In the field of dermatology and medical aesthetics, acne scar tissue is one of the leading conditions affecting skin integrity. This condition, encountered by many individuals from adolescence to adulthood, is a reflection of damage occurring in the lower layers of the skin. As Demiderm Polyclinic, serving in Alsancak, Izmir, in this comprehensive guide we will address the mechanism of action of laser technologies on acne scars, which patient profiles they are suitable for, and the biological basis of treatment processes.
1. Pathophysiology of Acne Scars: What Happens Under the Skin?
To understand the logic of laser treatments, it is first necessary to understand how acne scars form. Acne is an inflammatory process that begins in the hair follicle and sebaceous gland, called the pilosebaceous unit. When the follicle wall ruptures due to increased bacterial activity and sebum (oil), the inflammation spreads to the dermis layer.
The dermis is the area where collagen and elastin fibers, which give the skin its elasticity and firmness, are located. Inflammation destroys the healthy tissue here. The body initiates a wound healing process to repair this damage. However, this process does not always work perfectly:
- Insufficient Tissue Repair: If the body cannot produce enough collagen to fill the damaged area, depressions (atrophic scars) form on the skin surface.
- Excessive Tissue Repair: If the body produces more fibrotic tissue than necessary, raised (hypertrophic or keloid) scars appear on the skin surface.
Laser treatments aim to remodel precisely this “faulty healing” process.
2. Working Principle of Laser Technologies: Fractional Photothermolysis
Fractional laser systems are among the leading methods considered the “Gold Standard” in acne scar treatment today. The fundamental principle of this technology is the theory of “Fractional Photothermolysis”.
Selective Thermal Damage
Older generation lasers worked by peeling the entire surface of the skin, which prolonged the healing process and increased the risk of side effects. Fractional lasers, on the other hand, treat the skin like a filter, scanning it in microscopic columns (Microthermal Treatment Zones – MTZs). The laser beam damages specific points on the skin while leaving the surrounding tissue intact.
This approach has two main biological effects:
- Rapid Epithelialization: The intact tissues quickly migrate to the damaged microscopic areas, initiating healing within 24-48 hours.
Collagen Stimulation: The heat energy (thermal damage) transmitted by the laser to the dermis layer stimulates fibroblast cells. The body begins to produce new, regular, and firm collagen fibers to repair this controlled damage.
3. Types of Lasers Used in Acne Scar Treatment
In sunny regions like Izmir and for different skin types, choosing the right laser is critically important. The laser technologies frequently encountered in assessments at Demiderm Polyclinic are as follows:
| Laser Type | Wavelength | Mechanism of Action | Targeted Scar Type |
|---|---|---|---|
| CO2 Fractional Laser | 10,600 nm | Ablative (Peeling) + Thermal | Deep Boxcar, Rolling and some Icepick scars, serious skin rejuvenation. |
| Erbium:YAG Laser | 2,940 nm | Ablative (Less thermal damage) | More superficial Scars, pore problems, patients with limited healing time. |
| Pulsed Dye Laser (PDL) | 585-595 nm | Vascular (Vascular targeted) | Red acne scars (Post-inflammatory erythema), active acne. |
| Q-Switched / Pico Lasers | Various (1064/532 nm) | Pigment targeted / Photo-acoustic | Brown spots (Post-inflammatory hyperpigmentation). |
4. Who is Laser Treatment Suitable For?
(Patient Selection)
Not every individual may be a suitable candidate for laser treatment. During the initial consultations at Demiderm Polyclinic, the patient’s suitability is determined through a detailed medical history.
Ideal Candidate Profile:
- Scar Type Suitability: Individuals with atrophic (pitted) scars (Boxcar and Rolling types are the groups that respond best to laser treatment).
- Active Acne Status: Individuals whose active acne problem is largely under control. (Aggressive procedures performed while active inflammation is present can spread bacteria).
- Realistic Expectations: Individuals who understand that laser treatment aims to lighten the appearance of scars, reduce their depth, and improve skin texture, rather than completely erasing them.
- Sun Protection Awareness: Individuals who have the discipline to strictly adhere to the post-procedure sun protection protocol.
5. Who Might Be at Risk? (Contraindications)Laser treatment should be postponed or alternative methods should be considered in the following cases:
- Pregnancy and Breastfeeding: Hormonal changes may increase the risk of discoloration, and the procedure is not preferred for ethical reasons.
- Active Skin Infections: Presence of herpes or bacterial infection in the application area.
- Keloid Tendency: Ablative lasers may be risky in individuals whose bodies overreact to wounds and form raised scars.
- Photosensitizing Medications: Use of medications that cause photosensitivity.
6. Fitzpatrick Skin Type and Laser Safety
The skin structure of the population living in Izmir and the Aegean region varies. The skin type classification, medically known as the Fitzpatrick Scale, is crucial for laser safety.
