Good luck with your recovery and thanks for sharing. So happy to see a real scar treatment thread again and someone actually taking action that can improve scars. I really hope this works for you.

Interesting that your doctor gave you a blood thinner. I have never heard of that as most say co2 laser is attracted to water in the skin so the less blood, the better. I have also read that coagualtion and blood cotting at the base of the scar is good. No idea if either really make a difference.

Which laser did you choose? Based on the bleeding and swelling, it looks like Repair. With Total FX, they do Active FX last as it helps seal the skin and blood vessels. It just leaves you with a little pinpoint bleeding after the procedure. Deep FX alone is a different story.

What is your skin type? Curious to know if you are predisposed to any potential side effects, like people with Asian or olive skin.

You might start questioning your sanity over the next few days. Just remember, this phase is temporary and chances are, it will be worth it. Stay strong and best wishes for an awesome outcome!

Best of luck!

Good luck with your recovery and thanks for sharing. So happy to see a real scar treatment thread again and someone actually taking action that can improve scars. I really hope this works for you.

Interesting that your doctor gave you a blood thinner. I have never heard of that as most say co2 laser is attracted to water in the skin so the less blood, the better. I have also read that coagualtion and blood cotting at the base of the scar is good. No idea if either really make a difference.

Which laser did you choose? Based on the bleeding and swelling, it looks like Repair. With Total FX, they do Active FX last as it helps seal the skin and blood vessels. It just leaves you with a little pinpoint bleeding after the procedure. Deep FX alone is a different story.

What is your skin type? Curious to know if you are predisposed to any potential side effects, like people with Asian or olive skin.

You might start questioning your sanity over the next few days. Just remember, this phase is temporary and chances are, it will be worth it. Stay strong and best wishes for an awesome outcome!

Best of luck!

Thanks.

Not sure why it was given - but I trust the doctor. Personally I see some basis for it - for example when doctors inject PRP after laser treatments, same idea to some extent. More blood at the trauma site = more opportunity for healing. For example noone says to take any blood thinners before subcision but Dr.Rapaport says to take asprin before the procedure in order to pool more blood at the site. Who knows.

Didn't really have too much choice in lasers - as there are only a few doctors who have fractional co2 lasers around here (only one has re:pair and he's not very good). I went with doctor rather than type of laser (personally I think they're all the same.) To be honest - I'm not sure what brand he uses, but we agreed to go as aggressive as possible. I'll find out during the next checkup. If there was a good doctor around here who had the re:pair, I would do it - but there wasn't.

Probably skin type III if I had to guess?

How is everything working out? Any estimation upon the percentage improvement?

Can't believe I only just saw this thread now (hard to follow what proper there is amongst all the urine/avocado stuff). Definitely following! I hope you heal well and get great results! Can't wait to hear future updates. I'm also considering fractional CO2 for my scarring which is the same type as yours.

Good luck and keep us posted!

Thank you for elevating the discussion on this board. Hopefully the conversation can get back to science-backed treatments instead of the aforementioned urine / avocados / god knows. LOL... Anywhoo, it does look intense and I'm not aware of other C02 lasers that can cause this much bleeding. Would be great to know more details. Like Inspired said, can you give us some details about your skin type, level of scarring prior to treatment, etc?

hey thanks for this thread and please keep updating us on your progress as time goes on. i think you are going to have great results! i am getting co2 done (not the fractional co2 though) on some raised scarring on my chin and i just keep praying that i will get good results. the plastic surgeon who will do the laser claims this is the only way to try and make the raised scarring look better is to try and level it with the rest of the skin. anyway good luck and thank you for sharing your story!

