The Forever Clear BBL Laser Treatment Cleared My Chronic Acne
Courtesy of Jimmy Sung, MD
Acne sufferers are some of the most hopeful people. Despite a monthly (or even weekly) batch of new pimples, we are forever buying and applying the latest topical product, hoping it might finally be the solution we’ve been dreaming of. And every month (or week), we feel duped, having once again fallen into the trap of marketing when a new Vesuvius erupts on our faces. Yet, we go on buying and applying—boats against the current, as they say.
As someone who has had consistent—albeit moderate—whiteheads, blackheads, and cystic acne since puberty, I realized by my early 20s that if I were ever going to see significant and long-term results, I would need more than the latest topical products.
In 2017 and 2019, I went through two separate rounds of oral isotretinoin—often referred to by its brand name, Accutane—which is designed to shrink oil glands. It made my skin extremely sensitive and so dry that my lips would peel off in large strips. And though it initially cleared my acne, it came back within six months with the same severity. So in 2022, at age 29, I completed three sessions of AviClear, a laser designed to reduce the size of the sebaceous glands that produce sebum. It hurt so much that I quietly cried behind the protective goggles. It turned out to be entirely ineffective for my situation.
Historically, these first-line defenses work for the majority of people. According to multiple clinical studies, between 85 to 98 percent of patients reported that isotretinoin improved their acne or were free of acne. And clinical studies report that 90% of AviClear patients saw half of their acne resolve in six months. For stubborn cases like mine, there are far too many variables to know for sure why these options didn’t work, according to Dhaval Bhanusali, MD, a board-certified dermatologist in New York City. Issues that keep acne coming back can range from the body’s inability to clear pores to the scourge of many adult female acne sufferers: hormones.
I am currently on 100mg of daily spironolactone (a prescription oral pill) and 15% topical azelaic acid (a prescription topical gel). The former decreases levels of hormones that influence oil production (androgen and progesterone), and the latter helps keep pores clear and kills acne-related bacteria. The combination minimized the number of pimples I experienced during any given breakout, but did not change their frequency or the types of pimples I was getting.
This vicious cycle of hope and disappointment eventually brought me to Jimmy Sung, MD, a board-certified plastic surgeon in New York City. (Although not a dermatologist, Dr. Sung’s practice offers a wide range of lasers that I couldn’t find in all dermatology practices.)
“There are very different reasons for people to have acne, but [the result] ends up as one thing: inflammation,” he says. “If we can decrease the inflammation, then you're already winning half the battle.”
We decided I should try Forever Clear BBL, which, before you ask, does not stand for Brazilian Butt-Lift but broadband light. It works by heating the skin with various wavelengths of blue, yellow, and infrared light. And when the skin is heated at these specific wavelengths, it eliminates the p.acnes bacteria in existing acne, targets future acne, and reduces acne-associated pigmentation. “Light-based treatment doesn't necessarily completely replace other treatments. But it is good for somebody who isn't finding topicals helpful, who doesn't want to go on oral medicine, or for somebody whose skin is very sensitive and can't tolerate certain topicals,” said Marisa Garshick, MD, a board-certified dermatologist in New York City. Dr. Sung hypothesizes that broad-band light also damages cells programmed to create inflammation, which is another way the treatments might help control acne. Meanwhile, Patrick Bitter, MD, a board-certified dermatologist, believes inflammatory cells are reprogrammed to function like healthy cells, rather than being damaged by the laser. However, he notes that while dermatology understands how broadband light works, there is a dearth of literature on its cellular-level impact and no independent studies on Forever Clear’s efficacy. (Dr. Bitter’s interest in broadband light led him to develop a three-step protocol for Forever Clear that’s now common practice; he does not have financial ties to the company.)
I was curious to better understand what had prevented me from clearing my acne up to this point, and if I could learn more about my skin beyond what I saw on the surface. So Dr. Sung introduced me to VISIA. If you’ve never had the pleasure, it’s a machine that uses high-resolution photos to highlight all your possible skin worries like wrinkles, redness, and the sun damage that lurks beneath the surface, waiting to emerge as issues like dark spots. For me, the objective of my “photo shoot” was to look at redness that could be associated with the inflammation that goes hand-in-hand with acne. VISIA compared my images to a database of thousands of others’ images and showed that I was in the 61st percentile for someone of my age and skin type—meaning I scored “better” than 61% of my peers in redness. The point was not for me to feel a certain way but to measure what progress (if any) my skin would make over the next couple of months—if my redness went down, perhaps my inflammation was decreasing too.
“[I] like VISIA as an objective image modality to see beyond what the human eye can appreciate, as well as linearly track results over time,” said Dr. Bhanusali, who uses VISIA in his practice and said it is widely used in dermatology studies for objective image analysis.
