3 CO2 Fraxel Laser Sessions Later – Did My Old Atrophic Acne Scars Improve?

For those of you new to my corner of the internet, I have had acne for over 15 years and it’s only been in the past few years that I managed to finally gain control over my acne thanks to topical prescriptions and lifestyle changes. Now that it’s well controlled, I was finally able to get professional acne scarring revision on the old atrophic acne scars I developed from the dark days when I didn’t like skincare and had more than 15 active cysts at a time.


TIMELINE OF PROFESSIONAL ACNE SCARRING REVISION

Winter/Spring 2018 – At-Home Microneedling.

First Impressions: Banish Acne Scars Banish Starter Kit

REVIEW: Banish Acne Scars Banish Starter Kit

I did 4 sessions of at-home microneedling with a 0.5mm needle to start the acne scar revision process. Unfortunately, my acne was still not in the best state of control at the time.

Banish Acne Scars Banish Starter Kit from 2018

While I noticed improvement in texture, it was not enough to handle the old acne scars and my acne was not getting any better. It’s actually right after that experience which I hopped on the vitamin A bandwagon and started taking my clear skin journey more seriously. I realized that I can’t address the problem of acne scarring if I didn’t even have a handle on what caused them in the first place. I have done a few more at-home microneedling sessions in 2018 as well but stopped to just give my skin a break.

Fast forward to Spring 2020, my skin has been the clearest it’s been thanks to major lifestyle changes in combination with topical prescriptions Aczone and Retin-A Micro. Once my skin was consistently clear, I started looking at professional cosmetic procedures for my atrophic acne scars.

Fall 2020 Professional Microneedling.

Collage of healing progress after a professional microneedling session.

I have mentioned this in passing, but 2020 was a year that I had an “aha” moment for how to best control my acne. In short, the missing piece of the puzzle was lifestyle changes. It really put a perspective on my gut health and how it strongly ties to my skin. Anywho, I started up the journey of acne scar revision once again, and had 3 professional microneedling sessions done. I noticed after the 3 sessions my skin’s texture looked somewhat smoother, it temporarily plumped up my skin, but the stubborn scars with built up scar tissue still remained and I knew I had to take it a step further. Between at-home microneedling and professional microneedling, the latter is definitely superior; It just did more for permanent improvements on my skin.

2021 October First of 3 CO2 Fraxel Sessions.

What is CO2 Laser?

A carbon dioxide laser (CO2 laser) resurfaces skin with targeted beams of light. As the first laser designed for skin resurfacing, it’s been popular since the 1980s for the rejuvenation of aging and damaged skin. 

So how does a CO2 laser work? Electricity runs through a gas-filled tube to produce a specific wavelength of light. The light is emitted in short, concentrated beams, which target water molecules and vaporize skin cells. The laser removes surface cells of the epidermis, making way for fresh, clear new skin.

At the same time, it penetrates the skin’s deeper dermis layer to stimulate new collagen production, which firms and smooths skin over time.

CO2 laser treatments can address fine lines and wrinkles; discoloration (including sun damage and age spots); acne scars; stretch marks; and uneven skin texture on the face, neck, and chest. 

– Realself.com
A collage of three photos from my first CO2 Fraxel Laser session in October 2021. Left: numbing cream has been applied before the CO2 Fraxel Laser Procedure. Middle: state of face shortly after the CO2 Fraxel Laser Procedure + PRP Mesotherapy is completed. Right: face has been cleaned and a soothing cica balm has been applied.

I made a recovery vlog video if you want to check out how my face and neck healed as well as my skincare routine and the products I used.


MY CO2 FRAXEL LASER RESULTS

It has now been 3 months since my last session. I waited this long to share my results purposely because you need that time to see the progress. Some of you have asked me what I noticed in that 3-month period, but I didn’t want to give a premature answer. I wanted to wait until the right amount of time has passed for me to properly judge the procedure and review my overall experience with CO2 Fraxel Laser.

Keep in mind that 3 sessions and old scarring doesn’t mean the laser was at the highest strength each session. The last 2 sessions weren’t as heavy as the first because my skin was just not as tolerant to the pain like it was in the first session. Remember, I had these 3 laser sessions in the span of 4 months and my skin’s healing took around a month at a time until it finally normalized. The dermatologist had to consider the time period between the previous session(s), the actives I may have used in my skincare routine, whether or not I was on my period (fluctuating hormones will make your skin more sensitive at certain times of the month).

Left: June 2021, less exposure. Right: June 2022, more exposure.
Left: June 2021, more exposure. Right: June 2022, less exposure. It looks like I should have used equal exposure for before and afters, but I wanted to highlight that even with the right photo with less exposure and more shading on the cheeks, the texture is still not as visible. (I was also trying to pose the same but completely missed the mark on hand placement lol).
Left: June 2021. Right: June 2022, slightly more exposure (angle was difficult to replicate for the after photo). I find on the left, the scars are a bit more visible especially with the blush placement. Right, even with equal amount of blush application, I find I see more of the darkness of the blush than the texture. Texture still looks more obvious when I apply cheek products in general.

Atrophic Acne scars

I have been frequently asked to give a percentage of how much my scars have improved – frankly I have a hard time formulating one because when you look at yourself you always think the worst. Also I don’t want any of you watching to be fixated on a number because this is my experience, with my skin type, my skincare, my age, my wound healing process, the different laser intensity per session due to pain tolerance, and how I view myself. Having said that, I’m not going to give a number, I am just going to best describe what I see knowing all these factors about myself and provide some materials so I can hopefully convey the difference I see.

I noticed a way smoother complexion on my cheeks after the first session, more significant than microneedling. I’ve had family and friends in person and video call comment that they noticed a difference. Some of you in the comments have also noticed!