I was pretty much healed after about 6-7 days, only just some left over redness still present (3 weeks later). You can pull off a sunburn look after a week however. There wasn't any pain or anything during the recover, moreso annoying due to the peeling skin, itchyness and swelling. After about a week everything peeled and 80% of the swelling went away. 2nd week the bad redness got better and 90% of the swelling went away. Now there's just a tiny bit of swelling and some redness. I'll upload pics when I have some time.

hey thanks for this thread and please keep updating us on your progress as time goes on. i think you are going to have great results! i am getting co2 done (not the fractional co2 though) on some raised scarring on my chin and i just keep praying that i will get good results. the plastic surgeon who will do the laser claims this is the only way to try and make the raised scarring look better is to try and level it with the rest of the skin. anyway good luck and thank you for sharing your story!

I'm glad that you're getting good results. I did Mixto laser recently too but at a lower setting. How many passes did you do exactly? For my next session I don't know if I'm going to do 2 or 3.

Eye of newt, and toe of frog,

Wool of bat, and tongue of dog,

Adder's fork, and blind-worm's sting,

Lizard's leg, and howlet's wing

Ok I guess you guys are tired of the voodoo cures. NOT ALL FRACTIONSL LASERS ARE CREATED EQUAL!! Know your laser and your treatment levels, or you will come away dissatisfied. I haven't updated this in quite a while, but surely some of it must still be relevant.

http://www.acne.org/messageboard/index.php/topic/252527-laser-link-o-rama/

Ok I guess you guys are tired of the voodoo cures. NOT ALL FRACTIONSL LASERS ARE CREATED EQUAL!! Know your laser and your treatment levels, or you will come away dissatisfied. I haven't updated this in quite a while, but surely some of it must still be relevant.

http://www.acne.org/messageboard/index.php/topic/252527-laser-link-o-rama/

I don't see your point Dudley unless you're just posting for general info? The re:pair, smartxide, deepfx, affirm and to an extent mixto can provide similar settings. Yes, the re:pair goes a bit deeper and the ultrapulse & affirm can provide up to 100% ablation but generally speaking, the fractional co2 lasers are similar (especially for someone who doesn't have access to the re:pair). It depends more on the settings imo and if you read my previous posts, you would know that I wouldn't go into a laser without aggressive settings.....

ps. I also don't know why you're such a prophet of the re:pair. There have been no studies comparing the different lasers. They each have some advantages and disadvantages & there are other more important questions ie why is one pass at 60% better than 3 passes at 20%?

Most of the lasers comparing to the re:pair:

Use 30W, spot size is 350 microns and pulse width / dwell time is up to 2 ms - so ~60mJ. (pretty similar). You can actually hit 60mj with a 0.8ms dwell time. Technically speaking - the "30w" measurement is taken as an average between on and off times of the laser, I think the actual "on" wattage is higher.

The mixto is power 8 and index of 6 is 3.5ms pulsewidth and ~40mJ. (less risk of PIH)

They use spot treatment rather than rolling (advantage imo)

They go from 150-1000+ microns in depth (disadvantage imo), but deep enough to reach most scars. The deepfx goes even deeper than the re:pair at a similiar mj setting.

The affirm and dot can be adjusted each time from 0-100% ablation (advantage imo). This can also make them go deeper.

So you can either have smaller holes with less energy per hole but deeper (re:pair and deepfx) or you can have bigger holes with more energy but less deep (dot and affirm).

It is also yet unclear whether it is the depth of the "hole" drilled into the skin that is important, or whether it is the lateral thermal energy delivered to a particular depth that is the key point to get clinical results. I haven't seen any studies addressing this issue. Personally, I think heat/power to the site is more important than depth. I think 600 microns is more than enough to reach the base of most scars.

If you were posting just for general info, then you can disregard everything I said . Sorry for the rant, hope this might help someone in the future though.

acnescar123, frankly I am too far removed from the debate to have any desire to research the differences. I did that at one time, but now I am content with knowing what worked for me. I compiled the laser link thread some time ago when I was still actively having treatments, and I have not updated it in some time. At the time of the compilation Re:pair and DeepFX were considered far superior to the other lasers in results. If that has changed I wouldn't know. 4 years ago when I was looking at lasers anything other than Re:pair and DeepFX was considered inferior. All I know is what worked for me.

