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I have some mild to moderate rolling scars on my cheeks. I have done 2 sessions (Sep 2017 & Oct 2017) of subcision with some improvement (~30%). I was advised to do fractional CO2 asap next. My questions are:
- Does the amount of time between the subcision and fractional CO2 session affect the fractional CO2 effectiveness? I was told that I have to do the CO2 as soon as possible, or at least within 6 months, otherwise it will be less effective.
- Besides hyper-pigmentation, what are the risks of fractional CO2?
To address your questions:
1. Generally subcision (I assume with some collagen stimulators) will lead to collagen stimulation, and this is also what CO2 laser aims to do. Some experts suggest that an interval of at least 4 – 6 weeks is kept between each collagen-stimulating treatment for optimal results. There is no real good answer – as social downtime and other considerations have to be taken into account by the doctor in recommending the treatments.
My personal preference though is not to stretch the treatment too wide apart – 6 months does seem to me to be a little long. I would expect that would lead to reduced efficacy and perceived poorer results due to the natural progression of collagen breakdown over time.
2. Fractional lasers in general have a risk of hyperpigmentation. They also can result in acne outbreaks in some patients (especially those with active acne), and even re-activate herpes/cold sores. But these are generally manageable adverse events. Social downtime is probably the main problem patients face.
As such, do get your treatments done early to have optimal results, and your doctor should be able to advise you further on the treatments.
Wish you well!
Dr Winston Lee
Thank you for your questions. Dr Chua and Dr Lee have answered your questions well.
Unfortunately, there is no fixed protocol for doctors to treat acne scars. Understanding patient’s existing medical and skin conditions, severity of the acne scars, healing ability, and affordability of downtime is crucial.
This will lead to customisation of treatment plan using appropriate tools, to achieve good results.
A few things that I have learnt from my previous years of experience.
- Control your acne first before fixing your scars
- Different type of acne scars need different type of treatment
- Younger patients respond to acne scar treatment better
- Combination treatments give better results
Listed below are a few ways to treat mild to moderate rolling acne scars.
- Dermal fillers
- Fractional CO2/erbium glass/thulium/picosecond lasers
- Radiofrequency microneedling
I do combine subcision, dermal fillers and fractional lasers in one session for some of my cases. Not all the clinics will have the above mentioned tools.
Please discuss with your doctor regarding pros and cons of available treatments, estimated downtime and cost for the procedures.
All the best!
Dr Lim Ming Yee
Thank you for your questions and pictures. The collagen stimulatory effects from subcision and fractional CO2 are synergistic and will work well when done together in a certain time frame. Many doctors do it in the same session actually.
Recently though, a new study suggests that doing your subcision two to three weeks apart from the fractional resurfacing session yields marginally better results.
Beside hyperpigmentation, these are some possible risks of fractional CO2 treatment:
1. Prolonged redness
3. Infection or acne outbreak
Hope this helps!
With regards to your enquiry:
1. Does the amount of time between the subcision and fractional CO2 session affect the fractional CO2 effectiveness? I was told that I have to do the CO2 as soon as possible, or at least within 6 months, otherwise it will be less effective.
There is no general consensus at the moment as to when a fractional CO2 laser has to be done after subscision to obtain optimal results. Some do it in the same session whilst others do it 1 month or so apart.
A 6 months interval does seem to be a tad long, and I would not recommend waiting that long. Personally, if an interval is required, I keep it to within a month (or 2 months max).
It really depends on your treating physician as each doctor has their own protocol so I suggest seeking one who has experience in this field.
2. Besides hyper-pigmentation, what are the risks of fractional CO2?
Side effects include:
Hope this helps.
All the best!
Dr Ho Rui Ming