“Should be done under full anesthesia.”
Fraxel Repair: NOT worth it
Pain: Worst possible
I am on my fourth day of recovery after my Fraxel Re:pair procedure. My recovery has been uneventful, so far, but the procedure was unimaginably painful. It was done in a surgery center, under "twilight" sedation -- and with nerve blocking injections in my face -- but I felt everything. The passes of the laser were like being peeled with a hot knife. This procedure should be done under full anesthesia!
If you are considering having more than one thing done, it's possible to pair Fraxel with other work, such as liposuction, that is done while you are fully out. The fact that some doctors do Fraxel Re:pair in-office, with just a local injection and oral pain killers, is shocking. I have a very high tolerance for pain, and I was prepared to have this procedure hurt. Nothing could have prepared me for what it actually felt like. My body convulsed with each pass.
But on to the recovery.
After my treatment, my face looked frightening and raw, like it was covered in "road rash", as blood oozed from the laser perforations. It felt hot initially, but the nurses placed a cool vinegar compress on it, and my skin cooled. When I got home, I slept for an hour, then got up to do my first vinegar-water compress. The blood washed away, and I could see the dots of the laser's tracks. As the seepage of blood and serum continued, it looked as if I were sweating blood. I quickly applied a thick layer of Aquaphor, lay down on a towel-covered pillow, and waited for my next vinegar compress. I continued with compresses every two to two-and-a-half hours for 48 hours (setting an alarm at night). I had no pain, or stinging from the vinegar, and almost no inflammation. I slept with my head elevated, and I took a pain pill at night mostly so that I would remain still as I slept.
I was scrupulous about cleanliness when doing my compresses. I sterilized the bowl, in which I soaked my gauze, with Pinesol every time I used it. I washed my hands before touching my face for any reason, or used a tissue to press lightly on any place that tickled. I changed and washed my p.j.s and robe twice daily (seepage around my face, and sticky Aquaphor). I changed the towel on my pillow. I used a straw to drink.
On the second day, my skin was seeping only serum, not blood. There was no crusting, due to the regular compresses. My face looked red, but not overly raw. It felt deeply bruised in places. My eyelids were visibly bruised and purple. When I touched my forehead, where the skin is stretched taut, the skin felt thin and fragile, as if it might break. I made sure to keep away from the light in my bright house, and I kept up the soaks and thick slathering of Aquaphor (which by this time was in my hair, and all over my house).
On the third day, my skin was showing signs of wanting to crust. I upped the soaking times for the compresses, and applied Aquaphor as if I were frosting a cake. Some small pimples had erupted, and my skin had taken on a much redder, almost purple color. I was afraid of infection and an acne breakout, so I phoned my doctor's office and got the go-ahead to start using cleanser on my skin on day four.
Today is day four, and I was finally able to wash my hair and my face with mild cleansers (Aquaphor cleanser for my face), and switch to a mild moisturizer instead of the Aquaphor. My skin has formed a rough, almost sandpapery layer of what I assume is dead skin. In some areas it shows signs of wanting to slough off. When I applied a heavy layer of moisturizer followed by a titanium dioxide sunblock (the chemical sunblocks will sting and irritate your skin after Fraxel, so physical sunblocks are preferred), My deeply red skin turned purple, with a metallic sheen. So I strongly disagree with my doctor, who said that I would be able to leave the house on day four. I am still housebound and looking freaky.
Overall, I like the firming up I see on my skin (which I am told is partially due to temporary inflammation, as long-term improvement happens over months). I am very worried about how red my face is, and that some areas of my face seem to have diminished feeling, topically. However, that seeming numbness might be due to the layer of dead skin that hasn't peeled yet. I like that my acne scars seem to have been zapped off. It's too early for me to have a a final opinion on this procedure. But I cannot stress enough to anyone considering this: Fraxel Re:pair hurts. If I'd know what the pain level was, I never would have agreed to do this under partial sedation.
I will update this post as my face changes over the next weeks.
Updated on Dec 17, 2008:
A note on why I did not provide the name of my doctor:
I have purposely left off the name of my doctor so that I can be completely honest about the details of my Fraxel experience-- good and bad. I have encountered some reviews on this site that appear to be blatant promotions for medical practices. I do not agree with the practice of listing the name of the doctor for that reason: it invites such disguised advertising. For the record, the doctor who did my Fraxel is a well-respected, Board-certified plastic surgeon. The price I was charged is the going rate for my area.
Updated on Dec 17, 2008:
All previous updates on recovery are in the posts below.
