Laser Treatment for Acne Scars: How It Works, Efficacy, Cost

• Lasers treat acne scars by destroying damaged tissue and stimulating the production of collagen
• Two types of lasers are effective for acne scar treatment—ablative and nonablative—as well as fractional versions of each
• Complete acne scar removal isn’t possible, but lasers can make lesions less noticeable and minimize hyperpigmentation
• After laser treatment, it’s crucial to be diligent about sunscreen use to protect treated skin

Lasers have become increasingly effective for treating all types of acne scars. Some are used to treat depressions in the skin (atrophic acne scars), while others are best for raised, hyperpigmented lesions (hypertrophic acne scars) that can be itchy or painful. To determine the best laser treatment for acne scars, a dermatologist will consider the type and severity of your scars as well as your goals and expectations. 

Lasers cannot completely remove scars but they can make them less noticeable.

How It Works

Lasers employ heat and light to minimize the appearance of scars. Some types of lasers vaporize the upper layers of skin, causing it to peel off and reveal the new skin beneath – while simultaneously stimulating the production of new collagen and skin cells. 

Other types penetrate the skin deeply without disturbing or destroying the superficial layers to also stimulate collagen production.

Ideal candidates for acne scar laser treatments

Laser therapy is safe and effective for most people who have scarring from acne and who are realistic about the results. There are, however, people who would likely not get good results from laser therapy, such as those who:

• Still have active acne breakouts
• Smoke 
• Have deep wrinkles or sagging skin
• Have a chronic illness such as diabetes which can interfere with the healing process

Certain types of lasers can cause hyperpigmentation or less often, hypopigmentation in people with very dark skin. An exception is the nonablative submillisecond‐pulsed 1,064 nm Nd:YAG laser, which has been found to be effective and pose relatively little risk of causing pigmentation changes in dark skin.  

Efficacy of Laser Treatments for Acne Scars

In general, laser therapy is regarded as potentially more effective than other methods of acne scar treatment, such as dermabrasion and microneedling. However, even the most advanced lasers cannot completely remove scars; at best, they can make them less noticeable.

Best lasers for acne scars

There are three broad categories of lasers used to treat acne scars. Within each category, certain lasers have been found to be more effective than others.

Ablative lasers

Ablative laser treatment is also referred to as laser resurfacing. The energy from ablative lasers vaporizes cells on the surface layers of the skin, destroying the scar tissue and revealing new, smoother skin beneath.

In addition to removing scar tissue, the heat produced by an ablative laser stimulates collagen production. Two types of ablative lasers are effective in treating acne scars: the erbium YAG laser (which uses a combination of several naturally-occurring elements) and the CO₂ laser, which uses carbon dioxide to produce energy waves.

Nonablative lasers

Nonablative lasers do not damage the upper layers of skin. Instead, they direct energy deep beneath the surface of the skin to stimulate the production of collagen. Among the types of nonablative lasers used for acne scars are several versions of YAG lasers that differ in the length of the lightwaves they emit and a pulsed dye laser (PDL).

Fractional lasers

There are fractionated versions of both ablative and nonablative lasers. This means they direct energy in microscopic columns, destroying discrete areas of tissue while leaving surrounding tissue intact. The untouched tissue helps to support the healing process and fill in the areas where tissue was destroyed. 

Cost of Laser Treatments for Acne Scars

According to the American Society of Plastic Surgeons (ASPS), on average, ablative laser procedures cost around $1,960; nonablative procedures, $1,200. You may pay more or less depending on the region of the country you live in.

Aside from the procedure itself, be prepared to pay for related expenses such as anesthesia and prescription medications to manage discomfort after your procedure. Some dermatology practices offer financing, which can make paying for laser treatment more manageable.

What to Expect From Your Treatment

Laser treatment typically requires some preparation. About 2 weeks before the procedure, you may be instructed to:

• Quit smokIng 
• Avoid aspirin, ibuprofen, vitamin E or other medications that can interfere with blood clotting
• Stop using certain skin care products, in particular retinol and other acne treatments
• Limit sun exposure and stay away from tanning beds

Some practitioners prescribe antibiotics for patients who are prone to cold sores before laser treatments. 