Each of my three appointments—held between April and June—started with Dr. Sung using a CO2 resurfacing laser, which emits energy that is absorbed by water in cells, to break down and destroy damaged skin cells on a microscopic level. That’s a long way of saying it gently exfoliated the top layer of my skin, and left my skin baby smooth. The goal was to help the Forever Clear light penetrate better. After a few painless passes of the CO2 laser, he applied a thick gel to allow the large Forever Clear applicator to glide across my skin before doing three passes of blue, yellow, and infrared light. The process took only a few minutes and didn’t hurt at all. The only thing I felt was warmth as the applicator moved across my skin, and I was pleasantly surprised that there was no downtime like redness or peeling after. My acne experiences up until this point had trained me to associate discomfort and inconvenience as part of the progress. Additionally, a small percentage of patients report skin purging—a sudden onslaught of breakouts—after their first session, but fortunately, this was not my case. Afterward, Dr. Sung used a multi-wavelength laser called Excel V to help reduce redness; the laser again felt like a mild warmth wafting across my face and was painless.
I saw immediate improvement after my first appointment—within three days my existing acne subsided, my face felt smoother because of the CO2 laser, and my complexion was more even because of the redness reduction.
While the price can vary depending on geography and your practitioner, here, all three sessions of Forever Clear cost $1,999 while three sessions of the CO2 and Excel V combined cost $2,980. (As a beauty editor, I received my treatment gratis.) According to Dr. Bitter, single treatments of Forever Clear more often range from $250 to $300. He said he sometimes partners Forever Clear treatments with other lasers to address concerns like ice pick scars (which are small, indented acne scars) and sun damage, while Dr. Bhanusali said he will use Excel V if a patient has rosacea-associated redness.
Dr. Sung recommended I get three Forever Clear sessions to start, followed by occasional one-off appointments at my discretion—for example when my acne starts to return. As of now, I have yet to experience any cystic acne—though I did have a brief collection of whitehead breakouts in mid-September around my mouth and chin likely due to external factors (clogged pores, instead of hormones), which have now fully healed. During a follow-up consultation that same month, I tried the VISIA again, and my redness score improved to the 94th percentile, meaning I scored better than 94% of my peers in my age group and skin type. I felt at the time that I had aced some kind of test, going from a D student to an A+ one.
With the night-and-day change in my redness score and my positive physical results, I wondered if I was seeing Dr. Sung’s theory— that cellular inflammation impacts acne—play out in real time. And I wondered why the role of inflammation in acne was not discussed with patients like myself more often.
There’s so much focus on inflammation in general medical research now, and conversations around inflammation have even entered the mainstream, thanks to news reports and social media. For years, experts thought chronic inflammation was a consequence of various illnesses, but there is strong evidence that in some cases, inflammation itself can actually lead to disease. Some levels of inflammation are good and necessary for the body, such as healing wounds. Still, when your body is in a constant or chronic inflammation state, it can lead to various health problems because your immune system is constantly in attack mode, according to the Cleveland Clinic.
“What happens with acne is that the inflammation is not happening in a vacuum. It's happening in the context of other changes that also have to be present to create a pimple or a breakout,” says Dr. Garshick. These changes could be a result of your climate, diet, or menstrual cycle, among other factors.
“It is thought that some people who have certain inflammatory conditions like ulcerative colitis or Crohn's disease may be more likely to have inflammatory acne because we know their body is somewhat more revved up,” she adds. However, she cautions that the dermatological community has not thoroughly investigated or confirmed the relationship between diagnosable inflammatory conditions and inflammatory or cystic acne.
Typically, acne is classified as non-inflammatory and inflammatory, says Dr. Garshick, explaining that non-inflammatory acne typically consists of white and blackheads, while inflammatory acne is deep, sometimes painful, nodules and cysts. However, according to Emil A. Tanghetti, MD, a board-certified dermatologist in Sacramento, California, non-inflammatory acne is a misnomer. That’s because inflammation is present at all stages of acne development, perhaps even before the actual pimple appears.
Acne is complex, and there is not always a clear cause and effect. It’s that inability to pin down one precise cause that makes acne so challenging to treat. “Adult female acne is always the most difficult,” said Dr. Tanghetti. “It’s hormonally driven, and it's hard to address that component of acne.” According to the Yale School of Medicine, approximately 50% of women in their 20s, 33% of women in their 30s, and 25% of women in their 40s experience acne.
He added that most adult female acne patients in his clinic initially come in to consult on other skin issues, having most likely given up hope that their acne could ever be resolved. While complete and permanent resolution may not be possible, he said, effective management is.
I’m about six months out from my last treatment, which is usually when patients start to see acne return, according to Dr. Bitter and Dr. Sung, but so far my skin still looks crystal clear.
I often describe acne as a terrible game of Whac-a-Mole (a reference I hope Gen Z understands), waiting with anxious anticipation for a pimple to suddenly appear and for me to aggressively respond. But as I get further out from my last Forever Clear appointment, that anxiety has started to subside rather than increase. Given how long the results have lasted—and that it’s a low-maintenance and pain-free option—I finally feel like I‘ve found a workable long-term option for my acne.
Yes, my acne will come back, but this time, I will be rowing my boat with the current.
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Originally Appeared on Allure
