top of page

The Evolution of Treatments for Acne Scarring and Rejuvenation by Joel Bain Herron, MD

I can look back and reminisce on the evolution of the treatments that we have performed over the past 20 years in dermatology and cosmetic surgery. Unfortunately, that means that I have been in dermatology for over 20 years now. It seems not long ago I was regarded as the new kid in town.


20+ years ago, dermabrasion was one of our best options for significant acne scarring or facial rejuvenation. It was a brutal procedure mechanically removing the top layers of skin with a high speed rotary tool with resultant splatter of blood. It was a technically demanding treatment with some guess work for the depth of tissue removed and a narrow margin for error. The potential for scarring could be high in inexperienced hands.

Ablative CO2 Laser

The ablative CO2 laser was the next huge step in the evolution for these treatments. It was a blood-free procedure and we then had precise control over the depth of tissue removed with each pass. While results were better and safety improved, there was still about 2-3 weeks of downtime where patients would look like a burn victim. Many patients compared themselves to Freddy Krueger from A Nightmare on Elm Street. There was still potential for scarring if caution was not exercised. When I first started performing CO2 laser resurfacing around 2000, the cost was approximately $8,000/treatment.

Fractional CO2 Laser

The fractional CO2 laser was a great advancement in the early 2000s. We would brag to patients how they would now have only one week of downtime. While there is redness, peeling, and swelling, it is very manageable compared to the older treatments. The safety of the fractional CO2 compared to the older treatments is tremendous. We can even treat areas of the body beside the face, which we would only do reluctantly and conservatively with other treatments. The results from the fractional CO2 laser are close to, but not quite, comparable to the ablative CO2 laser. The fractional CO2 laser typically will cost a few thousand dollars per treatment.

Today: Secret RF

Fast forward to 2019. We are one of the first offices in the Columbus area to proudly offer Secret RF. Secret RF combines microneedling with radiofrequency. So you are able to benefit from the synergies of these two treatment modalities for acne scarring or rejuvenation with one device. With Secret RF, there is little to no downtime. Most patients are only pink for one to a few hours. The discomfort from the Secret RF is much less than all the other treatments that preceded it. Typically, only about one hour of topical numbing cream is required. Due to the minimal downtime, Secret RF is a treatment that can be repeated as needed for incremental improvement with each session. With multiple sessions, results can be comparable or better than the older modalities. With Secret RF, treatment is now offered for hundreds of dollars per treatment as opposed to thousands.



bottom of page