Guide to Fraxel Lasers


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 What does a fractional laser treat?

There are two types of fractional lasers now, the more gentle, erbium-type fractional lasers, like the Fraxel (often called “non-ablative” by doctors), and the CO2 (carbon dioxide) laser systems. 

In general, the Fraxel and similar lasers are better for younger patients (under 50), mild to moderate acne scarring, and fine wrinkles.  The CO2 systems are better for older patients, deeper wrinkles, some skin tightening, deeper acne scarring, and other scars. The fractionated CO2 lasers can treat more deeply, but they also can require more downtime than the Fraxel.

Learn more about CO2 resurfacing lasers: Dr. Irwin's Guide to Fractionated Carbon Dioxide Lasers for Sun Damage, Wrinkles, Acne Scars, and Surgical Scars.

fraxel laser treatment

 This article you are reading is about the more gentle erbium fractional lasers, like the original Fraxel.  These erbium glass fractional lasers treat the following:

  • Sun damage, fine wrinkles, and aging on the face, neck, chest and hands but also on the arms, legs, and back;
  • Certain cases of melasma;
  • Certain kinds of acne scarring and surgical scars;
  • To improve the crepiness and fine lines around the eye and on the eyelids.
  • To improve skin texture and tone.
  • To reduce precancerous lesions by replacing sun damaged skin with new skin.

Fractional lasers are generally NOT good for redness, but work somewhat on brown pigment and the above issues.   The Fraxel Dual works much better for pigment (cautions on melasma), so see the article on the Fraxel Dual if pigment is your main problem. 

A series of treatments (generally 3-5) are performed, usually one every 3-8 weeks. The benefits of fractional laser treatments are achieved with little discomfort and minimal risk. 

What is the difference between the Fraxel and the Fraxel Dual? 

The bottom line is that the Fraxel Dual treats pigment problems, brown spots, brown sun damage better than the plain/regular Fraxel.  It’s effect on melasma is still in question so be careful and skeptical if that is your main problem.  It is also better for larger areas like a sun damaged chest, arms, legs, or back.  See the article on the Fraxel Dual for more information.  

How does fractional (Fraxel) resurfacing work? 

The Fraxel laser creates tiny "microthermal" zones (think pixels) deep into the skin which the skin repairs by pushing out the old sun damaged skin (the tiny pixels) and replacing it with new skin. Each treatment replaces about 15-20% of the sun damaged, scarred or wrinkled skin. It triggers the body's natural healing process accelerating the production of collagen and new, healthy skin cells. 1,000-2,000 microthermal zones per are created each centimeter squared.

Can I do the Fraxel with other cosmetic treatments? 

Yes. With Restylane, Juvederm, other temporary or semi-permanent fillers, wait 1 week after having Fraxel done. For Sculptra, it is best to have the Fraxel treatments first, or you will need to wait 3 months after your last Sculptra injection to begin Fraxel treatment. With Thermage, wait one week before of after a Fraxel treatment.

How long do the effects of a Fraxel treatment last?

That depends on how well you protect your skin from the sun and your genetic aging process.  If you apply sunscreen and wear sun protective clothing, your skin will look good longer than if you are tanning, including tanning booths, or spend a lot of time outdoors.  If you are careful with your skin, your skin may continue to look good with annual maintenance treatments.

How long does the Fraxel take to work?  When will I see results?

Many people notice results within a week after their first treatment.  Their skin feels smoother, looks less blotchy, and has a glow to it.  

The results depend on what your issue is that you want treated.  If you are doing a series, you may need to wait the full length of the series, which can be 5-6 months, to see the complete and best results.  Usually, collagen will continue to develop even up to 3-6 months after your last treatment.

How much do Fraxel treatments cost? 

Fraxel is the brand name of one of the first fractional lasers. The cost varies by where you live, the office you go to, and the size of the area being treated. A full face laser resurfacing should cost ranges from $900 to about $1400. A full face plus eyelid should run approximately $1400 to $1900. And a full face with neck and chest will be $1500 to $1900. If you have scars that might benefit from a Fraxel, you will get a specific quotation.

