I'm considering Fraxel Re:store laser for severe acne scarring. I have Asian skin which is between Fitzpatrick Type V and VI. I've never seen Fraxel before/after photos on Type VI skin. I've had mild peels before (e.g. lactic acid peels 30% and 50%) on my face without hyperpigmentation. Is there a serious risk of hyperpigmentation for me with the Fraxel Laser? Will low laser settings be effective without causing any side effects?
Fraxel Re:store for Type VI Skin?
Doctor Answers (5)
Yes, but proceed with a well-qualified physician
Fraxel re:store for Acne Scars in Asian Skin
Type VI skin is always risky to treat. Type VI skin, the darkest skin possible, has been treated with Fraxel re:store. I have treated scars without pigmentation problems.
Asian skin is usually type IV. We do treat Asian skin with Fraxel re:store at low density, multiple treatments, separated by at least 3 to 4 weeks. Pre-treatment with a bleaching agent is also preferred. There is a low risk of hyperpigmentation in any patient. Avoidance of sun exposure and use of a good physical sun block and protective clothing is recommended.
Good luck and be well.
Most likely yes
First, I am wondering if you really have type 6 skin. Asian patients generally fall in the type 3-4 range. Imagine the darkest skin you have ever seen in your life and that would probably be a six. I lived and practiced in Japan for 2 years and have published articles on Asian skin and the Fraxel restore. We treat this type of skin in our practice on a daily basis and have great photos of this. In our research, we found that Asian skin is more likely to hyperpigment with increased density (% of skin treated in one session) and is not related to the depth of treatment. This technology is the best and safest for your skin type. You will most likely need at least 4 treatments. If you hyperpigment, it could last weeks to months, but the improvement in your acne scars will be long lasting. Seek out board certified derm or plastics for your treatment and make sure the physician does the treatment. Take care, Dr. Groff
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Fraxel for Acne Scars in Darker Skin Types
Since Fraxel Re:store is a non-ablative laser, there is significantly less risk of pigmentation issues compared to ablative CO2 treatments. When used at proper settings, it is a good option for darker skin types III-VI. Most Asians are Fitzpatrick Skin Type III-V. If you have had peels performed without pigmentation issues, you should be able to undergo Fraxel treatment without problems.
Fraxel is a safe option
In my experience, the key is the treatment level. If it is kept low (TL 4) is a good place to start, I have not seen post-inflammatory hyperpigmentation. The treatment level determines the density or percentage of coverage, which is more important than the energy level used when worrying about pigment. The energy levels used should be high to go deeper for acne scars. It is always a good idea to be pre- and post-treated with retinoids and hydroquinone, and of course, sun protection. It is also a good idea to do Re:store for darker skin types in the less sunny winter months. Clinique Medical now has an entire line that seems to improve results from this procedure as well. Ask your dermatologist about this and other pre-and post-treatment protocols to improve results and decrease complications.