Two weeks after the procedure, my skin is almost normal, and I am back to my regular life. Since some of the immediate improvements from Fraxel:Repair do regress before your collagen replacement takes over, I am still undecided as to the usefulness of this procedure. My choice of the "it's not worth it" button is based entirely upon the level of pain I experienced. No beauty treatment is worth that much pain to me. Done under full sedation, I would not consider this such an onerous procedure. My recovery process was relatively easy, though I did have a few side effects (including some potentially permanent facial numbness). Had I been fully sedated, would I have considered Fraxel "worth it"? My answer to that depends on whether I regain full feeling in my face. If I do, I'd say "yes". If I don't, then I would have to say "no way". Right now, I'm sticking with the "no".
I would urge anyone considering Fraxel Re:Pair to do a lot of reading about it first, and consider all the risks -- large and small -- before going ahead with it. Try to find someone who has had it done, with whom you can talk in person. Then ask yourself whether it's worth it for you. This is a cosmetic procedure. It's optional. Always keep that in mind.
Dec 6, 2008Comments and replies (26)
9 posts
8 Dec 2008
I had my fraxel repair three weeks ago. My face is still very red , with some places more so than others giving my face a patchy look. Makeup does not go on smoothly so it is very hard to cover the reddness. My skin has areas where it is very bumpy. Unfortunately, I got a bacterial infection on the 4th day of my procedure. It was resistant to the antibiotic, Keflex, the Dr. had me on. I was given Cipro which cleared the infection,but the infection had spread to several areas on my face and those areas are still very scaly and also difficult to cover with makeup... powder or liquid mineral makeup! Even without the complication I encountered, I can not see how anyone can say the "downtime" from this procedure is only 7 days. The positive side of this ordeal is what appears to be the tightening around my eye area. That area healed right away and looks good. Hopefully, I will be able to say the same thing about the rest of my face in another couple of weeks! I agree with California crookedteeth, the pain from this procedure is unbelievable even with nerve blocks and valium.
135 posts
8 Dec 2008
once again this is an example of the understated downtime and recovery. as well as the side effects. file a report with reliant (now thermage) so they are forced to change their literature.
75 posts
11 Dec 2008
Cyn, that is awful that you got an infection! That was one of my biggest fears. I hope that your skin evens out over time. Perhaps gylcolic peels would help, once you are able to get them (my doctor said I should wait until my skin is no longer red to start my peels again). They helped with my skin texture and color pre-Fraxel. Here is a good translucent sunscreen powder to try, which takes down the redness a lot (and also counters the sheen of titanium dioxide sunscreen): Colorscience Sunforgettable Dispensing Brush. It's UVA/UVB, SPF 30. I think I bought it from Bliss. It's expensive... sorry. I had my follow-up appointment with my doctor (day 6 of recovery), and was told that everything was on-track and that I looked very good for this stage. Much of my dead and hardened skin has come off in the shower (with very gentle, downward massaging in the steam). My skin is patchy and red overall, and I have areas where either broken capillaries (or just thin skin or bruising) make purple and red marks. I have very minor inflammation, mostly in my cheeks. When I apply Cetaphil cream, followed by a titanium dioxide sunscreen for babies, and then by a generous layer of a sunscreen powder, my skin color is closer to that of a fair Caucasian person, but nowhere near the normal color of my neck and chest. My forehead, viewed up close, makes me think of an elderly person who has undergone treatment for precancers of the skin. It has that same scaling and blotching. Since I lost some hair to the laser, my hairline is stubbly and unattractive, which doesn't help. At the doctor's office, I was introduced to another woman who had the same treatment on the same day I did, and she was way behind me in healing. She still had darkened, dead skin covering her her entire forehead. She seemed to be upset about it. So the healing time for Fraxel Re:Pair does seem to vary considerably. In my opinion, a week is needed before one can rejoin society, at least. If you are taking off time from work for this, it would be ideal to use five days of vacation bracketed by two weekends and the Friday before, and have the procedure done on that Friday -- if you can work it out with your doc, and good luck on that. One big area of concern for me is still the partial numbness of my temples. The feeling is like Novocaine when it is wearing off, and my doctor told me that this is indeed the cause. Novocaine was injected deeply into those areas, and it takes time for the feeling to come back. In most cases it does. Cross your fingers. My skin has started to itch, especially at night. I've continued the vinegar soaks a few times a day, and I still use Aquaphor at night because it calms the itch. I got up once last night for a vinegar soak. When I told my doctor that Fraxel should be done under sedation, he said that it was an option, but it was more cost and risk. I asked the cost difference, and was told $500. For someone who has been getting line fillers and Botox for some time, that's a drop in the bucket. I would have chosen full sedation, had I known it was an option. I am healthy, and face minimal risk from sedation.
