One of the most damaging aspects of severe acne is that it can leave lasting scars even after the skin condition has cleared. These marks are difficult to conceal with makeup because they create uneven contours in the skin that are evident in strong lighting. These atrophic scars may look like pock marks, large pores, or rippled areas. Depending on a patient’s skin tone, a professional dermatologist may recommend laser treatment for acne scars. Both ablative and non-ablative lasers are currently used for this type of treatment.

Ablative Lasers

Ablation is a medical term that refers to the removal of tissue from a treatment area. In an acne scar removal procedure, an ablative laser is used to vaporize the scarred epidermis (the surface layer of the skin). This type of resurfacing may also damage deeper layers of the dermis to some extent as well. The goal of ablative resurfacing is to prompt the skin to regenerate healthy, collagen rich tissue instead of scar tissue. With a fractional C0₂ laser, tiny pinpoint sections of skin are heated in a grid pattern throughout the treatment area to reduce overall damage and promote rapid healing.

Non-Ablative Lasers

As the name suggests, these lasers do not remove the surface layer of the skin. This is a less invasive procedure used to stimulate collagen production deeper in the dermis and reduce the appearance of acne scar depressions in the skin. Since non-ablative treatment is designed avoid disrupting the skin barrier, infection is not generally considered a risk with this procedure. A non-ablative fractional laser works by treating miniscule “zones” of skin within the target area but is even gentler than an ablative fractional laser with faster healing.

Some Patients May Have a “No Pain, No Gain” Attitude

The ablative approach provides more extensive skin resurfacing and has been shown in some trials to offer significant improvements with just 3 sessions. In contrast, the less intense non-ablative approach may take more sessions to deliver the desired results.

A small split face study has now been published comparing ablative and non-ablative laser treatment for acne scars. In this study, patients received ablative treatment on one side of their face and non-ablative treatment on the opposite side. The purpose of this particular study was to determine which technique delivered better results in a single treatment with a direct, side by side comparison.

In this study, the clinical improvement was similar for both types of laser treatment for acne scars after one session. However, the patient satisfaction level was higher with the ablative versus the non-ablative approach. This was in spite of the fact that patients reported much greater pain levels with the ablative laser. The crusting and scaling aftereffects were also more significant with ablation. Researchers are unsure how the patient’s perception of their level of improvement was affected by the greater degree of pain they had to undergo to achieve an objectively similar outcome.

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