ACNE SCAR TREATMENT - ENERGY DEVICES
Dr. Emil Henningsen is specialized in the treatment of acne scars and is internationally respected as an expert in this field.
He performs all forms of fractional and fully ablative laser resurfacing procedures, non-ablative lasers, RF microneedling, plasma exeresis, chemical peels and cross and more.
There are many different laser brands worldwide and much marketing. The name of the device is less important than the treatment method and the skills of the specialist. A supreme laser in the wrong hands can lead to formation of new scars or minimal improvement.
Any top brand laser for the “wrong” scar type will never improve the scar. However, the best lasers from well-known companies are safer and deliver predictable results.
CO2 laser and Erbium:YAG laser are the most powerful lasers in scar revision. These are used in either fractional or fully ablative mode. Downtime and outcome vary accordingly.
Many acne scars lie deep in the skin. These may be hard to target for lasers without causing much trauma to the skin surface. RF micro-needling is effective in treating subdermal scar tissue (fibrosis) without damaging the upper layers of the skin.
Pico lasers (e.g. PicoPlus) can improve superficial scars in darker skin types with zero or very short downtime.
Pulsed dye lasers (or nd:YAG or Alexandrite lasers) are used for redness after acne named PIE (post inflammatory erythema). Downtime (purpura) is a few days.
Learn about acne scar treatment with lasers and RF Micro-needling
What is the difference between CO2 and Erbium lasers?
The main difference are in the wavelengths. Erbium lasers produce 2,940 nm wavelength light, CO2 lasers produce 10,600 nm wavelength light.
The wavelength determines the effect on the skin. Both Erbium and CO2 lasers are ablative. This means that CO2 and Erbium lasers remove fractions of the skin (fractional setting) or the entire surface of the skin (re-surfacing).
Erbium lasers are strongly absorbed in water, so the Erbium laser does not produce as much heat in the skin and Erbium laser has shorter downtime and less risk of side-effects compared to CO2 lasers that are not absorbed in water.
CO2 lasers produce more heating and, in general, are slightly more effective in skin remodelling due to collateral heating of tissue. Both wavelengths are considered safe for acne scar revision. This results in smoother skin with less scarring.
Final results are seen months after the treatment.
What about Isotretinoin and laser?
Most laser procedures are safe on patients treated with Isotretinoin. Dr. Emil Henningsen has treated many patients on Isotretinoin with no complications.
Recent studies and papers have confirmed this. Have a look at this recept consensus report.
So, what lasers and energy devices do we offer?
Ablative lasers: CO2 (10,600 nm) and Erbium:YAG (2,940 nm)
The most potent lasers on the market for skin treatments are CO2 and Erbium lasers that are ablative lasers.
These are used to remove fractions of skin (fractional ablative laser treatment) or for full skin surface resurfacing (fully ablative). Dr. Emil Henningsen does all of these procedures.
Vascular lasers: Pulsed dye laser (585 nm) and Nd:YAG (1,064 nm)
Pulsed dye laser is a non-ablative laser, which is very effective for treatment of early, red scars.
The laser is highly absorbed in hemoglobin heating the blood vessel to destroy this. Indications are fresh red scars, hypertrophic scars and keloids, redness after ablative lasers Nd:YAG laser penetrates the skin deeper due to the longer wavelength which may be used for large blood vessels in hypertrophic scars and for resistant redness after acne
Pigment lasers: Q-switch Nd:YAG (1064) and KTP (532 nm)
Q-switched nd:YAG laser is a good laser for pigmented scars and post-inflammatory hyperpigmentation (PIH).
More treatments are needed for better outcome. 1064 nm targets deeper dermal pigment, whereas 532 nm targets superficial epidermal pigment.
There is no downtime after Nd:YAG laser, but expect one week downtime after KTP laser. Both lasers may be combined with bleaching agents such as Hydroquinone for home use.
Radiofrequency (RF) microneedling: Genius
Insulated needles deliver RF energy from each of 49 small encapsulated needle tips that penetrate the skin to a certain depth up to 3.5 mm.
This treatment remodels your dermal skin with minimal trauma to the skin surface.
Downtime is usually short (3-4 days). This is a very new energy device that has replaced the “Infíni” by Lutronic. Genius is indicated for a large spectrum of acne scars and is effective for rolling scars and boxcars.
FAQ about treatment with laser and RF Micro-needling
Fractional laser resurfacing treats ‘fractions’ of skin enabling quicker recovery and shorter downtime for patients. Most patients will benefit from a series of fractional laser treatments.