Quite frankly since I am older my interest has turned to Plastic Surgery. I come on here more out of habit than anything else, and I only comment on laser threads. I will continue with Re:pair as a tune up after plastic surgery. I went through dermabrasion and regular CO2 with no results. When I did Re:pair it worked so why go anywhere else.

I agree with Dudley. Not all fractional co2 lasers are equal. MixTo isn't even a pulsed laser. It is not a deep laser either. It is no different than traditional co2 in fractional mode. They claim this carries less risk of side-effects and that this makes their technology (which is only different from traditional because it is micro fractional) superior. I have done a lot of research on this too over many years.

Inspired we have fought these debates some time ago, and neither of us have the need to go back. I assume Re:pair and DeepFX are still considered the superior lasers. As you can tell I am a little removed from the debate, and not up to date. I am either through with my laser work or I might get Re:pair as a tune up after plastic surgery. It is great for tightening the skin also, which was its intended application.

holy crap that looks intense! where in ontario did you have this done? i wish you the best of luck man

MixTo isn't even a pulsed laser. It is not a deep laser either. It is no different than traditional co2 in fractional mode. They claim this carries less risk of side-effects and that this makes their technology (which is only different from traditional because it is micro fractional) superior. I have done a lot of research on this too over many years.

That's not true at all. The reason the mixto carries less risk is due to the dwell time - it has nothing to do with depth. Longer dwell times = less heat = less thermal damage = less risk of PIH

"The MiXto does have the ability to go as deep as our competition when using the 180m handpiece with the proper Wattage and Pulse Duration" - which is ~500 microns.

Most doctors only go until they hit the reticular dermis - which is ~300-700 microns in depth (as there is no more tissue to ablate). The issue with icepicks though is that they're usually around 2000 microns in depth (boxcars are ~500) - this is why the top of the scar will improve and look softer, but the scar itself is too deep to actually improve. Dermabrasion is usually around 300 microns and Phenol peels are 500-1000 microns. The new scarfx is 4000 microns. The old school co2 lasers did ~100 microns per pass.

Every fractional co2 laser can hit the reticular dermis. BUT - the question is, would you prefer more heat/power (smartxide, affirm), depth (re:pair, deepfx) or less of both but less risk of PIH (mixto). If I was in a big city in the US, I would find a doctor who does multiple lasers at the same time to get all the benefits.

ps. Just a small update : all the swelling is gone, just still redness, noticing about a 30% overall improvement. All the actual scars are "there" but they're less noticeable. Hopefully they get plumped up from the bottom over the next few months.

Mixto is a continuous light, not pulsed light, laser. It is carefully worded on their site. 500 microns is superficial and is comparable to Active FX in terms of depth. If I had the energy and wasn't restricted to a phone right now, I would do this debate.

Glad you are healing well and still wish you the best of luck.

Keep in mind, in my research, I needed a laser that could improve deep damage. Softening of scars is great but after time, the surface returns to normal. At least, that's been my experience. I had one deep scar treated with MixTo and found the scar looked smoother for several months. The depth looked improved during the swelling stage. The scar eventually returned to normal and I saw no improvement in depth. Your skin does have memory. If you are not destroying the deeper damage, i believe the scars return to normal. Shaving down is no different than a deep peel in my opinion. As your skin recovers and ages, I believe the scars do return to normal when you have only had a superficial depth treated because the real damage exists deeper than 500 microns. If you search the forum, you will find posts where we have been really technical on this in the part on this board.

Also, I want to add that while I have done Total FX, I do believe the surface improvement and softening are temporary. I am willing to pay for that temporary improvement.

Ain't no big thing. That is just blood that washes off. It may look scary but it is nothing. Once he washes it off everything is brought into perspective.

holy crap that looks intense! where in ontario did you have this done? i wish you the best of luck man

Mixto is a continuous light, not pulsed light, laser. It is carefully worded on their site. 500 microns is superficial and is comparable to Active FX in terms of depth. If I had the energy and wasn't restricted to a phone right now, I would do this debate.

