Fractional Resurfacing with the FRAXEL® Laser
The Fraxel® laser is a breakthrough solution for the treatment of a variety of important cosmetic conditions, including dyspigmentation, photoaging, fine lines and wrinkles, melasma, and acne scarring. The Fraxel® laser combines the strength of an ablative treatment with the gentle safety of a non-ablative source.
Until recently, two types of light sources have been available for resurfacing: “Ablative” and “Non-ablative”. Ablative lasers, like the CO2 or Erbium:YAG lasers, remove the entire epidermis and portions of the dermis by vaporizing tissue at high temperatures with large treatment spot sizes. Ablative resurfacing is therefore very effective at destroying skin tissue and improving skin texture, moderate facial wrinkles, and dyspigmentation. Patients undergo a healing period of 1-2 weeks while the ablated area is replaced with a new papillary dermis and overlying epidermis; during which time patients experience discomfort, swelling, and unpleasant oozing and crusting. Once healed, patients experience prolonged redness that may last for several months. Non-ablative lasers and light sources, such as the pulsed dye laser, intense pulsed light (IPL™), and the Nd:YAG laser, treat skin conditions without removing or disrupting the skin surface. The healing response in the thermally injured dermis produces new collagen and repairs tissue defects associated with photoaging. Non-ablative treatments may improve skin texture, fine lines and wrinkles, dyspigmentation, dilated capillaries, redness and rosacea. These treatments have very few side-effects and involve minimal downtime, but require numerous treatments over many months to achieve only modest results.
“Fractional” Laser Resurfacing
The Fraxel® employs a new concept in laser resurfacing known as “fractional” photothermolysis. Fractional photothermolysis means a portion of the skin is treated, and a portion of the skin remains untreated; zones of treated skin are surrounded by intact, unaffected skin – so that only a portion, or “fraction”, of the skin is treated in any given session.
The Fraxel® is a mid infra-red (Erbium Fiber, 1550nm) laser which targets water in the skin. The Fraxel® employs an Intelligent Optical Tracking System (IOTS) that creates thousands of microscopic laser spots, each 70-100 microns in diameter, surrounded by untreated normal skin. These laser spots (known as Microthermal Treatment Zones, or MTZs) are deep microscopic columns of ablated tissue extending through the epidermis into the dermis. This advanced system of optics also ensures that the laser creates a consistent treatment zone pattern, delivering up to 2,000 MTZs/cm2 (microthermal zones per square centimeter) in a regular treatment session. The Fraxel® therefore produces a million microscopic points of light per treatment session.
The MTZs are not visible to the naked eye but can be seen under the microscope as shown by this area of treated skin.
Just as important, however, are the areas of skin that are left untreated surrounding each treatment zone. For every MTZ the Fraxel® laser creates, it leaves the surrounding skin unaffected and intact. This “fractional” treatment allows the skin to heal much faster than if the entire skin surface were treated at one time. The MTZs are extruded as microscopic epidermal necrotic debris. These treatment zones then heal by the production of new collagen and skin cells from the surrounding intact skin. Many of the stem cells in the papillary dermis are spared resulting in both rapid re-epithelialization of the epidermis as well as dermal collagen remodeling to depths of 400-700 microns. By design, each Fraxel® laser treatment session targets between 20% and 25% of the skin’s surface.
Benefits of Fraxel Laser
Whereas conventional ablative laser resurfacing treats the entire skin surface (removes the entire epidermis and varying thicknesses of dermis) and creates a full open wound, the Fraxel® laser does not disrupt the entire skin surface—providing the benefits of less discomfort, minimal downtime, rapid healing without oozing or prolonged redness, an extremely low risk for infection, scarring, and hypopigmentation, and no need for general anesthesia. The Fraxel® laser is a safer device that is well tolerated.
The Fraxel® simultaneously targets the epidermis for pigment, texture, and tone; and the dermis for pigment, collagen remodeling and resulting dermal thickening. Fraxel® treatment has shown significant improvements in skin texture, fine lines and wrinkles, and skin discolorations or mottled pigmentation such as age spots and sun damage. Because a Fraxel® laser treatment spares tissue, it can be used on most skin types and all over the face and body. Fraxel® can be safely and predictably used on delicate skin areas such as the neck, chest, arms and hands. Fraxel® allows us to treat patients we could not help as effectively before—particularly those with acne scarring, melasma, and dyspigmentation, and especially in individuals with darker skin tones. We can treat the textural changes and dyspigmentation of facial aging that is not adequately addressed with surgery. Fraxel® produces some dermal thickening, wrinkle improvement, skin tightening, and improves skin quality.
Treatment is accomplished with the use of topical anesthesia and an external air cooling device for patient comfort. The laser hand piece is rolled over the skin surface to deliver the laser treatment. Studies demonstrate that an effective treatment regimen is usually four Fraxel® laser sessions, spaced (two to) four weeks apart. Results are immediate and progressive. Patients note improvements after each and every treatment session. Improvement continues over weeks and months as your skin continues to produce new collagen in the treated area, producing longer beneficial changes associated with a healthy, youthful appearance.
Fractional resurfacing cannot quite treat deep lines and wrinkles as well as ablative laser resurfacing or the deepest peels; but what the Fraxel® does accomplish is a smart approach to resurfacing without the risk and “downtime” that is associated with these other treatment modalities. The limited downtime is very favorable, but is not zero.
Post-Treatment Information for Fraxel Laser Treatment
- Following treatment, patients will experience a mild to moderate windburn or sunburn sensation and swelling. Most swelling is gone in 2 days and most redness subsides over 3-5 days.
- Women can apply makeup after treatments, and men can shave
- There are no weeping or open wounds to care for and patients may return to work the next day. Others may require a little more time depending upon their skin condition and treatment.
- Your skin will naturally and vigorously exfoliate as new skin replaces dead tissue. Flaking is similar to that of minor sunburn, but is not painful. Use of a moisturizer will mask the appearance of flaking.
- A bronze appearance may persist for a few days as the microscopic areas are sloughed.
- A few patients will experience petechiae (tiny purple dots/bruises) which fade over several days, or an occasional blister.
- Be sure to use sunscreen (broad spectrum UV-B and UV-A spf 30) to protect your skin from sun exposure during both the healing phase and for several months after treatment. For added protection, use wide-brimmed hats and protective clothing when in direct sunlight.
The Fraxel® laser is FDA approved for soft tissue coagulation, skin resurfacing procedures, the treatment of acne scarring, the correction of periorbital lines and wrinkles, and for pigmented lesions, including age spots, melasma, sun spots and skin discoloration.