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Treating Deep Acne Scars: Ablative or Non-Ablative Lasers?

Acne Scar Treatment

Treating Deep Acne Scars: Ablative or Non-Ablative Lasers?

If having an acne breakout isn’t distressing enough – unsightly acne scars that don’t seem to fade can be an even bigger hurdle to overcome.

“Scarring” occurs when the collagen in our skin gets damaged from inflammation –leading to permanent texture changes in the skin. While certain scars will naturally fade away overtime, the ones that remain can be difficult to treat.

Types of acne scars

Atrophic scars are the most common type – involving tissue loss during the wound-healing process of acne lesions; they appear as indentations that are further classified into icepick (deep and narrow scars), rolling (superficial scars that are easily smoothed out when stretched) and boxcar (wide and shallower with distinct edges) scars.

There are also hypertrophic and keloid scars that happen due to an excess of scar tissue; resulting in raised elevations of the skin instead.

Fortunately, there are plenty of acne scar treatments that are available to consumers today – from topical medications, micro-needling, chemicals peels, dermal fillers, and radiofrequency (RF) treatments – many of them work great on mild acne scarring.  However, most of them do not work as well when it comes to deep and matured acne scars as they are unable to reach into the deeper layers of the skin.

This is where acne scar laser treatment can come in to provide faster and more effective results. Using powerful laser light at varying wavelengths to address specific concerns with the skin – lasers can be used to treat a variety of conditions including wrinkles, pigmentation, and acne.

When referring to laser treatments, there are two main types that we always hear about: ablative and non-ablative lasers.

What is the difference?

In short, ablative lasers work by removing the top layers of the skin and inciting a wound response; which in turn helps to stimulate collagen and elastin to encourage remodelling of the skin.

On the other hand, non-ablative lasers do not act to wound the skin – instead working deep within the skin’s layers to target specific cells without damaging the surrounding tissues.

The pros and cons

If we were to rewind just 20 years ago, ablative laser treatments was considered to be the gold-standard for acne scars. Lasers such as the CO2 and Erbium (Er:YAG) lasers were very effective in improving the appearance of atrophic acne scars; however, they quickly became widely associated with long recovery periods and unpleasant side effects such as redness and post-inflammatory hyperpigmentation (PIH).

This lead to the growth of non-ablative lasers like the Nd:YAG laser – which although came with less adverse effects and minimal downtime, required more treatment sessions in order to see results.

And there are plenty of studies that show this: a review of 26 studies reported that treating acne scars is far more effective when using ablative lasers than non-ablative ones. Whereas patients using ablative lasers saw an improvement as high as 83% – this number was at best, 50% in the non-ablative group.

A separate study done by South Korean doctors also did a comparison – they found that the non-ablative laser group has a lower improvement score and required a greater number of treatments as compared to the ablative group. In addition, subjects in the ablative laser group reported a prolonged recovery period and a higher risk of complications.

Fractional lasers: the perfect middle-ground

In 2004, a new and improved category of lasers emerged – fractional lasers are able to deliver heat and light in a pixelated fashion – essentially treating the skin a fraction at a time instead of blasting the entire area with intense energy.

Coming in both ablative and non-ablative forms – fractional technology has allowed patients to achieve the same powerful results of an ablative laser, while seeing less side effects and minimal downtime with that of an non-ablative laser.

They are the ideal balance between ablative and non-ablative lasers – and brands such as Fraxel, Q-switch, Nd:YAG, picosecond, and pulsed-dye lasers all fall under this promising category.

Given that patients desire treatments that provide them the least amount of downtime with maximum results, the focus has now shifted towards fractional technologies to deliver either laser, light-based, or RF energy to the skin – all of which we offer at The Clifford Clinic.

The best treatment: a combination approach

Not all lasers are created equal – the best way to discern which is the right one for you is to first understand their specifications and how they work in order to match your needs and objectives.

The thing is, many patients often face different acne scar types – which is why using a combination approach is often recommended at our clinic. Our doctors have painstakingly developed a safe and effective spectrum of solutions that differ from other conventional methods in the market – with over 10 different treatment technologies that you can tap into for the best acne spot and acne laser treatment!

At The Clifford Clinic, we offer a comprehensive range of fractional, ablative, and non-ablative lasers to help you achieve a fresh, glowing complexion. With over 18 years of medical practice treating acne and offering acne scar removal treatment – you can rest assured that you are in good hands at our state-of-the-art clinic. Contact us to book your appointment today!


  • How fast will I see results with Fractional CO2 Laser?

With fractional ablative lasers such as the fractional CO2 laser, patients can expect an average improvement of 50% – 80% of atrophic scars over a period of 12 – 18 months after their treatment session.

  • What other acne scar removal treatments do you offer?

We also offer non-laser treatments such as subcision, TCA cross, and the powerful Secret RF, which uses RF energy combined with microneedles to penetrate the deeper layers of the skin and treat even deep acne scars.

Depending on the type of acne scar you have and your skin type, we also have pulsed-dye lasers such as the Vbeam, which works exceptionally well to resolve redness and pigmentation.

  • How does radiofrequency (RF) treatments work? Are they any effective?

RF treatments work differently than lasers in that they are thermal heating systems; i.e., they work more like a microwave than a laser light.

They have the added advantage of having a higher penetration depth – the Infini RF is a micro-needling RF treatment that is able to reach up to 3.5mm (as compared to 1.5mm with the fractional CO2 laser) within the skin to effectively target deep acne scars by heating the dermis to disrupt the scar tissue and trigger the production of new collagen.

They are often recommended over laser treatments since they provide excellent results, zero downtime, and no adverse effects for patients of all skin types.