How are Fraxel laser treatments performed? 

You need to arrive about 1-1 ½ hours before your treatment. You or a technician will cleanse the treatment area and then apply a numbing cream to the area to be treated. Then you just relax, read, or listen to music, while the numbing cream takes affect. 

After you numb for about an hour, the numbing cream will be removed. With first-generation Fraxel I, a blue dye was then applied. With the newer Fraxel II, the dye is not necessary. You’ll be taken to the laser room, made comfortable, and a thin layer of gel will be applied to help the laser rollers slide evenly over the face.   The newest Fraxel that is paired with the Fraxel Dual does not require gel.  

The treatment takes about an hour for a full face and feels a little like a "pins and needles" sensation. The discomfort ranges from mild to moderate. Plan on being in the office for 2 ½ hours total. Most people drive to and from their own Fraxel appointments. 

What is the process for Fraxel eyelid treatment? 

Patients should try to arrive with a clean face, including all eye cosmetics, and you should inform your clinician if you have any permanent makeup before beginning the treatment. Numbing eye drops are placed in the eye to aid in the insertion of a contact lens-like eye shield to protect the eye. The shield fits comfortably within the eye. 

The eye treatment is then performed on the upper and lower eyelids. Fraxel eyelid treatment may be performed at the same time as Fraxel face treatment. Remember, it is normal like all areas treated with the Fraxel, to some swelling and redness for 2-3 days after the treatment. 

Is there anything I should do before a Fraxel treatment?  

Here are examples of the type of instructions you may see from your doctor. 

  • Stop use of Accutane 6-12 months before any treatments

1-2 WEEK BEFORE TREATMENT:

  • Buy several bags of ice packs/frozen peas
  • Buy Cetaphil or another gentle cleanser
  • Stop use of Asprin, Advil and Aleve if possible.  Tylenol is ok.
  • Stop use of all Retinols/Retin-A
  • Renova, Tazorac, “anti-aging” products
  • Stop use of all glycolic acid treatments
  • Avoid sun exposure 2 weeks prior to your treatment
  • Stop minocycline, doxycycline and tetracycline
  • Stop waxing
  • Stop abrasive scrubs and microdermabrasion treatments
  • Call your doctor if you have a history of cold sores-  you may need a prescription for Valtrex or Famvir to begin the day before

 DAY OF TREATMENT:

  • VERY IMPORTANT – BE ON TIME -  You will need the full time for numbing and photos
  • Eat a meal 1-2 hours before your treatment – this prevents feeling jittery with the numbing cream
  • No caffeine for 4 hours before your treatment
  • Wear comfortable/ washable sweats or clothes
  • Arrive with no make-up or eye contacts 
  • Bring a wide brimmed hat to your appointment to wear after your treatment.
  • Are you pregnant or breast feeding?
  • If so, you are not a candidate at this time
  • Tendency to hyperpigment?
  • Talk to your doctor about starting a bleaching regimen four weeks before your treatment series 

What will I look like right after the treatment and what is the healing time? 

During the first 24 hours after treatment, your skin may feel as though it is sunburned. Ice packs or frozen peas are used 5-10 minutes per hour for the first 5-6 hours after the treatment. 

Your skin will look very red immediately after the treatment and will fade over the next 1-3 days. Usually you can go back to normal activities including work, with make-up, within 1-3 days (your doctor will estimate for you). Occasionally, the redness may take longer to resolve. Make-up can be worn to reduce the red. Rarely, bruising may develop, which can take up to two weeks to resolve. Allow 2-3 weeks for weddings, reunions, family pictures, etc just to be safe.

Within a few days after each treatment, a "bronzed" look to the skin is common, which can last 1-2 weeks. Your skin may flake and exfoliate a little. Using a moisturizer will help reduce the appearance of dry flakes. Remember, it will take several treatments to obtain optimal results.

Here are examples of instructions your doctor might give you for care after your Fraxel treatment.