Glad you are healing well and still wish you the best of luck.

I'm not arguing that the mixto is less powerful because it is (with the reduced risk of side effects due to the decreased dwell times.) The active fx only goes to 120 microns at the highest setting.

However, you have to keep in mind "ablation depth" and thermal damage depth are two different things. Yes - the deep fx has up to 1.6mm of thermal damage *but* it has only a 700 micron ablation depth (same as all the other lasers.) However some of the other lasers deliver more thermal damage horizontally to the columns themselves (rather than depth.) Once multiple passes gets into the mix, it becomes even more complicated (since you can do a 700 micron ablation and then do 1-2 more passes.) So the question becomes if you want heat deeper OR heat into the thermal columns - I have no idea which works better. Considering that the erbium lasers do work (in most studies similar to co2 ones) I think there is more to the equation that just depth alone. Something like dermabrasion also gives decent results and only goes 200-300 microns in depth.

Sanjoseskin summed it up well in another post:

"You can see the total lesion depth at 70 mj is 1.5mm. You can also clearly see the ablation vs thermal zone 2 thermal damage, which penetrates down achieving the 1.5mm lesion depth, or more commonly the averaged lesion depth of 1.6mm that is advertised.

This wonderfully shows that the ablation depth is actually around .600-.700mm if we are visually estimating, the remainder is about .900mm or approx 1mm of thermal damage. The ablation depth plus thermal damage depths add up to give you lesion depth of 1.5mm or 1.6mm.

To compare with ultrapulse, approx .700mm of ablation depth, results in only an additional .200mm of thermal damage. For a total lesion deapth approx of .900mm. So you attain the same ablation depth, but you spare healthy tissue, and avoid possible complications that comes along with too deep and wide of thermal damage. What does this mean? It means you can go deeper, without worrying that you are causing excess thermal damage, which is the leading cause of hypopigmentation with CO2. You can also treat deeper, and treat patients who alreadly have thermal damage, such as burn patients. However, both have pretty good records. There is no reason why acne scar patients, shouldn't see good results with both. That is if lasers work for scarring."

I think the re:pair is probably the best choice, although I'm not a fan of the rolling handpiece and the fact it's usually 1.5-2x more expensive (disposable costs). Barring that - I would choose the best doctor rather than best laser and people shouldn't be put off just because it's not the deepfx or re:pair.

There is nothing you can quote on this forum that I have not read. I more than understand lasers. The depths you are quoting are incorrect. Watch this video from the start. You might find the ablation/thermal damage chart interesting: http://www.lumenis.com/webinar_archive/videoplayer.php?id=1602390770001

My doctor hit my scars at 35mj with Deep FX and then did a second pass at 15mj with a higher density. Look at the chart for the total depth including ablation. you might also find the part on continuous light vs pulsed light interesting. Lumenis makes both type

Acnescar123, I am far past the laser debates. I did my research over 4 years ago, and I have no idea what has changed in the last few years. As you probably know I advocate Re:pair. At the time of my consideration DeepFX was really the only other treatment I seriously considered. The Lasers of a Lesser God appeared to be inferior at that time. My major argument now is what I know first hand to be the effectiveness of Re:pair. The data you present is interesting, and perhaps people are achieving good results with the other lasers, but I made my decision, and it was an excellent decision. It was a decision that changed my life, and I would not change a thing. I am a fan of the rolling handpiece. My interest is in plastic surgery at this point. Here are a couple of interesting forums if anyone is interested.

http://messageboards.makemeheal.com/

http://messageboards.makemeheal.com/george-yang-doctor/ Dr. Yang gives some interesting and in depth answers, and he may of particular interest to people of Asian heritage.

