging acne scars as it destroys both epidermal sides; the inferior area of the bridge & the base itself. Certainly an alternative to excision🔪 . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers, pico comes into mind. TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👩🏼‍🦱This Patient: Was treated with TCA followed by ablative laser resurfacing. Skin Type 3+ so hypopigmentation will take a few more months to settle . . 👉Caution: Saucer scars, midline & polymorphic acne scars . . 🎬Action: For mild cases of scarring, my nurses @cliniccutis (Katie & Alison) have been extensively trained in the application of TCA to open pores & deep acne scars, in addition to laser resurfacing & RF #microneedling with #lutronic Genius RFM . . 🙄💉🔪🔫What I do: I treat severe acne scars primarily with surgical subcision, excision & fully ablative lasers or complex atrophic - hypertrophic scars. Please book in with my clinical nurses if you have cosmetic issues such as enlarged pores or objectively mild acne scars. Trying to keep my waiting times down, Ta!!!🙏🏼🙏🏼🙏🏼 . . 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 @drdavinlim @cliniccutis #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #brisbanedermatologist #brisbaneskin #hashtaghacksMF #acnescarsnomore #acnescarsbegone #ogscareraser #scareraser (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CFnoPsdDCT_/?igshid=l5q30xntq213

Simple focal deep chemical peels can treat linear scars . . 🔬👉Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers, pico comes into mind. TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👃🏻This Patient: Was treated with TCA 5 years ago. 2 sessions. Many ways to deliver including tooth pick, syringe drop (at that time), paint . . 🚧Caution: Midline scars (extension) . . 🎥Action: For mild cases of scarring, my nurses @cliniccutis (Katie & Alison) have been extensively trained in the application of TCA to open pores & acne scars. Treatments start at $390 AUD. CO2 laser resurfacing $490 to $990 AUD . . 👊What I do: I treat severe acne scars primarily with surgical subcision, excision & fully ablative lasers or complex atrophic - hypertrophic scars . . 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #acnescarsnomore #acnescarsbegone for good... (at Cutis Clinic) https://www.instagram.com/p/CEpjGxVD3Mz/?igshid=6goiy5q2uvau

I had to think outside the box for this case of scar revision . . 🔬Skin Science: One of the most challenging cases of scar revision. Scars are highly atrophic with elastolysis & outpocketing due to lack of support. Additionally there was significant subdermal fibrosis involving the neck & face. Biopsies down to the lower subcutaneous fat shows extension of scar tissue beyond this depth . . 👉🔫💉🔬🔪🔫🩸🪓🧱Previous revision: RFM using #geniusRF & #infiniRF, as well as fractional CO2 lasers, non-ablative lasers, surgical subcision with 12,14, 16, 18G Nokor, 22, G cannula, surgical excision, mini-S-Face lift, dilute Ca OH apatite, PLLA, HA filler, prolonged course of abs, dilute ILCS . . 💯👌🏻What finally worked well: Fractional full thickness excision removing both scar & atrophic tissue . . 💡More to come: Final results from other cases to come, will give a brief outline prior to journal publications . . 😎Dr Davin Lim Brisbane Dermatologist @drdavinlim @cliniccutis AU🇦🇺 . . #nomorescars #healthyskin #scardoctor #acnescars #acnescarrevision #acnescartreatment #skinrejuvenation #beforeandafters #lasersurgery is overrated (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CDZrz0Fjx58/?igshid=a2gdhwiergvt

This is HYPOPIGMENTATION following TCA CROSS. Photo is about 10 years old . . 🔬Skin Science: TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars . . 👉👀This Patient: is my only documented case of hypopigmentation following this procedure. Photo is 6/12 post treatment. No family hx of vitiligo, no evidence elsewhere. I did not take a biopsy . . 📋Treatment: attempted psoralen and phototherapy (pre Lumigan), considered fractional focal lasers to induce pigmentation, pre- #Recell . . 🆘Risks of TCA include hypo over hyper. The latter is usually easier to manage long term. Scar widening- esp in ill-defined scars, and midline scars (nose). Cover with antibacterial topicals or po for duration of healing (5-8 days) . . 📚📖Am currently writing a paper on the use of TCA for scar types. Other focal peels I use include Phenol-Croton Oil, will do that in another post . . 😎Dr Davin Lim, Brisbane Dermatologist Australia🇦🇺 #chemicalpeels #TCA #TCACROSS #acnescars #acnescarrevision #acnescartreatment #acnescarsnomore #acnescarsbegone for good... (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CC-VVU4jS_K/?igshid=1vrpnuan3r7gm