  • Ice for ten minutes every hour for the next 5 – 6 hours to reduce swelling.  Use a bag of frozen peas covered with a thin clean cloth/towel.
  • Avoid scratching orrubbing the treated skin – do not put adhesive dressings over treated areas.
  • Men may shave 1-2 days post-treatment but be gentle 
  • Avoid all saunas and hot tubs. Showers can be taken, but avoid hot water and direct shower spray to treatment area for 3 days following treatment.
  • Avoid strenuous exercise for 48-72 hours (this includes all yoga).
  • Avoid alcoholic beverages for 24-48 hours.
  • Sleep with 1-2 extra pillows at night to keep head raised for the two nights.
  • Avoid direct sunlight for a minimum of 4 weeks after your treatment and wear a sun block with 10% zinc or titanium for the next 4 weeks.  If actively outdoors, you should reapply your sunscreen every 2-4 hours and wear a wide-brimmed hat 
  • Do not use any retinoid, Retin-A or glycolic products for 1-2 weeks post-procedure.  Do not use any non prescription creams without checking with your doctor first.
  • Refrain from any chemical peel treatments or microdermabrasion for 4 weeks post-procedure.

Can I go back to work and activities immediately? 

No, you will need to take the rest of that day off to ice and care for the treated area. You can go back to all of your activities, including exercise when your doctor approves it, usually 1-7 days after your laser treatment. Swimming in a chlorinated pool is not advised for 1-3 weeks. You may exercise outside with a full brimmed hat and with a high-quality sunscreen with 10% zinc or titanium when your doctor approves it.

How many treatments will I need? 

Three to five treatments, approximately 3-8 weeks apart. An estimate should be given to you at your consultation. The number depends on the extent of your sun damage, acne scarring or wrinkles. Gradual improvement occurs with each treatment.

Are there any reasons not to be treated with these lasers? 

Reasons not to do a fractional laser treatment may include use of medications that increase photosensitivity, use of anticoagulants, history of bleeding disorders, and pregnancy.

Are there any medical or cosmetic side effects?

The main side effects are temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister (like a sunburn blister).  Your laser center should review with you side effects in your consent form.

What about competitors to the Fraxel? 

To make things even more confusing, there are now fractional resurfacing lasers (like the Fraxel) and more ablative fractional carbon dioxide lasers (like the DOT, the Active Fx and the Affirm). 

The ablative fractional CO2 lasers treat more deeply but also require more healing time or downtime.  For more information on the fractional carbon dioxide lasers, click on this link to Dr. Irwin's Guide to Fractionated Carbon Dioxide Lasers.

The Fraxel laser, which is the first of the non-ablative fractional lasers, certainly has the most study data behind it and the most impressive record so far. But again, as we get more information, it will be interesting to see which of these devices proves to be the most useful. For now, I still recommend sticking with Fraxel laser rejuvenation because the results are the most predictable and consistent.

How does the Fraxel laser work for acne scars?

Many of the original studies with this laser were done on patients with acne scarring.  It works well for acne scarring as long as the scarring is mild or moderate.  If the scarring is deep or there is a skin sagging associated with the scars, a fractionated CO2 laser is generally a better choice.  If the Fraxel is used for deeper scars, expect to need a higher number of treatments than is average.   

How does the Fraxel work for sagging skin?

This laser does NOT work well for sagging skin. 

How does the Fraxel work for wrinkles? 

The Fraxel has a modest but noticeable effect on wrinkles that are mild to moderate.  It’s not the best choice for deep wrinkles and wrinkles associated with volume loss and sagging.  For wrinkles, younger patients more in the 30-50 range will generally get the best results with this laser.  It still has a very positive effect on sun damage and texture changes due to sun damage if a 3-5 treatment series is performed. 

Link to Fractional Laser Video Demonstration

Next, learn about which skin care product Dr. Irwin uses in her personal regimen

See Dr. Irwin's expert answers to other reader's questions on Fraxel lasers:

Does Fraxel or any laser thin the skin?

When is the best time to have the Fraxel Restore?

How risky is Fraxel laser for Asian skin? 

From www.SkinTour.com and Dr. Brandith Irwin. Copyright 2008-2014 SkinTour LLC. All rights reserved. Journalists, bloggers, and media may reprint this without permission so long as they include this credit box with the article.
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