The most obvious, indented scars – one on each cheek – are noticeably more lifted and not as deep. On a daily basis doing my skincare routine I rarely notice them.

On a daily basis, going about my day, experiencing all kinds of lighting… I don’t even notice my scarring and I don’t even look like a person who has experienced really bad acne.

My mother-in-law who was a medical esthetician commented that it looks like I achieved what I sought out to do for my acne scars and there doesn’t seem to be a need to continue with the CO2 Fraxel Laser sessions.

My husband who never cared about my scarring in the first place (but obviously cared how they deeply affected me) has seen the change in my skin since the time we first met almost 9 years ago! From breakouts, post-red acne marks and atrophic scarring to now – he commented that he can also visibly see a difference in my cheeks and pores. Friends who have also seen me before and after all 3 procedures commented they have noticed a smoother appearance as well, that it doesn’t look like I ever experienced bad acne.

There are still times I see some scarring; One of them being when I apply a heavy amount of makeup to my cheeks. Cheek products create shadowing and make them more noticeable, particularly on the backs of my cheeks. Before acne scar revision in general, my eyes would immediately wander to that area because I knew that if I placed a lot of bronzer or blush there, the texture would appear more obvious. Now it’s more subtle, but in general I don’t apply as much makeup as I used to.

If I look real close, like such a close amount in various angles and lighting that no one else other than myself would look – I still see some lingering texture. I did this a few years ago when I was first very concerned about my atrophic acne scars and I’ve come to realize how silly it was. If I look at past photos or videos of myself prior to treatments, my scarring really wasn’t that bad. The only time it ever looked bad was when I went out of my way to cast my cheeks under atrocious lighting that no one including myself would ever notice.

So I still have texture. But the fact that I have to go through such awkward angles and lighting to even see it on myself, plus how much more lifted the most visible indented scars are – I think doing CO2 Fraxel Laser has been quite successful.

Other things I noticed alongside acne scar improvement

My pores while still visible are definitely reduced. My makeup routine prior needed a pore primer and powder to really pack it in but now it takes little effort to blur out my pores and most days I don’t reach for a primer or powder (maybe in the hot, sweaty summer).

Neck skin texture looks smoother and more refined – I find the quality of it matches my face. I’m happy about this because I was barely using any actives on my neck prior to the procedure. The tech neck lines visibly reduced – not 100% but for me I notice they don’t look as deep and a lot lighter.


OVERALL THOUGHTS ON EXPERIENCE WITH CO2 FRAXEL LASER

PROS OF CO2 FRAXEL LASER

  • Procedure is exactly what I needed to see the improvements I wanted to achieve for my skin that skincare could not provide for me.
  • Solidified my expectations with skincare and what I can achieve. I’ve seen the benefits of layering hydration, using actives like tretinoin and chemical exfoliants, but doing this procedure definitely solidified my expectations on how far skincare can get me. 
  • I like that I saw visible improvements after 1 procedure. Family, friends and some viewers have noticed as well.
  • Neck looks more refined and skin quality matches with my face. The lines I have while not completely gone have lightened. I just need to not look at my phone so much and keep a good posture. My mom and mother-in-law for example have less visible lines on their necks than I do, and they are in their 60s.
  • Mental clarity. I know the scars were never as bad as I perceived them to be. When I look at past photos even before starting any type of acne scar revision, they were not that bad. But if I were to imagine myself, the scarring was always there and I would see them first. Now when I picture myself, I see me first. Not my acne scarring, not my acne, just me.

CONS OF CO2 FRAXEL LASER

  • Cost. If you have scars like mine where they are old it will take a few sessions to get them really smoothed out, so you may be investing in this procedure in the thousands.
  • Down Time Post-Laser. Depending on the strength of the laser, swelling takes a few days to die down, scabbing maybe 5 days, overall redness longer. Not everyone has the luxury of working from home and even then you can’t really go out with your face in such a sensitive state. For me I work from home and even I was getting impatient with the recovery after the 2nd session.
  • Extensive Healing Time for FitzPatrick Skin Types bordering 3 and 4. You may get a little scared. While my face now is bright and even, it took maybe a month or so for this dark and dull look on my face to go away. You can see it in my post-laser skincare routine video, I found my face not as collected as I like it to be. Despite the length of time, I consistently made sure to use wound healing, soothing and moisturizing products to ensure a successful healing process.
  • The Pain. No amount of numbing cream will stop you from feeling pain. Unless you are completely void of nerves…

BEFORE CONSIDERING CO2 FRAXEL LASER…

Watch Dr. Davin Lim’s Youtube channel – Dr. Lim is a dermatologist based in Australia that specializes in acne scarring – talks about CO2 Fraxel Laser, Microneedling, Subcision, and other acne related topics.

Browse Realself.com – on this website you can find doctor input, patient questions, reviews on various skin procedures and treatments, and you can also potentially find a doctor in your local area for a specific treatment/procedure.

Lastly, schedule an in-person Dermatologist consultation. No one online will be able to answer your questions as well as a professional who sees your skin up close, understands your skin concerns, history, the products you use.


DO I RECOMMEND CO2 FRAXEL LASER?

Yes, because it is guaranteed to result in improvements in skin texture. However, I would reserve this procedure for those of you who have a very good understanding of your body, your skin, how you heal, and if you have realistic expectations of the results.

If you are trying to achieve unrealistic skin goals, you do not understand your skin, you don’t have good control over your acne which is causing the scarring in the first place – I would say hold off; It may turn into a waste of money for you.


And that’s all folks! I hope my experience with CO2 Fraxel Laser helped you in some way when it comes to your own skin concerns and whether or not this procedure is worth the price and down-time.

xo, M

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