Guide to Fraxel Lasers

What does a fractional laser treat?

There are two types of fractional lasers now, the more gentle fractional lasers that use an erbium glass laser (like the original Fraxel), and the more powerful fractional carbon dioxide (CO2) lasers.  The fractionated carbon dioxide lasers can treat more deeply, but they also can require more downtime than the more gentle, non-CO2 fractionated lasers.

Click on this link to go to Dr. Irwin's Guide to Fractionated Carbon Dioxide Lasers for Sun Damage, Wrinkles, Acne Scars, and Surgical Scars.

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

• sun damage, 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 damaged skin with new skin.

Fractional lasers are generally not good for redness, but work very well on brown pigment and the above issues.

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

Although there are several competing fractional lasers, the Fraxel laser pioneered this technology and has been on the market for the longest. So I will refer here to the Fraxel.

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 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, and Cosmoplast, 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 month 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.  If you apply sunscreen and wear sun protective clothing, your skin will look good longer than if you are tanning like crazy.  If you are careful with your skin, your skin will probably 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 months, to see the best results.

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 should cost from $900 to about $1400. A full face plus eyelid should run $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 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, listen to music, while the numbing cream takes affect.

After you numb for about an hour, the numbing gel 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 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 & 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 having some mild swelling and redness for 2-3 days after the treatment.

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/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 1-3 days. Usually you can go back to normal activities including work, with make-up, the next day. 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 "bronzing" 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.

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 the next day or the day after. Swimming in a chlorinated pool is not advised for 1 week. You may exercise outside with a hat and with a high-quality sunscreen with 5% zinc or titanium.

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, 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 mild, 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 non-ablative fractional resurfacing lasers (like the Fraxel) and ablative fractional carbon dioxide lasers (like the DOT, the Active Fx and the Affirm).

The non-ablative fractional resurfacing lasers do this process of fractionally resurfacing your face, usually 15 to 20% with each treatment without any visible marks. Your face is red for a short bit and then that turns to a kind of bronzy color and then it heals over quite nicely without ever needing to miss time from work or social activities except for a couple of days.

The ablative fractional CO2 lasers treat more deeply but also require some 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 non-ablative laser, which is the first of the 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 would recommend sticking with the Fraxel because the results are the most predictable and are consistently excellent.

If you live in a large urban area near doctors with extensive laser experience, and you don't mind a bit more downtime, you can certainly investigate the ablative fractional CO2 lasers, like the DOT or the Active Fx.

How does the Fraxel laser work for acne scars?

How does the Fraxel work for sagging skin?

How does the Fraxel work for wrinkles? 

Link to Fractional Laser Video Demonstration

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

From www.SkinTour.com and Dr. Brandith Irwin. Copyright 2008-2012 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.