Indication
(Acne) scars
Fractional lasers and RF microneedling are among the most widely used treatments for acne scarring. Both create a controlled injury in the dermis, which the skin repairs by laying down new collagen. Our range includes the eCO2 3D fractional CO₂ laser, the UltraClear and DualMode erbium lasers, and the Genius for RF microneedling.
eCO2 3D
What determines how acne scars are treated?
Most acne scars are atrophic: deep inflammation breaks down collagen in the dermis, and the skin does not fully replace what is lost. Shape and depth together determine the approach. Broad, shallow scars respond best to fractional treatment. Narrow, deep scars and scars tethered to the underlying tissue usually need a further technique as well as energy-based treatment. Treatment usually takes several sessions.
The same techniques are used for scars after injury, burns or surgery; hypertrophic scars and keloids need caution. Active acne and the red and brown marks it leaves are covered on our acne page.
Ablative, non-ablative or RF microneedling?
Ablative fractional lasers vaporise narrow columns of tissue down into the dermis, with intact skin in between. Acne scars improve slightly more with fractional CO₂ than with RF microneedling, but the treatment is more painful and the recovery longer. Erbium leaves less heat around each column, and on erbium lasers with a coagulative component, the amount of heat is adjustable.
In RF microneedling, fine needles deliver radiofrequency current into the dermis. The effect comes close to that of fractional CO₂, and the skin recovers faster.
Non-ablative fractional lasers heat the dermis without opening the skin: recovery is faster, but more sessions are needed.
CO₂ and erbium light is absorbed by water, not by melanin. Even so, darker skin more often reacts to the inflammation that follows ablative treatment with post-inflammatory hyperpigmentation (PIH). PIH is less common after RF microneedling than after fractional CO₂. Fitzpatrick skin types V and VI need extra caution.
Which device for acne scars?
For deep atrophic scars in patients who accept a longer recovery, fractional CO₂ is the obvious choice; in our range, that is the eCO2 3D.
Erbium offers ablative treatment with control over how much heat is left behind. The UltraClear is an erbium fibre laser at 2910 nm. Its coagulation is set separately, and its modes range from superficial to the deep Laser-Coring. The DualMode, an Er:YAG handpiece (2940 nm) for the Etherea MX, combines ablation and coagulation in a single pulse, according to Vydence.
Where a practice treats many patients with darker skin, or patients want little downtime, RF microneedling suits best, with the Genius. Its insulated needles deliver the energy only at the set depth, up to 3.5 mm, so the epidermis is largely spared.
For a gentler approach, there are the non-ablative Mosaic 3D, a 1550 nm Er:glass laser, and the LaseMD Ultra thulium laser at 1927 nm. For practices that already have an Etherea MX, there is the ProDeep: a 1340 nm Nd:YAP handpiece that, according to Vydence, reaches deeper into the skin than conventional non-ablative fractional lasers.
The PicoPlus picosecond laser and the handPICO picosecond handpiece for the Etherea MX, both used for pigment and tattoos, can also be used for scars with a fractional handpiece or lens.
We'll go through the scars and skin types you see, and the equipment you already have. After installation, we provide clinical training, treatment protocols and technical support. You can buy a device outright or lease it.
Technologies for this indication
Alexandrite (755 nm)
With picosecond pulses and a fractional lens, which spreads the beam over small points with a high fluence. Picosecond lasers are also used for scars [1].
CO₂ laser (10,600 nm)
In atrophic scars, such as acne scars, the dermis has to remodel. Fractional CO₂ vaporises narrow columns into the dermis, with a rim of coagulation that triggers collagen repair. According to a systematic review of seven studies, acne scars improved by 30 to 70% in most patients [2]. A meta-analysis of eight randomised studies found more improvement with fractional CO₂ than with RF microneedling, but also more pain, more frequent post-inflammatory hyperpigmentation (PIH) and longer-lasting redness [3]. For traumatic scars, too, an expert consensus sees an important role for ablative fractional treatment [4].
Erbium
In atrophic scars, such as acne scars, the aim is remodelling in the dermis. Ablative erbium reaches the dermis through narrow channels. Er:YAG with a coagulating component improved acne scars, including in skin types III and IV [5][6]. The 2910 nm erbium fibre laser also improved acne scars, in skin types II to IV [7][8]. In a meta-analysis, fractional CO₂ more often gave over 50% improvement than fractional erbium lasers (Er:YAG and non-ablative Er:glass combined), with more pain and longer downtime [9].
Nd:YAG (1064 nm)
A fractional handpiece with microlenses concentrates 1064 nm picosecond pulses into a grid of small points in the skin. In a randomised split-face study, acne scars improved as much with it as with a 1550 nm non-ablative fractional laser, with more pinpoint bleeding and less pain [10]. In another split-face study, the scar score did not differ significantly from fractional CO₂, but physicians rated the CO₂ side as more improved; there were fewer side effects on the picosecond side [11].