Facts on fractional laser for scar treatment:
● Fractional CO2 and Erbium lasers are effective for acne scar treatments
● Fractional resurfacing treats a portion of your skin
● Using a scanner the doctor can control the percentage of skin treated
● Fractional lasers have shorter recovery time and lower risk of complications compared to fully ablative laser resurfacing
● Up to 70% improvement of superficial and textural scars can be seen after four treatments
● Side effects are generally rare and laser procedures are very well tolerated
● Recovery time may be tailored according to your preferences, typically 3-5 days
● Erbium fractional laser has shorter downtime compared to CO2
● Erbium fractional lasers are safer in darker skin compared to CO2
● CO2 fractional lasers have longer downtime, however they deliver slightly better outcomes
● Pulsed dye lasers are brilliant for treating fresh / red scars and typically two treatments are needed spaced 3-4 weeks
● Everyone will have an individual pattern of acne scarring, and a bespoke treatment program will give superior results
● RF microneedling (Genius) is not a laser but it is also fractional in the way that it penetrates fractions of skin and delivers radiofrequency (heat) to the dermis
Ablation means skin removal.
Ablative lasers (CO2 / Erbium) remove a percentage of the skin surface.
Ablative lasers are the most potent lasers for treatment of acne scars.
All acne scar treatment procedures are performed by Dr. Emil Henningsen at our Cutis Clinic in Odense. A strong local anaesthetic cream is applied minimum 1 hour prior to treatment.
We offer you painkillers as well (Paracetamol and Ibuprofen). Just before the laser procedure, the cream is wiped off and the skin is disinfected with an antibacterial solution.
A computer-guided scanner is placed on the treatment area and the laser is applied. Each laser treatment takes 10 to 20 minutes to perform. After laser, we apply an antibiotic ointment to the treated areas.
Cooling is used during and after the procedure to minimize discomfort.
In general, skin texture with minor depressed / atrophic scars respond well to fractional ablative laser treatment.
In some cases, rolling scars are tethered (anchored) and must be treated with subcision for optimal results.
In order to lift scars to the same level, deeper icepeaks and boxcars should be treated with TCA cross before any latter laser treatment.
The correct treatment method for your scars will give you the best results – not necessarily a laser. Lasers are only one of the tools used for revision of acne scars. In general, fractional CO2 laser is the most effective laser for scar revision, but the risk of side-effects is a bit higher.
Different lasers and treatment indications
● Fractional CO2 laser – a very good fractional laser for all grades of textural scars. CO2 laser suits fair (Caucasian) skin types, but may even treat darker skin types (with adjusted settings, lower density). Downtime is controlled by the operator. Your skin will usually heal in 3-6 days.
● Fractional Erbium laser – a very good laser for all grades of textural scars. Suits fair AND darker skin types with less risk of skin darkening (PIH) compared to fractional CO2 laser. The effect on acne scars is almost equal. Your skin will heal in 2 – 4 days.
● Erbium laser resurfacing is very often followed immediately by fractional ablative laser. This is the most effective treatment for skin texture and superficial acne scars at the same level. Downtime varies between 8-10 days. Erbium resurfacing is very safe on Caucasian / fair skin and the risk of pigmentation (PIH) after treatment is higher on dark skin compared to fractional. The risk of infection and new scar formation is higher compared to fractional. Antibiotic tablets are recommended (we will prescribe or deliver these at the initial consultation).
● Pulsed dye laser (PDL) – gold standard laser for red (early) scars. Safe on Caucasian / fair skin, but can also treat type 3 skin types. Darker skin may have treaments with lower setting (fluence). In fair skin, PDL treatment may convert redness to purple spots that will fade in about one week. PDL may be combined with others energy devices such as CO2 or Erbium laser if intense skin remodelling is indicated. PDL is also used after ablative lasers to speed up healing or immediately after radiofrequency microneedling (Genius) for the same purpose.
● Q-switched nano-second laser (QS) – a good laser for pigmented lesions and scars (PIH). Safe on every skin type. Zero downtime. QS is often combined with Hydroquinone cream for home use 2-5 night per week.
● Long-pulsed nd:YAG laser – used for non-ablative skin treatments to reduce inflammation and for gentle remodelling of skin texture and scars on all skin types. No downtime.
The number of laser treatments for acne scars depend on your starting point and factors such as the treatment method, the device used, the skill sets of the practitioner, the depth and type of your scars, your healing response, your tolerance to downtime, your skin colour etc. In most cases, 3 to 4 sessions of fractional CO2 / Erbium laser may lead to 60 – 70% improvement.