This patient: Is of Islander extraction, skin type 4. Generally ethnic skin will scar more readily cf skin type 1-2, PIH is certainly more common. The flip side is that ethnicity can respond faster to procedures that remodel collagen (laser, subcision, RF, HIFU etc…) This is certainly well known amongst #dermatologists . . 🖐🏽Rate limiting factors: In this patient, it is the skin type. TCA & laser can lead to PIH (post inflammatory hyperpigmentation). Careful titration of TCA concentration coupled with sensible CO2 parameters (taking into account density, energy & PD of the laser) can reduce but not eliminate PIH. Got it just right in this case. . . 💉🔫🔪🩸🍌Variable skill sets: It is important to master surgical skills including basic excision, elevation & surgical #subcision . The second skill set should be the use of #dermalfillers; essential if one can not remodel #collagen or replace atrophic adipose tissue. All other skill sets including the use of #co2lasers, #microneedling, #Fraxel, #picolaser, #erbium lasers & RF devices can be picked up quickly as most are ‘standard operating protocol’ driven, albeit modification of parameters can give better results . . 🧑🏾‍🦲👩‍🦳👩🏼‍🦰🧑🏻‍🦰👩🏽🧒🏻Variable patient factors: Here is the big one! Everyone lies on a bell curve. Fast responders lie to the right, slow responders to the left. Remodelling scars & tissue #neocollagenesis is a biological phenomenon, dependent on the immune system of the host, this patient lies to the right of the curve . . 😎Dr Davin Lim Brisbane Dermatologist @drdavinlim🇦🇺 . #acnescars #acnescarrevision #acnescartreatment #dermatologistbrisbane #TCA #TCACROSS #chemicalpeels #icepickscars (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CCJ70ZMDglX/?igshid=1pwvaeumeq87j

These are from punch excision of acne scars. Acne scar revision is complex, many variables including the skill sets of your specialist #dermatologist - plastic surgeon. Many variables govern response. Excision is an essential skill set for the revision of scars . . 👌🏻Variable skill sets: It is important to master surgical skills including basic excision, elevation & surgical #subcision . The second skill set should be the use of #dermalfillers; essential if one can not remodel #collagen or replace atrophic adipose tissue. All other skill sets including the use of #co2lasers, #microneedling, #Fraxel, #picolaser, #erbium lasers & RF devices can be picked up quickly as most are ‘standard operating protocol’ driven . . 👉👀This patient: Has deep ice pick scars, linear scars as well as rolling scars. TCA or even phenol croton oil peels can improve #icepicks Given the depth, punch excision was performed to several deep scars . . 📊📈📉Variable patient factors: Here is the big one! Everyone lies on a bell curve. Fast responders lie to the right, slow responders to the left. Remodelling scars & tissue #neocollagenesis is a biological phenomenon, dependent on the immune system of the host . . 😎Dr Davin Lim Brisbane Dermatologist @drdavinlim🇦🇺 . #acnescars #acnescarrevision #acnescartreatment #dermatologistbrisbane #TCA #TCACROSS #chemicalpeels #icepickscars (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CCHtB_1jB7w/?igshid=16077wcw4ak0j

