Acne Scars: Why We Combine CO2 Laser, Subcision, and Filler

Why do we combine CO2 laser, subcision, and filler for acne scars?

Acne scars present various morphologies, from atrophic (depressed) to hypertrophic (raised). To achieve significant and lasting improvement, a single treatment is often not enough. Therefore, at Santé Clínica Estética, our board-certified doctors design combined protocols that address the different layers and characteristics of each scar.

The combination of CO2 laser, subcision, and filler allows for synergistic action. The CO2 laser improves surface texture and stimulates collagen. Subcision releases the adhesions that pull the skin downwards. Filler elevates depressions, achieving a more homogeneous and natural result.

Understanding acne scars

Acne scars are the result of the healing process of severe inflammatory lesions. When acne damages the deep layers of the skin, the body produces collagen in a disorganized or insufficient way. This can lead to the formation of different types of scars.

The most common types include atrophic scars, which are divided into "icepick" (deep and narrow), "boxcar" (depressions with defined edges), and "rolling" (undulating). There are also hypertrophic or keloid scars, which are raised and result from an overproduction of collagen. Our approach primarily focuses on atrophic scars.

Fractional CO2 laser: Skin surface renewal

Fractional CO2 laser is a fundamental tool in the treatment of acne scars. This laser emits light beams that create micro-columns of energy in the skin. These micro-columns stimulate the production of new collagen and elastin.

At the same time, fractional CO2 laser removes superficial layers of damaged skin, which improves overall texture, tone, and luminosity. This skin renewal process helps to smooth the edges of scars and reduce their depth. At Santé, the CO2 laser is programmed with different intensities (mild, medium, strong, very strong) according to each patient's needs.

Subcision: Releasing depressions

Subcision is a manual technique used to treat atrophic and "rolling" type acne scars. These scars are often anchored to deeper tissues by fibrous bands. These bands pull the skin's surface downwards, creating a depression.

During subcision, a qualified medical professional uses a special needle to break these fibrous bands beneath the scar. By releasing these adhesions, the skin can lift, and the scar becomes less noticeable. This procedure is performed under local anesthesia for the patient's comfort.

Hyaluronic acid filler: Restoring volume

Once adhesions have been released through subcision, atrophic scars can benefit from hyaluronic acid filler. Hyaluronic acid is a biocompatible substance that is injected directly beneath the depressed scar. Its function is to replenish lost volume and elevate the scar to the level of the surrounding skin.

Hyaluronic acid filler offers an immediate result and contributes to a more uniform skin surface. In addition, hyaluronic acid can also stimulate long-term collagen production. The duration of the filler's effect varies individually but usually lasts several months, after which a touch-up may be necessary.

The combined protocol of Santé Clínica Estética

At Santé, our approach to acne scars is always personalized. After a detailed medical evaluation, the team will design a treatment plan that may include one or more sessions of each technique. The combination is chosen based on the type, depth, and extent of the scars. Results vary depending on the individual and the severity of the scars.

For example, a patient with "boxcar" and "rolling" scars could benefit from subcision followed by filler, and CO2 laser sessions to improve overall texture. It is recommended to perform these treatments during months of low sun exposure (autumn and winter) due to the photosensitivity generated by the CO2 laser.

Flow of a Typical Combined Protocol for Acne Scars

flowchart TD
    A[Medical Consultation and Evaluation] --> B[Diagnosis and Personalized Planning];
    B --> C[Subcision for Anchored Scars];
    C --> D[Initial Post-Subcision Recovery];
    D --> E{Hyaluronic Acid Filler?};
    E -- Yes --> F[Hyaluronic Acid Filler];
    E -- No --> G[Fractional CO2 Laser Sessions];
    F --> G;
    G --> H[Post-CO2 Laser Recovery];
    H --> I[Follow-up and Plan Adjustment];
    I --> J[Maintenance and New Sessions (as needed)];

Table of Indicative Prices for Combined Protocol Components

Treatment	Price per Session (EUR)	Intensity / Quantity
Fractional CO2 Laser (full face)	400	Mild
Fractional CO2 Laser (full face)	600	Medium
Fractional CO2 Laser (full face)	1.200	Strong
Fractional CO2 Laser (full face)	1.500	Very Strong
Fractional CO2 for acne scars	400	Medium
Fractional CO2 for acne scars	600	Strong
Hyaluronic Acid Filler (per area)	350	Per area (e.g., nasolabial fold, jawline)
Subcision	Not listed as a standalone service	According to medical evaluation

Medical literature, such as that published in the Journal of Clinical and Aesthetic Dermatology, suggests that combined treatments for acne scars, including ablative lasers and subcision techniques, can show significantly greater improvement compared to monotherapies. It is important to remember that individual results may vary.

Key points

• Acne scars require a combined approach due to their complexity.
• Fractional CO2 laser renews the surface and stimulates collagen.
• Subcision releases depressed scars anchored to deep tissues.
• Hyaluronic acid fills depressions, restoring volume.
• Treatments are personalized and performed by qualified medical professionals.
• Recovery varies, but it is important to follow post-treatment instructions.
• Results are progressively evaluated over several weeks or months, and individual variability is a key factor.

How Santé Clinics approaches it

At Santé Clínica Estética, your well-being and the achievement of natural and safe results are our priority. We always begin with a comprehensive medical assessment, which allows us to understand the morphology of your scars and your expectations. Our team of qualified medical professionals, including Dr. Sol Monsalve, our Medical Director, will design a personalized protocol adapted to your skin type and scars.

We use cutting-edge technology, such as the Alma Hybrid laser, to guarantee maximum efficacy and safety in each session. Throughout the process, we will accompany you with continuous follow-up and resolve any questions. We understand that each case is unique, and therefore, your treatment plan can be adjusted to optimize results, always seeking gradual and harmonious improvement.

We offer a free aesthetic consultation so you can meet our team and discuss your concerns. We are available to assist you in Spanish, English, Portuguese, and Russian.

Frequently asked questions

Is the combined treatment for acne scars painful?

Procedures are performed with topical or local anesthesia to minimize any discomfort. Some patients may experience a burning or pressure sensation during CO2 laser and subcision, but it is generally tolerable. After treatment, there may be some swelling and sensitivity.

How long does it take to see results?

Results from hyaluronic acid filler are immediately visible. However, the improvement in texture and scar depth with CO2 laser and subcision is a gradual process. Collagen stimulation takes several weeks or months to fully manifest. Generally, multiple sessions are required to obtain optimal results, and improvement continues for months after the last session. Individual results may vary.

Are there contraindications for this type of treatment?

Yes, there are some contraindications. It is not recommended for pregnant or breastfeeding women, people with active skin infections, autoimmune diseases, or those taking certain photosensitizing medications. During the medical consultation, a complete evaluation will be performed to determine if this treatment is suitable for you.

What is the approximate cost of a combined treatment?

The cost varies significantly depending on the number of sessions and the specific combination of treatments needed for each case. A fractional CO2 laser session for acne scars can range from 400 € (medium) to 600 € (strong). Hyaluronic acid filler for an area costs 350 €. During your free consultation, we will provide you with a detailed and personalized quote.

What care should I take after the treatment?

After treatment, it is crucial to follow your doctor's instructions. This includes rigorous use of broad-spectrum sunscreen (SPF 50+), avoiding direct sun exposure, keeping the skin hydrated with specific products, and not manipulating scabs or flaking. Avoiding makeup during the first few days is also important for proper healing.