# Quantitative Evaluation of the Effectiveness of Erbium Glass Laser Therapy for Acne Scars
## 4 Discussion
While the system provided valuable comparative data, the authors noted the absence of formal validation for quantitative measurements, highlighting a limitation in methodological precision. Despite this, significant reductions intexture scores were observed following treatment with the erbium glass laser, demonstrating its ability to smoothen and refine skin texture. Notably, during the procedure, a Cryo 6 Skin Cooling System was employed to cool the skin, primarily to reduce pain and protect the epidermis from thermal damage. While this approach enhanced patient comfort and minimized post-treatment erythema and scabbing, it may have influenced the efficacy of thermal energy delivery, which is crucial for collagen remodeling and neocollagenesis. By mitigating surface heat, cooling might limit the full penetration of thermal energy into the skin, potentially moderating the overall impact of the laser on scar reduction. However, the balance between patient comfort and treatment efficacy is an important consideration, and further research is needed to determine the optimal cooling parameters for fractional non-ablative laser therapies [20]. The findings of [PERSON] et al. on the efficacy of non-ablative fractional 1540 nm erbium glass laser treatments for improving skin texture further support the observed benefits of similar laser systems in dermatological treatments. Their study demonstrated significant reductions in skin roughness volume (49.5%), roughness-affected area (46%), and maximum depth depression (24.6%) after five monthly treatment sessions. These results align with our findings, underscoring the capacity of non-ablative lasers to stimulate neocollagenesis while preserving the epidermis, resulting in both structural and esthetic enhancements. The shorter downtime and lower risk of complications associated with non-ablative approaches make them particularly advantageous for patients seeking minimally invasive treatments. Additionally, their application of advanced 3D imaging for quantifying treatment outcomes reinforces the importance of objective assessment methods, which ensure precise and reproducible evaluations critical for optimizing therapeutic protocols. These insights emphasize the growing role of non-ablative lasers in dermatological practice, offering effective and patient-friendly solutions for skin rejuvenation and scar reduction [21]. In our study, we addressed these methodological gaps by incorporating advanced imaging techniques, such as Antera 3D(r) and HFUS, to quantitatively measure improvements in skin texture, density, and volume. The absence of cooling in our protocol may have allowed for deeper energy delivery, enhancing the observed effects on dermal remodeling and collagen synthesis. These tools allowed for objective and reproducible evaluations, strengthening the reliability of our findings compared to more subjective assessment methods. HFUS has shown utility in monitoring therapeutic progress by quantitatively measuring increases in epidermal thickness and dermal density post-treatment, markers indicative of collagen production, and dermal remodeling--key outcomes for effective scar treatment. Antera 3D(r) imaging complements HFUS by focusing on the scar's surface characteristics, including skin texture and volumetric changes [22; 23]. The increase in skin density post-treatment suggests an improvement in collagen content and other structural proteins within the skin. Atrophic scars are characterized by collagen deficiency, resulting in indentations and depressions in the skin. By increasing skin density, the laser therapy effectively fills in these indentations, reducing the visibility of scars. A thicker epidermis can mask surface-level scars, making them less visible. Since a thinner epidermis may highlight the presence of scars, increasing its thickness through treatment helps to smooth the skin surface. This protective layer also supports overall skin health and regeneration. Deep folds and irregularities are often associated with rolling scars, which create a wavy texture.