Ablative lasers can be useful in the revision of certain scar types. My go to lasers are erbium & CO2; both in fractional & fully ablative mode . . 🔬Skin Science: Acne scar revision should be manual, only picking up devices like lasers & RFM (radiofrequency microneedling) should we require them. In some scar types, lasers are the PRIMARY modality, whist in other scar types, lasers do not play a role in revision . . 👀Acne Scars: can be mixed dermal + subcutaneous atrophy. If it is dermal, revision is easy; lasers, #microneedling #RFmicroneedling, #ematrix, #Fraxel, #fractionallasers #chemicalpeels etc..etc..etc.. can help. Press a button, don’t burn too much, & Bob is your mother’s brother. The downside of laser is the recovery, especially with fully ablative lasers . . 🔫👌🏻Lasers used: My ablative lasers include ProFractional erbium, fully ablative erbium #sciton, CO2 in different power-pulse durations, including CORE nice focal length to work with, Ultrapulse (crazy power), Mixto CO2 (short PD). Non-ablative lasers are underwhelming in the context of moderate to severe scars . . 👉Fat Atrophy is challenging. Especially if there are tethers. If an explosion occurs in the fat, it takes the fat out, AND usually creates tethers (scar tissue)- aka rolling, atrophic scars. You need to break tethers BEFORE filling or a donut will occur. Simple physics of filler following the path of least resistance. If there is atrophy, your body’s immune system needs to correct it. Dermal is not too hard- #collagen remodelling - #neocollagenesis HOWEVER adipose or fat is challenging . . 😎Davin Lim, Dermatologist Brisbane Australia🇦🇺 . #acnescartreatment #acnescarrevision #acnescarsupport #dermatologist #brisbanedermatology (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CBmJvuQDcXN/?igshid=1vf7qq9wivr2

Acne scar revision has complications. These are very rarely shown, & often never discussed . . 🔬Skin Science: Depending on the procedure, various complications can arise. These include PIH from lasers, persistent redness from energy devices, grids from fractional lasers - #microneedling, paradoxical iatrogenic scars, widening of scars from #TCApeels, & in this case haematomas from surgical #subcision . . 🔪💉Subcision: Is my go to procedure for the management of moderate to severe ‘deep’ scars. I subcise with instruments ranging from 12 G all the way to 30 G. The more aggressive the treatment, the higher the rate of blood clots . . 🙄Management: early evacuation will prevent long term complications. Very rarely do I use a drain post procedure. Organised haematomas are more difficult to treat- NS or ILCS injections. USS can be useful in the ddx between haematomas vs #acnecysts. Most can be identified clinically. PIH can occur in some patients due to hemosiderin deposition in the dermal layer . . 💯Best practice: If one is performing #acne scar revision procedures, one should be well versed in the management of all potential complications, as these do arise . . 😎Dr Davin Lim Brisbane Dermatologist🇦🇺 #acnescars #acnecysttreatment #scardoctor #scartreatment #acnescartreatment #acnescarrevision (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CAldELGHkTz/?igshid=fzg9yyptouhi

Acne scar revision is complex, many variables including the skill sets of your specialist #dermatologist - plastic surgeon. Many variables govern response, in this case it is the patient’s immune system that did most of the work- I only facilitated the process !!! . . 🙄Variable skill sets: The number one skill set to master is #subcision, that is in the context of atrophic moderate to severe #acnescars. The second skill set should be the use of #dermalfillers; essential if one can not remodel #collagen or replace atrophic adipose tissue. All other skill sets including the use of #co2lasers, #microneedling, #Fraxel, #picolaser, #erbium lasers & RF devices can be picked up quickly . . 👍🏻This patient: is a super fast responder. I expect this level of improvement over 12 months, & not just 3 ! Rate limiting scars (I though) were the deep broad #boxcaracnescars on the cheeks, in addition to her darker skin type. I treated her with TCA Paint feathering broad scars with hard pressure to the deeper narrow scars. Completed the job with CO2 laser resurfacing . . 📊📈📉Variable patient factors: Here is the big one! Everyone lies on a bell curve. Fast responders lie to the right, slow responders to the left. All things considered, the variation in remodelling of acne scars is the genetic trait of the patient. This patient lies to the right of the bell curve . . 😎Dr Davin Lim Brisbane Dermatologist .🇦🇺 #acnescars #acnescarrevision #acnescartreatment #dermatologistbrisbane (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CAbbTN_H1dB/?igshid=158noi8bc4ivr