RF microneedling
RF microneedling delivers heat through the needles into the dermis, where atrophic scars are located, and largely spares the epidermis. According to a systematic review of 16 studies with 481 patients, RF microneedling as monotherapy, without a combination treatment, is probably effective for acne scars; the authors do call for more randomised studies [12]. In two randomised split-face studies with fractional CO₂ as comparator, the scars improved to a similar degree on both sides. In one, RF microneedling was more painful during treatment and CO₂ caused more skin reactions [13]; in the other, the skin recovered faster after RF microneedling and there was less hyperpigmentation [14].
Devices for this indication
Etherea MX
UltraClear
FlexSys Laser
Hollywood Spectra
Healite II
PicoSure Pro
ReClear IPL
ZYE – 755 nm Alexandrite laser platform
ZYE – 1064 nm Nd:YAG laser platform
Genius
LaseMD Ultra
Mosaic 3D
PicoPlus
eCO2 3D
Which device suits your practice?
Schedule a consultation and we will help you make the right choice.
References
- Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med. 2021;53(1):9–49. doi:10.1002/lsm.23244
- Ptaszek B, Czernecka M, Podsiadło S. The Use of a Fractional Laser in Acne Scar Treatment—A Systematic Review. Life (Basel). 2025;15(6):915. doi:10.3390/life15060915
- Argobi Y, Tobeigei F, Alasiri FI. Fractional CO2 Laser Versus Micro Needling Radiofrequency for Post Acne Scarring: A Meta‐Analysis of RCTs. J Cosmet Dermatol. 2026;25(3):e70765. doi:10.1111/jocd.70765
- Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, Uebelhoer NS, Waibel JS. Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing. JAMA Dermatol. 2014;150(2):187–193. doi:10.1001/jamadermatol.2013.7761Consensus of eight experts, based largely on clinical experience.
- Tanzi EL, Alster TS. Treatment of atrophic facial acne scars with a dual-mode Er:YAG laser. Dermatol Surg. 2002;28(7):551–555. doi:10.1046/j.1524-4725.2002.01319.x
- Hu S, Hsiao WC, Chen MC, Huang YL, Chang SL, Shih PY, Gold MH. Ablative fractional erbium-doped yttrium aluminum garnet laser with coagulation mode for the treatment of atrophic acne scars in Asian skin. Dermatol Surg. 2011;37(7):939–944. doi:10.1111/j.1524-4725.2011.02009.x
- Murray TN, Guo EL, Richmond H, Friedman PM. Single treatment scar resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser. Lasers Surg Med. 2024;56(1):19–22. doi:10.1002/lsm.23729Retrospective series; one author sits on Acclaro's medical advisory board.
- Bernstein E, Alajmi A, Wang J, Hochman E, Biesman B, Sanzo JF. The 2910-nm fiber laser is safe and effective for improving acne scarring. Lasers Surg Med. 2024;56(9):755–761. doi:10.1002/lsm.23845
- Song X, Zhi BW. Comparative efficacy and safety of fractional carbon dioxide and erbium-based fractional lasers for atrophic acne scars: a systematic review and meta-analysis. Lasers Med Sci. 2026;41:222. doi:10.1007/s10103-026-05022-z
- Chayavichitsilp P, Limtong P, Triyangkulsri K, Pratumchart N. Comparison of fractional neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm picosecond laser and fractional 1550-nm erbium fiber laser in facial acne scar treatment. Lasers Med Sci. 2020;35(3):695–700. doi:10.1007/s10103-019-02891-5
- Yuan Y, He Y, Fang J, Zhang M, Wu Q. Comparison of the fractionated Nd:YAG 1064-nm picosecond laser with holographic optics and the fractional CO₂ laser in atrophic acne scar treatment: a prospective, randomized, split-face study. Int J Dermatol. 2025;64(1):85–91. doi:10.1111/ijd.17296
- Niaz G, Ajeebi Y, Alshamrani H, Khalmurad M, Lee K. Fractional radiofrequency microneedling as a monotherapy in acne scar management: a systematic review of current evidence. Clin Cosmet Investig Dermatol. 2025;18:19–29. doi:10.2147/CCID.S502295
- Hendel K, Karmisholt K, Hedelund L, Haedersdal M. Fractional CO2-laser versus microneedle radiofrequency for acne scars: a randomized, single treatment, split-face trial. Lasers Surg Med. 2023;55(4):335–343. doi:10.1002/lsm.23655
- Li W, Zheng C, Yuan X, Wu Z, Li C, Li C, Hu Z, Nie B, Shi Y, Yu Q. Comparative efficacy, recovery, and pigmentary safety of radiofrequency microneedling and fractional carbon dioxide laser for facial atrophic acne scars: a prospective randomized split-face trial. J Dermatolog Treat. 2026;37(1):2687842. doi:10.1080/09546634.2026.2687842
Looking for a treatment yourself?
We supply equipment to clinics and practices. Ask a practice near you which devices they use.