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It’s 2022, let’s face it – acne is no longer considered a ‘cosmetic’ condition; it is a medical condition that requires medical treatments. 

If you’ve exhausted your options (i.e. topicals, orals) and are not seeing the results you desire, maybe it’s time to consider lasers. 

My patients always ask me, “Doc, must I really opt for lasers? They are really expensive!”

Well, the short answer is no – you don’t HAVE to opt for lasers. But lasers and/or energy-based devices can be very helpful if you want to achieve clear skin quickly. 

With that said, not all types of acne will benefit from laser treatment, which I will explain later in the article. 

How do lasers for acne treatment work?

Lasers work by generating heat in the deeper layers of the skin, where the sebaceous glands are. Our sebaceous glands produce sebum; excessive sebum production contributes to acne. 

Lasers are thought to work by reducing activity of these oil glands, killing the C acne bacteria and reducing inflammation in the skin. 

Is laser treatment good for acne? 

As an aesthetic doctor, I should be quick to push lasers as a frontline acne treatment – except that wouldn’t be the whole truth. 

Unlike acne scars, acne is a condition that occurs due to a combination of factors including

• Excess oil production 
• Inflammation 
• Clogged pores 
• Bacteria overgrowth 

As such, to successfully treat acne, you must address all these factors – this is often done through oral and/or topical medication. These should always be the first line[1] of treatment for treating any type of acne. 

So when do lasers come in? 

As a rule of thumb, lasers and energy-based devices come in this situations: 

• You have exhausted all medical treatments – topicals, orals etc and are not seeing desirable results
• You want a faster result by combining lasers and medical treatments (on their own, acne medication can take months or years to work) 

In that vein, that is to say lasers work synergically with acne medication. Lasers can also help ameliorate the side effects of acne, such as post-inflammatory hyperpigmentation (PIH) and atrophic scars.  

At The Artisan Clinic, we employ 2 different lasers here – Elite IQ and the PicoSure Pro.

PicoSure Pro helps: 

• Remove stubborn acne spots (PIH)
• Remodel the skin through the focus lens LIOB, helping improve the appearance of acne scars

More stubborn cases of acne require the long pulsed Elite IQ, which: 

• Generates more heat energy to tackle the overactive sebaceous glands
• Work better for Asian skin (usually contains more melanin) due to its 1064nm wavelength and longer pulse duration (more photothermal effect and heat energy generated
• Larger spot sizes available for better penetration into the skin compared with 755nm. 

Can lasers work for cystic acne? 

No, lasers typically do not work well for cystic acne because the cysts are too deep and laser penetration to that depth is suboptimal. The gold standard for treating cystic acne is still oral isotretinoin (vitamin A derivatives). Once the deep seated infection and inflammation goes down, you may then consider laser treatment to ameliorate the scars and pigmentation. 

Can lasers make acne worse?

Yes, any laser can make acne worse and some lasers, especially ablative lasers, are more likely to result in breakouts. This is due to:

• Improper skin preparation

It is imperative to cleanse the skin thoroughly before treatment. Before commencing treatment, I recommend doing a Hydrafacial to clear the skin of clogged pores and dead skin cells – doing so also helps improve the effectiveness of treatment. Patients with badly inflamed skin can be started on oral antibiotics pre and post treatment to reduce flare ups.

• Poor compliance to post-procedure instructions

This involves picking scabs, using harsh cleansers or exfoliating scrubs, and restarting retinoids and peels too early. 

• Not compliant to after-care routine

After your laser treatment, make sure to apply the serums provided by your doctor to reduce inflammation and protect the skin barrier.

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References 

Oge', L. K., Broussard, A., & Marshall, M. D. (2019). Acne Vulgaris: Diagnosis and Treatment. American family physician, 100(8), 475–484.