Question: I’d like to get a smoother texture to my skin and also improve some pigmentation issues and acne scars. Does a chemical peel seem like a good choice for this?

Answer: A chemical peel can certainly be an excellent choice for improvement in discolorations and textural abnormalities of the skin and even acne scarring if the peel is deep enough to improve this.  Most peels, however, are not going to be deep enough to improve the acne scarring and you would need a very aggressive approach to make any sort of significant visual improvement in this problem; nonetheless, frequently by performing more superficial peels we can make a visible improvement in the texture and discolorations of the skin and this in turn makes the skin look healthier and can give the illusion that the acne scarring is improved.

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Question: Is Erbium laser resurfacing a good treatment for acne scars?

Answer: Erbium laser resurfacing, I think, is an excellent treatment for acne scars since it is an ablative treatment, which means that it vaporizes tissue and causes a significant amount of new collagen deposition.  My personal opinion on acne scarring is that you need to treat this problem extremely aggressively to even get an improvement in the quality of the acne scarring.  So, minor or mild treatments really are completely ineffective.  At this time, I actually prefer the fractionated Erbium laser or ProFractional Laser treatments for acne scarring where tunnels are vaporized into the skin and heat is laid down into these tunnels in the deep dermis creating a healing response where a large amount of collagen is deposited into the skin.  This creates a significant improvement in the surface characteristics of acne scarring, but I do recommend that patients get three treatments spaced at least one month apart for maximum results.  Overall downtime when you combine the three treatments is actually longer than a single deep Erbium laser resurfacing, but the risks are virtually eliminated.  The effectiveness is improved in my opinion, and these can be performed in a spa setting.  

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Question: Is microdermabrasion effective in treating acne scars? 

Answer: Overall, I would have to say that microdermabrasion is really not effective at treating acne scars, but here may be a slight illusion that the acne scarring looks better due to the fact that the overall appearance of the skin is slightly improved with microdermabrasion treatments. Acne scarring unfortunately is an extremely difficult problem to correct and my personal opinion is that very aggressive treatments are required to improve acne scarring significantly. I currently recommend a deep ProFractional laser treatment for acne scarring and this typically requires 3 treatments based at least a month apart for adequate improvement. I do discuss with my acne scarring patients the fact that we will never completely get rid of acne scarring, but if we can significantly improve the appearance of the acne scarring virtually all of these patients were quite happy and satisfied with these treatments.

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