While there are numerous medical treatments for active acne, including topical and oral antibiotics, retinoids, hormone therapies, isotretinoin, and more recently laser treatments, a significant percentage of patients develop permanent acne scarring. Acne scars can have significant psychosocial consequences, including reduced quality of life, emotional distress, and negative self-concept.1
Acne scarring poses particular treatment challenges for patients of color. Higher rates of postinflammatory hyperpigmentation (PIH), increased risk of keloid formation, and increased melanocyte reactivity complicate treatment selection and safety.2 Previous literature suggests that up to 90% of patients with darker Fitzpatrick skin types may experience PIH after acne lesions, highlighting the importance of safe, effective scar treatments that are applicable to all skin tones.3
Acne scars are broadly categorized into atrophic, hypertrophic, or keloid, with atrophic scars further subdivided into roller, trolley, and ice pack types. These scar morphologies reflect underlying disturbances in the architecture of collagen, elastin, and dermal extracellular matrix, largely driven by inflammatory pathways. Many existing procedural therapies—such as chemical peels, microneedling, subcision, radiofrequency, ultrasound, and resurfacing lasers—aim to stimulate neocollagenogenesis and dermal remodeling. However, depth of treatment, safety and tolerability remain limiting factors, particularly in darker skin.4
A recent prospective, multicenter clinical trial evaluating a novel nonablative 1550 nm laser incorporating Focal Point technology in various skin types for acne scarring. This delivery system differs from traditional 1550 nm lasers by using conical rather than purely vertical beams, allowing the energy to converge at specific skin depths while dispersing the flux into superficial layers. As a result, higher pulse energies—up to 150 mJ—can be safely delivered, compared to the roughly 70 mJ limit of previous devices.3
A total of 47 subjects aged 21 to 72 years were enrolled at 3 US clinical sites. Importantly, purposeful registration to Fitzpatrick skin types I to VI was performed, addressing a common limitation in previous laser studies. Subjects received between 1 and 6 treatments at 3- to 6-week intervals, with follow-up assessments at 1 and 3 months after the final treatment. Treatments targeted 1 or 2 dermal layers, including deeper coagulation zones at 700-1300 µm and more superficial zones at 200-400 µm.
Efficacy outcomes were assessed using multiple validated measures, including the Global Aesthetic Improvement Scale (GAIS), blinded photographic review, and the ECCA Acne Scar Scale. The investigator’s GAIS ratings showed that 78% of subjects were rated as either “much improved” or “improved”, with no subjects experiencing clinical deterioration. Specifically, patients rated as “no change” were largely among early participants treated with lower potency or single-pass protocols.
Blinded reviewer analysis showed high agreement, with at least 2 of 3 reviewers correctly identifying baseline and post-treatment images in over 90% of subjects. In addition, blinded dermatological assessment using the ECCA scale showed a statistically significant mean improvement of 30.3 points, with more than 90% of participants meeting response criteria.
Tolerability of the treatment was acceptable, with a mean pain score of 4.4 out of 10 using local anesthesia alone. No subject discontinued treatment due to discomfort. Safety results were favorable, with no serious adverse events reported. Expected transient effects included erythema, swelling, and a temporary burning or stinging sensation. One case of prolonged hyperpigmentation occurred in a Fitzpatrick type III individual and resolved with medical management.
Subgroup analysis revealed no statistically significant differences in efficacy or adverse effects between lighter (FST I–III) and darker (FST IV–VI) skin types. This finding is clinically relevant given historical concerns about laser resurfacing in skin of color. The low rate of PIH observed in this study compares favorably with the higher rates reported for traditional nonablative resurfacing lasers.
This multicenter study suggests that a new generation 1550 nm non-ablative laser using Focal Point technology can safely and effectively improve acne scarring in a wide range of skin types. The ability to deliver higher energies to deeper dermal targets while preserving the epidermis represents a major technological advance. Although long-term follow-up and comparative studies would be beneficial, the findings contribute valuable evidence to support expanded laser treatment options for acne scars, particularly in populations historically at higher risk for treatment-related pigmentary complications.
References
- Li Y, Hu X, Dong G, Wang X, Liu T. Acne treatment: research progress and new perspectives. Front Med (Lausanne). 2024 Jul 10 11:1425675. doi: 10.3389/fmed.2024.1425675.
- Alexis AF, Harper JC, Stein Gold LF, Tan JKL. Treatment of acne in patients with colored skin. Semin Cutan Med Surg. 2018;37(3S):S71-S73. doi:10.12788/j.sder.2018.027
- Wang JV, Pomerantz H, Tran TN, et al. Treatment of acne scars in fitzpatrick skin types I-VI using a new non-ablative 1550 nm laser with focal point technology. J Cosmet Dermatol. 2025;24(12):e70620. doi:10.1111/jocd.70620
- Zhang M, Liu C, Zhang S, Chu R, Ren X. Advances in acne scar treatment. Front Med (Lausanne). 2025 Aug 29 12:1643035. doi: 10.3389/fmed.2025.1643035.