There is nothing you can quote on this forum that I have not read. I more than understand lasers. The depths you are quoting are incorrect. Watch this video from the start. You might find the ablation/thermal damage chart interesting: http://www.lumenis.com/webinar_archive/videoplayer.php?id=1602390770001

My doctor hit my scars at 35mj with Deep FX and then did a second pass at 15mj with a higher density. Look at the chart for the total depth including ablation. you might also find the part on continuous light vs pulsed light interesting. Lumenis makes both type

Thank you for the excellent link. I am happy to hear about your success with DeepFX. I have encountered something interesting. I have seen continued improvement almost 2 years after my last Re:pair. It is very subtle but it is definitely improvement. I didn't think this was possible. It is probably only about 5%, and I probably noticed it about 6 months ago, long after final results should have been in. I am thinking because I am older my collagen rebuilding time might be extended.

There is nothing you can quote on this forum that I have not read. I more than understand lasers. The depths you are quoting are incorrect. Watch this video from the start. You might find the ablation/thermal damage chart interesting: http://www.lumenis.com/webinar_archive/videoplayer.php?id=1602390770001

My doctor hit my scars at 35mj with Deep FX and then did a second pass at 15mj with a higher density. Look at the chart for the total depth including ablation. you might also find the part on continuous light vs pulsed light interesting. Lumenis makes both type

Not sure how you can say my numbers are wrong as those are the numbers they advertise.....

The video is great, but two things to keep in mind 1. The doctor is working for lumenis and more importantly 2. most doctors won't go past 15-25 mj (even if you ask them to be aggressive) - which evens out to around 700 microns. That being said,

"Deep FX at 15 mJ fluence achieves 450 ¼ (0.45 mm) depth of ablation and around 300-800 ¼ more coagulation below the base (total 1 mm)"

"Deep FX at 35-40 mJ fluence that is commonly used for deep scars reaches up to total 1.2 mm." (so basically an extra 200 microns total)

When you look at the smartxide for example:

"Selectable Depth Mode: from 0.1 to 2 mm with 0.1 mm steps"

"Deep Fractional Capability - up to 2,000 microns penetration"

"the DOT gives it the ability to apply a microburst of up to 5 pulses into each fractional spot. Each micropulse has the very high DOT peak power for clean ablation at about 50 microseconds each. As a result the DOT can ablate several times deeper than before and as deep as any clinical indication requires including scars and very deep wrinkles."

Not *all* lasers are equal, but a lot of them are.

Dudley - I understand you had amazing results with deepfx but most of these lasers weren't around 5 years ago, so saying "re:pair" at aggressive settings is the only option for people isn't as accurate anymore. I'm also quite surprised you never got any improvements with dermabrasion and old school co2 - as reading case studies and talking to doctors, those treatments generally work well (but at the cost of possible side effects). ps. Since you were talking about hair transplants earlier - you should look into Dr Gho ( http://www.hasci.com/en/ )

"I have seen continued improvement almost 2 years after my last Re:pair."

That's interesting as well, as I've read multiple studies saying the results go down in time. Good to hear not everyone lowers their results to an extent.

pps. the fractora should probably have something mentioned in here (not a laser, but interesting) - http://www.acne.org/messageboard/topic/329693-fractora-rf-needling-device/ . It does 62mj at a 1mm ablation depth.

I stand by what I said. Deep FX has more than a maximum ablation depth of 700 microns and Active FX has more than a maximum ablation depth of 120 microns. I don't know where you are getting that chart but Lumenis is constantly updating the software to the Ultrapulse and I hardly think the numbers on their charts from 2012 are a lie.

You obviously know more than anyone else, even doctors. With that said, this debate is pointless.

I will say again that not all fractional co2 are the same and making such a bold statement is misleading to people new to laser treatment. Following that belief, Active FX is no different than Deep FX and MixTo is comparable to Repair. I totally disagree. I don't even believe Repair is the same as Deep FX. I believe Repair is comparable to Total FX.

Btw, most doctors are not going to do the maximum with any laser. What one doctor considers aggressive, another experienced with acne scarring may consider moderate or standard according to safety guidelines for your skin type. That's one reason I try to understand a laser and settings before deciding to invest $1000s in treatment. If you are not attacking the scar at the base and using aggressive settings, I believe you can expect minimum results.