Laser Therapy for Pitted Acne Scars

Laser treatment for pitted acne scars is a timing question as much as a technology one. Healing takes days to weeks, results take months, and some lasers need a series of visits. All of that has to fit around the seasons, the sun and whatever else your calendar holds.

The American Society for Dermatologic Surgery and the American Academy of Dermatology answer four questions about lasers for acne scars: which scars are called pitted, how resurfacing and gentler laser therapy differ, what healing involves and what lasers cannot do. The choice of laser for any one person belongs to a dermatologist who has examined your skin.

What pitted scars are

The American Society for Dermatologic Surgery describes atrophic or depressed scarring as scars that develop when there is a loss of tissue. It names two common types: "icepick" scars, which are usually small, yet obvious holes in the skin, and "boxcar" scars, which are depressed areas, usually round or oval in shape with steeply angled sides, similar to chickenpox scars.

Knowing these two shapes gives you words for the consultation. When you book a consultation, take a photo of how your scars look in ordinary daylight and describe which of these shapes they resemble.

Resurfacing, the stronger approach

The American Society for Dermatologic Surgery says ablative laser resurfacing is a procedure that uses a wand-like laser instrument to remove the upper layers of skin from acne scarring. It says it is sometimes referred to as "laser peeling" since it removes old skin cells in order to reveal newer, more youthful cells.

The same society says ablative laser resurfacing also heats the skin layers underneath to promote collagen production, which stimulates skin in the treatment area to heal in a smoother, more even appearance.

There are two mechanisms in that description: removal of upper layers and heating below them. Ask a dermatologist which one drives the plan for your scars. A dermatology society's page on laser resurfacing for acne scars is the source of the description above and is worth reading before a consultation.

Healing, day by day

The American Society for Dermatologic Surgery says laser resurfacing patients can expect the treated area to swell for 24 to 48 hours after treatment, itch or sting for 12 to 72 hours, and slough and peel off old skin five to seven days after treatment. It says healing typically takes 10 to 21 days, depending on the size and location of the procedure.

A healing window of 10 to 21 days is where season enters the plan. Healing skin is something to arrange around work, travel and outdoor time, so ask what sun protection and indoor time your dermatologist expects during those weeks.

Gentler laser and light therapy

The American Society for Dermatologic Surgery says that in laser/light therapy, an intense but gentle beam of light is used to treat acne scarring without damaging surrounding tissue.

Resurfacing is not the only laser approach. Ask whether the laser proposed for you removes skin or leaves it intact, and what each means for healing. A dermatology society's page on laser therapy for acne scars describes this approach.

Which scars lasers suit, and what they cannot do

The American Society for Dermatologic Surgery says laser resurfacing is most effective for treating superficial scars caused by acne, surgery or trauma that are not growing or getting thicker.

The American Academy of Dermatology says dermatologists use lasers to resurface skin with acne scars, and that as your skin heals after laser resurfacing, it produces collagen and elastin, which can diminish the appearance of scars.

The American Academy of Dermatology is also direct about the limit: laser treatment cannot get rid of a scar. It says laser treatment can make a scar less noticeable, but when you have laser scar treatment, you are replacing one scar with another less-noticeable scar.

Those statements should shape the question you ask. Whether your scars count as superficial is a matter for an examination, and so is what "less noticeable" would mean in your case. Ask for a realistic description of the end result and not only the best case.

More than one visit, and patience

The American Academy of Dermatology says you may need more than one laser treatment, and that a dermatologist may schedule a series of laser treatments to give a patient long-lasting results and the most improvement. It says this is often necessary with a type of laser called a non-ablative laser, which has no downtime but may take a few treatments to reach the desired results.

The American Academy of Dermatology also says results take time to appear. It says it can take months to see the results from laser scar treatment, and that you may notice little improvement at first.

Those two points change how to plan. A series of visits with little visible change at first needs room in the calendar, and judging the outcome too early is easy. Ask how many visits are expected, how far apart they fall, and when you and your dermatologist will decide whether the treatment is working.

Taking questions to the consultation

Laser treatment for pitted scars comes down to a small set of questions. What are my scars, and which laser is proposed? Does it remove skin or leave it intact? How long is healing, and what does it ask of me outdoors? How many visits, and when will we judge the result? What can I realistically expect?

Bring them to a licensed dermatologist who can examine your skin, and read the sources named above before you go. The aim is a plan that fits both your skin and the months ahead.