Abstract

Objectives: This study aimed to evaluate the effectiveness of the combination of ablative fractional resurfacing laser with other methods, specifically fractional CO2 laser and chemical peel in atrophic scars treatment. Introduction: Atrophic scars, which were results of losing or contracting collagen fibers below the skin, present a most common but also significant challenge after acne treatment. They greatly affect patient’s appearance, self-esteem, and overall quality of life. Currently, there are various treatments for these scars, such as laser therapy, chemical peels, micro needling, punch techniques, subcision, and even combinations of these methods. However, the poor clinical responses of these methods showing the need for ongoing research and clinical optimization in this situation. Materials / method: 40 patients presenting with moderate to severe atrophic scars, they received a treatment utilizing a combination of Fractional CO2 Laser and Chemical Peel. The regimen comprised five sessions, every 4 weeks. Each session had two stages: patients firstly received laser treatment with two passes. First pass targeted the entire facial area with energy levels ranging from 25-35mJ. Second pass focused on areas with more depressed scars, utilizing energy levels of 45-65mJ. Continuously by undergoing chemical peel application with 15% TCA on the laser-treated skin until reaching the desired endpoint. Results: After 5 months, patients were evaluated for atrophic scars severity, skin surface, and satisfaction with treatment outcomes. Every patient saw improvement in atrophic scars and skin texture, as well as a reduction in hyperpigmentation. Though some experienced temporary issues like irritation, prolonged redness, and hyperpigmentation during the treatment, these were effectively managed. At the end of the treatment, all patients were pleased with the treatment outcomes and have higher seft- esteem, better quality of life. Conclusion: This is a synergistic combination, as the fractional laser helps to bring peeling agents into the skin, enhancing the chemical peel’s effects without requiring high energy and still has its efficiency. The combination is a promising method for skin regeneration and increasing collagen, making it a excellent option for treating atrophic scars. However, this procedure also carries risks, particularly in terms of pigmentation disorders. Therefore, the indication must be carefully selected and requires proper care before, during, and after the procedure.