Comparison of Fractional Erbium-Doped Yttrium Aluminum Garnet and Carbon Dioxide Lasers in Resurfacing of Atrophic Acne Scars in Asians


  • The authors have indicated no significant interest with commercial supporters.

Address correspondence and reprint requests to: Woraphong Manuskiatti, MD, Department of Dermatology Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkok 10700, Thailand, or e-mail:



The efficacy of fractional erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers are well substantiated.


To compare the efficacy and safety of these two laser systems for treatment of atrophic scars in dark-skinned patients.

Materials and Methods

Twenty-four subjects with acne scars were randomly treated with a fractional Er:YAG laser on one side and a fractional CO2 laser on the other side. All subjects received two treatments with a 2-month interval. Objective and subjective assessments were obtained at baseline and 1, 3, and 6 months after the final treatment.


At the 6 month follow up, 55% and 65% of Er: YAG and CO2 laser sites, respectively, were graded as having more than 50% improvement of scars. Improvement progressed significantly from 1- to 6-month follow-up (< .001). There was no significant difference in clinical improvement between the two systems at 1- (= .90), 3- (= .54), and 6-month (= .87) follow-up. Reduction in scar volume corresponded to clinical evaluation.


Fractional Er:YAG and CO2 lasers provided comparable outcomes of scar treatment, but fractional CO2 laser was associated with greater treatment discomfort.