In my experience the results of fractional laser therapy have been disappointing–seeming to be far more device manufacturer backed marketing hype than hard science.
For treating multiple atrophic (indented, depressed, sunken) scars (whether resulting from acne, surgery, chicken pox or trauma), I have personally achieved more consistent and gratifying results using a combination of subcision, fractional microneedling therapy (medical microneedling) or, when deemed appropriate, such as when multiple lesions are present in a specific region, such as the cheek or chin, the punctuated phenol peel.
Subcision is a simple procedure that uses a needle-like cutting device that is slipped under the scar (under local anesthetic) and moved from side to side in order to break up the fibrous bands of scar tissue. This allows for the surface of the scar to float to the surface and also to promote new, more normal collagen synthesis to fill the potential space created. The result–a much more shallow scar and often significant visual improvement. A decided benefit to this approach is that the results are permanent, since the technique is predicated upon the person’s own ability to produce new, naitve collagen in response to treatment (neocollagenesis).
When there is an unsightly surface texture to the scar, a series of medical microneedling treatments can be initiated. For relatively small scars, the DermaStamp can be used. This is a small instrument with a series of sterilized needles attached, which may be used, under local anesthesia, to disrupt the surface of the scar, allowing it to reform in a more uniform texture and sometimes color. Alternatively, large areas can be covered more easily and quickly with an automated, electrically driven device used for this purpose known as Dermapen. Occasionally, the surrounding area under scars can be volumized and smoothed, prior to treatment, by the injection, in a fanlike fashion, of a volumizing agent with a high lifting force.
The above approach, which essentially is a more limited version of the Nonsurgical 3D Vectoring Facelift (used for minimal facial sagging and jowling), not only gives immediate improvement by stretching and making more superficial the overlying atrophic scars, but also makes the fractional microneedle therapy, easier to perform.This is an especially useful add-on when there is an overall sunken appearance to the cheeks, a not uncommon occurrence following severe facial acne.
The Punctuated Phenol Peel technique may also be used. With this technique, also performed as a series of treatments, microdroplets of full strength phenol are placed along the scar–leaving intervening untreated spaces (a fractionated approach) from which healing may take more rapidly and with less risk for actually causing a scar.
Most often, I have found that subcision performed alone or combined with medical microneedling is capable of producing quite a gratifying aesthetic improvement.