Laser treatments aren’t especially painful. Some people describe the sensation as similar to having a rubber band snapped against their skin. Ablative laser surgery is most likely to cause discomfort since it involves destroying layers of skin, and so may require injections of local anesthesia or even mild sedation.

Nonablative laser treatment may be slightly uncomfortable, at most. If any anesthesia is necessary, it’s likely to be a topical cream to numb the treatment area.

After the procedure

Because the upper layers of skin are destroyed, recovery from ablative laser treatment is more involved than recovery from nonablative laser treatment. After an ablative laser procedure, the treated skin will look and feel as if it has been severely sunburned:red, raw and painful. Skin may develop blisters and ooze a yellowish fluid that can dry and crust over. 

Your dermatologist will provide you with instructions on how to keep the treated area clean and protected. It will take about 5 days for these symptoms to subside and for the damaged skin to peel off. The skin beneath will be pink, but over time will heal and revert to your natural tone.  

Once your skin has healed, you will need to use sunscreen diligently. After 6 weeks you should be able to resume using topical anti-aging products such as retinol or glycolic acid.

If you have nonablative laser therapy, your recovery will be much simpler. The treated area may appear pink and slightly swollen immediately following the procedure but will look and feel normal after a day or two.

Results

Laser treatment can diminish scarring and rejuvenate scarred skin, but it won’t completely remove scars. Atrophic scars, which are indentations in the skin, can be lifted to be more level with the surrounding skin. Hypertrophic scars are firm, raised, hyperpigmented lesions that are sometimes painful or itchy. Laser treatment can make them softer and more level with the surrounding skin, as well as minimize discoloration and relieve discomfort.

Research has found CO₂ laser treatment produces better results for acne scars, while erbium YAG laser treatment tends to require less downtime. Hypertrophic and boxcar acne scars respond best to ablative laser treatment. Because they’re relatively deep, ice pick scars may require more than one resurfacing treatment.

Before and Afters

Side Effects and Risk Factors

Laser treatment for acne scars is considered a safe procedure. However, there are some potential side effects including:

• Bacterial infection
• Reactivation of cold sores
• Changes in skin color (hyperpigmentation or hypopigmentation)
• Proliferation of tiny white bumps called milia
• Redness and swelling that lasts longer than expected
• Worsening of scars

Your dermatologist may take measures to help prevent certain side effects, such as prescribing a prophylactic antibiotic. 

Alternative Treatments for Acne Scars

If laser resurfacing or nonablative laser treatment isn’t an option for you, there are other treatment options including:

• Dermabrasion or microdermabrasion, in which a wire brush or an instrument containing diamond particles is used to scrape away the outer layers of skin 
• Dermaplaning, a procedure similar to dermabrasion that removes skin with an instrument that’s similar to an electric razor 
• Microneedling uses an instrument studded with rows of thin needles that create minute punctures in the skin. As these microscopic wounds heal, new collagen is produced
• Dermal fillers are substances injected into depressed scars to be more level with surrounding skin. Dermal fillers commonly used include collagen, hyaluronic acid and polymethyl methacrylate (PMMA). Sometimes a patient’s own fat tissue is used
• Chemical peels can help improve the appearance of scarring by applying a chemical solution that peels away the top layers of skin to reveal a fresh layer of skin
• Subcision involves inserting a needle into a scar and moving it in a fanlike motion to break up the tissue.

Takeaway

Laser treatment is by far one of the most effective ways to diminish the appearance of acne scars and is safe for most people, although those with dark skin should avoid certain types of lasers due to the risk of hyperpigmentation or hypopigmentation. There are several types of lasers your dermatologist will consider to devise the best treatment plan for you.

While a laser can’t eliminate acne scars altogether, they can effectively make deep or hyperpigmented scars less noticeable and relieve discomfort from raised scars. If acne scars have made you self-conscious about your appearance, laser treatment may be a safe and effective way to make them less noticeable and boost your self-confidence.