Focal Acne Scar Treatment (FAST), a New Approach to Atrophic Acne Scars: A Case Series

October 2013 | Volume 12 | Issue 10 | Original Article | 1163 | Copyright © October 2013

Eric S. Schweiger MDa,b and Lauren Sundick RPA-Ca

aSchweiger Dermatology, New York, NY
bDepartment of Dermatology, Mount Sinai Medical Center, New York, NY

BACKGROUND: Acne scars are a common concern in dermatology. Fractional CO2 laser resurfacing is a recent addition in our armamentarium of treatment options for acne scars and has been shown to be an excellent option for patients with atrophic acne scars. Patients with acne scars receiving fractional CO2 resurfacing usually have both the acne scars and surrounding unscarred areas treated in common practice. There has yet to be a study that looked at the implications of only focally treating the acne scars while leaving surrounding normal skin untreated.
OBJECTIVE: To evaluate the safety and efficacy of a focal approach to fractional CO2 laser treatment for acne scars, coined “Focal Acne Scar Treatment” or “FAST”
PATIENTS and METHODS: This retrospective case series was conducted at Schweiger Dermatology, in New York, NY, with patients treated from November 2011 through May 2012. Overall, six patients (ages 18 to 48) were treated with the fractional CO2 laser resurfacing, using a so called “FAST” technique treating only the acne scars and leaving normal skin untreated. Evaluation was based on physician and patient assessment of improvement at one week and four weeks post-treatment.
RESULTS: All six patients treated with the Focal Acne Scar Treatment technique of fractional CO2 laser resurfacing had significant improvement post treatment ranging from 40% to 70% as estimated by the treating dermatologist and patient at four weeks post treatment. Patient satisfaction was high following FAST method. Temporary post-inflammatory hyperpigmentation was seen in two patients but resolved after a single 1550 nm Erbium Glass fractional laser treatment.
CONCLUSION: The Focal Acne Scar Treatment technique is an effective method of improving the appearance of atrophic acne scars. Higher energy and density levels can be used when utilizing this technique, resulting in improved outcomes when compared with whole face fractional CO2 laser resurfacing. Healing is improved and faster with this technique and no increased incidence of permanent adverse events were found. More studies are needed to further evaluate this new technique.

J Drugs Dermatol. 2013;12(10):1163-1167.


Acne is a very common condition that has been reported to affect as many as 80% of adolescents and young adults. The incidence of acne scarring in the general population is between one and 11 percent,1 making the treatment of acne scarring a very relevant topic in dermatology today.
While there are many options available for the treatment of acne scars, therapies have evolved over time. Acne scar treatments have transitioned from chemical peels to dermabrasion to traditional laser resurfacing with fully ablative lasers to non-ablative fractional lasers and recently to fractionally ablative lasers.2 Fractional ablative carbon dioxide (CO2) lasers have emerged as the “gold standard” treatment for acne scarring in recent years due to their efficacy, safety and relatively limited downtime.3,4 Fractional CO2 laser resurfacing causes local damage to the skin, ablating the epidermis and portions of the dermis, as well as sending heat down into the dermis to stimulate the formation of new collagen. The non-ablated areas of a fractional CO2 laser treatment allow for faster tissue healing and minimal postoperative healing time. Although Fractional CO2 laser resurfacing has emerged as the gold standard for laser treatment of acne scars, some practitioners prefer non-ablative Erbium laser resurfacing treatments, due to decreased pain during treatments and faster healing time after each treatment.5
Currently, when treating facial acne scars with a fractional CO2 laser, resurfacing is usually performed by treating the entire face, including the scarred and surrounding non-scarred skin. The rationale for treating the entire face and not only the scars is to give an “even” appearance to the treated skin and to avoid concerns of irregular appearing hyper- or hypopigmentation. There has yet to be a study that looked at only focally treat-