How long after isotretinoin can you have laser treatment for acne scars?
The traditional advice was to wait twelve months after completing isotretinoin before any laser or surgical treatment of scars, on the basis that healing would be impaired. That advice has since been re-examined and the evidence behind it is considerably weaker than was assumed. Generally I advise waiting around six months, although for a different reason from the original one.
The twelve month rule originated in a small number of reports a number of years ago describing severe scarring following aggressive resurfacing in patients who had recently taken isotretinoin. Those observations were extrapolated into a blanket rule covering all procedures for a full year. It became standard advice and was widely repeated.
Reassessment of the evidence has found very little to support a blanket twelve month delay, and many dermatologists now treat considerably earlier. The risk is not zero and the concern should still be discussed, however it does not justify a rigid year of waiting in every case.
The reason I nonetheless suggest waiting has nothing to do with healing. Acne scars continue to remodel and improve spontaneously for twelve to eighteen months after the acne itself settles, so treating at three months means treating scars which would have improved in any event, and paying for the privilege. Waiting also confirms that the acne is genuinely controlled, since commencing scar treatment while acne remains active means new scars form while the existing ones are being treated.
Around six months after finishing the course, with the acne fully settled, is a reasonable point at which to begin in most cases. Where there is a strong reason to start sooner this is worth discussing rather than assuming that a year is mandatory. Isotretinoin is a prescription-only medicine and treatment must be supervised by a dermatologist.
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