Background and Objective Pulsed carbon dioxide (CO2) laser devices are considered highly effective treatment options for skin resurfacing. However, the high risk for significant treatment complications following CO2 resurfacing has warranted the development of new treatment modalities. The concept of fractional photothermolysis was developed to address the shortcomings of ablative and non‐ablative device modalities. This report evaluates a fractional approach to CO2 laser resurfacing for the treatment of moderate to severe acne scarring. The primary endpoint of the study was the overall improvement in the appearance of acne scarring. Study Design/Materials and Methods Thirty subjects, with moderate to severe acne scarring, underwent up to three treatments with an FDA IDE and IRB approved 10,600 nm fractional CO2 laser system. All subjects were Fitzpatrick skin types I–V and 18–75 years of age. Treatment parameters ranged from 20 to 100 mJ with total densities of 600–1,600 MTZ/cm2. Improvement of acne scarring was evaluated at 1 and 3 months post‐treatment. Results Twenty‐three out of 25 subjects sustained clinical improvement in the appearance of acne scarring at the 3‐month follow‐up visits according to study investigator quartile improvement scoring. Subjects also had improvement in their overall appearance, including pigmentation and rhytides. Serosanguinous oozing resolved within 24–48 hours following treatment. All subjects had transient erythema, which resolved in the majority of subjects within 1–3 months. Post‐operative downtime was significantly decreased compared to traditional ablative resurfacing. No serious complications were reported. Conclusion Fractional deep dermal ablation improves moderate to severe acne scarring. The added benefit is a considerable reduction both in downtime and risk of complications when compared to traditional CO2 ablative resurfacing techniques. Lasers Surg. Med. 41:122–127, 2009. © 2009 Wiley‐Liss, Inc.

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