- Type I-II (Light Skin): High tolerance to laser, low risk of discoloration.
- Type III-IV (Wheat and Dark Skin): This is the most common type in Türkiye. Because melanin pigment is dense, they carry the risk of “Post-inflammatory Hyperpigmentation” (post-treatment discoloration) at incorrect energy levels. In this group, Demiderm Polyclinic physicians make dosage adjustments with precision.
- Type V-VI (Dark Skin): Very high risk of discoloration. Fractional radiofrequency or non-ablative systems can be preferred instead of ablative lasers.
7. Advantages of Laser Acne Scar Treatment
In the field of medical aesthetics, laser technologies offer the following advantages compared to older methods such as dermabrasion or deep chemical peels:
Controlled Depth
Laser devices offer the possibility of digitally adjusting how many microns below the skin the energy will penetrate. This allows the physician to use different parameters for superficial scars and different parameters for deep scars.
Short Recovery Time (Downtime)
Thanks to fractional technology, since 100% of the skin is not damaged, the recovery process, which takes weeks in classical methods, allows for a return to social life in 5-7 days with laser applications (depending on the device).
Holistic Improvement in Skin Quality
Laser not only fills in pits; it also evens out the overall skin tone, tightens pores, and reduces the appearance of fine wrinkles. This creates a “rejuvenation” effect.
8. Treatment Process: Step-by-Step Expectations
The procedures performed at Demiderm Polyclinic in Alsancak follow standard medical protocols.
Preparation Phase
Approximately 30-45 minutes before the procedure, local anesthetic creams are applied to the treatment area. This is to reduce the heat and stinging sensation felt during the procedure to a tolerable level. The skin is thoroughly cleaned and disinfected.
Application Phase
The physician selects the appropriate head and energy level according to the intensity of the scars. The procedure time is approximately 20-30 minutes for the entire face. During the application, the skin surface is relaxed using systems that blow cold air (cryo-cooling).
First 24 Hours After the Procedure
After the application, a feeling of warmth similar to sunburn, redness (erythema), and edema (swelling) on the skin are expected and normal inflammatory responses. This indicates that the healing process has begun.
9. Seasonal Timing: Izmir Climate and Laser
Izmir is a city with a high UV (Ultraviolet) index for much of the year. Since ablative (peeling) laser treatments temporarily remove the skin’s protective barrier (stratum corneum), the skin becomes vulnerable to the sun.
Therefore, for deep treatments such as CO2 Fractional Laser, the period between October and April (Autumn and Winter months) is considered the most suitable time. In the summer months, non-ablative lasers or radiofrequency systems can be preferred, accompanied by strict sun protection.
10. Post-Treatment Care and Complication Management
The success of laser treatment depends as much on the care protocol the patient applies at home as on the procedure performed in the clinic.
Golden Rules:
- Sun Protection: Broad-spectrum sunscreens with at least SPF 50 should be used even when the weather is cloudy and reapplied every 2-3 hours.
- Moisturizing: The skin may become dry and tight during the healing process. Water-based, fragrance-free restorative creams recommended by a doctor should be used.
- Scabbing: Tiny, pinpoint scabs (micro-crustaceans) may form from the 3rd-4th day onwards. These scabs should absolutely not be removed by hand; they should be allowed to fall off naturally..
- Avoiding Heat: For the first few days, activities that dilate blood vessels, such as hot showers, Turkish baths, and saunas, should be avoided.
11. Session Intervals and Treatment Duration
Collagen synthesis (neocollagenosis) is a biologically time-consuming process. After laser treatment, the formation of new collagen fibers begins on the 21st day and continues for 3 to 6 months. Therefore, it is necessary to allow the skin to heal between sessions.
Generally, 3 to 6 sessions can be planned, depending on the depth of the scars, with intervals of 3-4 weeks. Cumulative improvement is observed with each session.
12. The Importance of Combined Treatments
In some cases, laser alone may not be sufficient. At Demiderm Polyclinic, a holistic approach is adopted, and combinations can be suggested for different scar types:
- Subcision: Release of ligaments pulling the skin down at depths inaccessible to lasers using a needle.
- TCA Cross: Application of acid to the base of narrow (Icepick) scars where laser beams cannot penetrate.
- Mesotherapy / PRP: Injection of growth factors and vitamins to increase the skin’s healing rate.
Acne scar treatment is a medical process requiring patience and discipline. Laser technologies, when applied with the right patient selection and by competent hands, are powerful tools that significantly improve skin tissue. Demiderm Polyclinic, located in Alsancak, Izmir, creates treatment maps suitable for your skin structure in light of scientific data and manages the process within the framework of medical ethics.
A detailed physician evaluation is essential in every step you take regarding your skin health.
