BACKGROUND AND OBJECTIVES: Acne scars affect the entire population, causing significant distress and concern. Previous treatments for acne scars have yielded varying degrees of success and associated side effects. Fractional photothermolysis has been shown to improve scars, including surgical scars, hypopigmented scars, and atrophic acne scars. The newest system has the option of increased fluences for greater depth of penetration and variable treatment coverage. Our aim was to determine the efficacy and safety of the second-generation erbium-doped 1,550-nm fractional photothermolysis laser (1,550-nm Fraxel SR laser, Reliant Technologies Inc.) in the treatment of all types of acne scars and of all severities. STUDY DESIGN/MATERIALS AND METHODS: Twenty-nine patients (20 females and 9 males, ages 15-65 years), Fitzpatrick Skin Types I to V, were treated with two to six treatments with the second-generation erbium-doped 1,550-nm fractional photothermolysis laser at 1-month intervals. Fluences ranged from 35 to 40 mJ/microthermal zone. Treatment levels varied from 7 to 10 and "Advanced Level 1," corresponding to treatment coverage of 20% to 35%. Patients were graded on a 4-point scale by three independent physicians using digital photography. RESULTS: The majority of patients achieved a 50% to 75% improvement in facial and back acne scarring (18 of 29 patients). Five patients had an improvement of greater than 75% in acne scarring, 5 patients had a 25% to 50% improvement in acne scarring, and 1 patient had less than a 25% response to treatment. The patients' degree of satisfaction paralleled the physicians' assessment. Side effects were minimal and no posttreatment pigmentary changes were noted. CONCLUSION: Fractional photothermolysis is a safe and efficacious treatment modality for the treatment of all types of acne scars of all severities. No adverse effects were noted, including in patients with Fitzpatrick Skin Types III to V. The authors have indicated no significant interest with commercial supporters.
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