Hi Phillipa:

 Both can work well depending on how they are done.  The Fraxel Restore (erbium) laser takes 3-4 treatments to be really effective for actinic keratoses (AKs)  but the advantage is that you can go right back to work and activities. The Fraxel Repair (CO2) takes 1 or 2 treatments but you'll need at least a week off work usually.  If you are asian, hispanic or african american, the Fraxel Restore is much safer for you, since you'll want to avoid pigmentation problems after the laser.

 The IPL photofacial is not effective for AKs unless it's done in conjunction with aminolevulinic acid (ALA) which is a liquid photosenstizer that is painted on for an interval (usually 30-60 minutes) before the IPL treatment. The ALA soaks preferentially into the precancerous spots and then it is activated by the IPL.  This can be very effective but it is also a bit unpredictable in that some patients react only mildly to this with some redness and mild peeling and others really need 3-7 days off work to heal.  There can be pigmentation problems after this as well.

I hope this is helpful and your dermatologist should be able to fill in all the details!  Dr. Irwin