Treatments are spaced with 2-3 month intervals. More treatments may be performed for even better outcomes.
Some patients aim for the best possible outcomes and go far beyond this number of laser treatments.
Fractional laser produces thousands of tiny ‘ablation’ holes in the skin. Each hole is the diameter of a shaft of hair, however these columns extend up to 2 mm into the skin where the scars lie.
The laser targets the scarred areas and stiff collagen, but also leaves areas of healthy tissue to regenerate.
This fractional treatment allows your skin to heal much quicker than if the entire surface was treated at once.
Erbium and CO2 laser resurfacing is used for the treatment of superficial acne scars that lie in the same level of the skin.
We use numbing cream and nerve block (Lidocain injection) for anesthesia – and mild sedation, if needed (extra charge).
Most often, we use Erbium resurfacing to remove the upper layer of the skin, usually 200-400 microns depth.
As we reach the papillary dermis, some pinpoint bleeding will be seen. This is followed by fractional Erbium or fractional CO2 laser treatment for added effect. Fractional laser creates deep columns of ablation (tissue
removal and coagulation) in the deeper dermis.
The main difference is that laser uses light whereas Genius uses radiofrequency.
Genius has a tip with sterile, insulated needles that penetrate the skin and scar tissue to deliver energy at the optimal depth.
Downtime after Genius is app. four days with aggressive settings, whereas the downtime after fractional CO2 laser with aggressive settings are minimum 1 week. Discomfort during treatment with Genius is higher than with fractional CO2 laser, but the aftercourse is more tolerable after Genius.
Risk of side-effect like pigmentation changes and infection is lower with Genius, which is safe on all skin types all year round.
Patients with superficial skin imperfections (pigment, sunspots, enlarged pores) respond well to CO2 laser, and deeper skin challenges respond better to Genius RF micro-needling.
After fractional CO2 or Erbium laser treatment, your skin will be red, swollen, oozing, and may pin-point bleed for 1-3 days and then gradually decreases.
Discomfort will gradually decrease after 1-2 hours.
Aftercare for CO2 and Erbium laser resurfacing and RF microneedling
For the first week after each treatment:
● Gently wash your skin at least two times daily using a mild facial cleanser
● Rinse or shower your face, wash your hair with shampoo and conditioner as needed
● Apply generous amounts of Cicalfate cream (Avéne) or Cicaplast cream (La Roche-Posay) more times daily. These creams are developed for post-laser skin care.
● Makeup can be used when the skin has healed.
● Keep your skin cool – but not cold. Avoid hot showers and sauna.
● Keep your skin clean. Avoid dust, dirt, and contaminated skin contact
● No picking, let crusts peel off by themselves.
To reduce the risk of skin infection, we may deliver antibiotic tablets (Azithromycin 500 mg) for you. You should take one tablet daily for three days.
If you have a history of recurrent cold sore (herpes labialis), we will deliver you antiviral tablets (Valaciclovir 500 mg). You should take one tablet twice daily for 5 days.
We strive to achieve optimal results with paramount safety and follow-up. However, there is a risk with any procedure involving energy devices.
When laser treatments are performed by an experienced specialist, complications are very rare.
Potential complications include:
● Infection. Less than 2% of cases.
● Scarring is rare and may follow secondary infection.
● Grids or marks from the laser in the skin is seen in less than 10% of cases, however this is reversible with laser resurfacing.
● Post-inflammatory skin pigmentation changes are uncommon in fair skin, but may be seen in 10% or more of cases in ethnic skin. Bleaching creams (Hydroquinone 5%) used one month before and after laser treatment reduces the risk of skin colour changes in dark patients. Hydroquinone is sold over the counter in some countries. We cannot prescribe HQ abroad, but you could speak to a local dermatologist about a prescription or seek at Amazon.
● Erythema (redness) and swelling is commonly seen after Genius, Erbium and CO2 laser treatments. Redness and swelling gradually fades over 3-4 days following Genius treatment and it takes a few weeks after fractional laser treatment, but some redness may persist for 2-3 months after laser resurfacing.
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Dr. Henningsen is available for appointments Wednesday, Thursday and Friday in Cutis Clinic Odense (close to Odense Central Station)
If in doubt, please call the clinic at +45 7020 7066 (press 9 for English) on weekdays between 8:30-11:00 am or 2:00 – 4:00 pm.
or send us an e-mail at: email@example.com
Do you have questions or want to book an appointment?
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