Last Updated on July 31st, 2019
There is some acne laser treatment for nearly everyone who has acne. Some laser therapies are only performed at the dermatologist’s office, but other laser therapies are available for safe and affordable home acne care.
Article Table of Contents
First of all, a couple of warnings before you consider treating marks, wrinkles, scars, or other potential cosmetic issues with laser: The darker your skin, the less likely it is that any kind of in-office, hot laser treatment is a good idea for you. Rosacea sufferers should avoid laser treatment altogether as the heat will likely aggravate the condition.
For people who have especially dark skin tones, hot laser treatment can set off a cycle of inflammation and skin darkening that only gets worse with time. If you are of native African heritage, you probably do not want to try any kind of laser treatment except the cool laser therapies available for at-home use, and even then you will need to be careful to avoid overheating the skin.
The unique advantage of laser therapies for acne1 is that the operator of the laser can choose the intensity of the treatment, targeting exactly the layer of the skin that is most important to changing the texture and contours of the skin. Low-power laser therapies are usually referred to as “cool2,” while higher-power laser therapies are known as “hot3.” Cool lasers act by heating water in blood plasma, while hot lasers activate hemoglobin in red blood cells.
When people see advertisements for at-home laser treatments for acne4, they usually have a mental image of pointing a laser at a pimple and zapping it with energy to make it fall right off the face. This is not quite the way cool lasers for personal acne care work. In fact, any healing after use of an at-home laser therapy device will be accomplished by the skin itself.
At-home laser kits generate just enough power to stimulate the circulation of fluids beneath the skin. The water in blood plasma warms up slightly so blood flows faster through the skin. This allows the skin to circulate more inflammatory substances out and more oxygen and nutrients in.
Acne-affected skin is pushed to the surface and dies5, gradually replaced by skin beneath it. Sometimes this is all that is needed to clear up blemishes, although the process is not very helpful for scars. Many users of home acne laser treatment kits find the initial $100 to $300 expense to be a very worthwhile investment.
There is also a more powerful “cool” laser used in dermatologist offices. This laser also works by heating water in the blood circulating in the skin6. The doctor’s office version of the cool laser is designed to bring water in blood plasma, but not any other surrounding tissues, to the boiling point. Just 30 millionths of an inch (about 0.00012 mm) of skin is affected, but that is enough to kill blood cells and interrupt circulation of fluids beneath the skin. Acne-affected skin on the surface dies and falls off, and almost always grows back smooth.
Home acne laser treatment is essentially painless. There is no need for time off from work, and the procedure can be repeated several times a week as directed by the manufacturer. (More is not always better, especially if you have dark skin tones.)
Cool laser treatment at the dermatologist’s clinic is not as painful as other treatment alternatives, but a lot more painful than home treatment with cool laser. When treated with cool laser at the dermatologist office, the skin may be raw, red, and painful for 2 or 3 days, but people who have a procedure on Thursday usually can go back to work on Monday. Your skin may be especially sensitive to the sun for several months—at which time you may need to schedule another treatment to keep your skin smooth.
Dermatologists use “hot” lasers to direct higher levels of energy to precise layers of skin7. The idea is to heat a very thin layer of tissue so quickly that the heat does not have time to spread to surrounding tissues before the laser is turned off. That is why lasers used in acne skin care are typically of the “pulsing” variety.
The earliest lasers were designed to stop the production of collagen beneath skin with protruding acne scars. The scar sank back down to the level of the surrounding skin and then could be masked with makeup. Doctors at first used what was called a continuous wave neodymium:yttrium-aluminum-garnet or YAG laser, but the scars treated with YAG laser therapy tended to come back in a few months. The YAG laser was replaced with a carbon dioxide laser, but scars returned in about a year.
In the 1990’s, dermatologists began using a pulsed dye laser8 that could be fine-tuned to treat an extremely thin layer of skin, measured in millionths of an inch. With the pulsed dye laser, scar treatments tend to last for several years. Refinements of the technique now allow scar treatment to be essentially permanent, with minimal risk of damage to surrounding tissues.
Hot lasers heat hemoglobin rather than water. They zero in on the first blood vessel underneath an acne scar, cauterizing it, and stopping the regrowth of the scar. The darker the skin above the blood vessel, however, the more heat is absorbed in the surface of the skin rather than in the blood vessel below it, so that the skin itself can be severely damaged by the laser.
What your doctor may not remember to tell you about hot laser treatment is that certain foods and medications can increase the photosensitivity9 of your skin so that heating spreads to tissues where it is not supposed to go. The high blood pressure medications known as ACE-inhibitors (usually drugs that end in “-il,” such as lisinopril, ramapril, or verapamil) increase the sensitivity of the skin to light. St. John’s wort, psoralea, dong quai, angelica, and vegetables in the carrot family also increase the sensitivity of the skin to light. Light-sensitive skin is more likely to be burned during the procedure and more likely to produce a “sloppy” result from the acne laser treatment.
If you have an inflammatory skin condition, such as cystic acne, psoriasis, or eczema, laser treatment may make it worse (where the laser is used). And if you have a viral skin infection, such as herpes or cold sores, exposure to laser light may activate the virus and cause inflammation that is far worse than acne. It is important that your doctor starts work at the bottom of your face, to maintain the greatest possible flexibility of your facial skin.
It is extremely important to follow the doctor’s orders exactly after the procedure. It is never a good idea to use a detergent cleanser on skin recently treated with laser10. It is always essential to protect the skin from sunlight for up to two weeks after the procedure. (These precautions are not necessary with at-home acne laser treatment.)
Even when nothing goes wrong, acne laser treatments are almost never 100% effective. They do not result in perfect skin. Compared to competing methods, however, acne laser treatments are faster and much more nearly pain-free, producing lasting results.
To be your most trusted ally in your pursuit of clear, healthy skin.