36 posts
8 Dec 2008
Thank you for the excellent play by play regarding your recent Fraxel Repair. Sorry to hear about the pain you experienced. Why didn't you demand more pain meds. This is inexcusable. Well, keep us posted on your healing process. I would love to see pics if you have any. I really seem to think it takes a good month to look halfway decent and perhaps three to see results. I wish you all the best and be patient .I think the final outcome may be worth it. I'm, next!! Oh! can you email me your physicia's name as it doesnt say in your post. Thanks, Chardy
75 posts
9 Dec 2008
Chardy, my doctor said he asked me during the procedure whether I wanted to stop and get more meds, but in fact he didn't ask. He just kept going. At one point I did interrupt him to tell him to stop pushing so hard on my eyeball (which he was doing while using the laser near my eye). One of the drugs you get in "twilight sedation" is supposed to make the patient forget the entire procedure, including the pain. I remember the whole thing, though. So I think that the drug mix was off. May the anesthetist have Fraxel! This is day seven for me, and the skin on my lower face is much smoother. My forehead is still looking like a wall from which you've partially stripped wallpaper -- patchy and vaguely striped. I've had some pigment come up in stripes on my left cheek. I think this must have been from driving to the doctor's office yesterday (sun through the driver's side window), even though I was plastered with sunscreen at the time. I'm sure this pigment will fade over time, but I'm not going to be driving mid-day for a while. There is one thing that is really bugging me. In between my eyes I have a patch of dark red dots about the size of a nickel. They are obviously the holes left by the laser, and they came up after I had peeled. I have a similar dark spot in the indent of my chin. Areas of thin skin? I am anxious for them to fade. No improvement in the feeling in my temples yet. My doctor suggested that this numbness might help my migraines (!). Skin care has been washing in the shower with Aquaphor cleanser, short vinegar water soaks three times a day, Cetaphil cream during the day and Aquaphor ointment at night. I think that the vinegar soaks are no longer part of my required regimen, but they feel good and they make sense to me. My skin still feels very vulnerable. The vinegar water feels deeply cleansing and soothing. My husband brought home a chocolate cake from a good bakery and made reservations for us to visit a resort in a month. That's an entirely different type of medicine, but a good one.
9 posts
9 Dec 2008
Hi California "CT"... You sounded like you were very careful about evading an infection. I also changed Pillowcases, washed hands etc etc. I thought I did everything right, but obviously I did NOT! The bacterial infection certainly complicated my recovery. Thanks for the hint on makeup help. But, any type of powder just "CAKES" and looks terrible. My face feels so tight and sort of "itchy" after a couple of hours after I apply any type of cover up on the face..[forget trying to cover the neck]. I am just trying to be patient and realizing that "time" will heal. I am sure the type of skin one has makes a difference in the recovery time. I do have 'thin' skin' which contributes to the prolonged reddness of my face and neck. I also had some of those patches of dark areas you describe. As I said I am over three weeks out and they are fading... Hang in there! I also had some numbness in my face area, but that has subsided three plus weeks out. I did start to add VIT. C to my recovery creams and that really seemed to help in my skin recovery. . I use COSMEDIX vit c in a powder form that can be added to any product. Very happy with that product.
75 posts
9 Dec 2008
Hey, Cyn -- I'll look into the Cosmedix. It sounds like a good idea. I'm a little scared to hear that you still have the dark areas after three weeks. Yikes! I am trying to be patient. Great news about the numbness subsiding, though! Thanks for that. I think that if you had Keflex-resistant bacteria in your body or in your environment when you had the Fraxel, you would probably have gotten an infection anyway. Keflex works systemically by destroying the outer "walls" of bacteria in your body, and any susceptible critters will die when exposed, but it's used for a narrow range of infections. Cipro is a broad-spectrum antibiotic that is used against many things, including the very scary MRSA. You probably did everything right, but the drug didn't work for you. Did the doctor do a culture? Was it a staph infection? I saw a photo of someone's horrible, disfiguring infection from Fraxel (I think it was on this site), and my gut, germaphobe reaction was... that's just where someone would hold a phone against a cheek. I avoided the phone as much as possible my first three days. When I had to use it, I held it about three inches away from my head. But then I'm the kind of person who washes my hands after using my keyboard -- all the time. The sunblock powder I mentioned disappears on the skin, btw. It's not a makeup. But here is another thing to try. It's a tinted, full-spectrum sunblock (physical, not chemical block) that is full of dimethicone so it goes on like silk: Tizo 3 Protection, SPF 40.
9 posts
10 Dec 2008
hi California CT, Thanks for your insight regarding Keflex. Yes, Dr. did cultures..... for MARSA, Yeast, Herpes etc. The culture came back as a Enterbocater Cloacae. Are you familiar with it? You sound like you know quite a bit about infection/bacterias etc. I looked it up online...Not sure how it showed up on my skin.. neither is the DR. It did not show up until Day 5. and I went to her on Day 1,3[ she said everythig looked fine those days] and then Day 7. So, by the time I got to her it had spread considerably. I was not sure what was going on, but I noticed it looked different than the other peeling skin,. I just wish she had caught it before it spread... on Day 3. I will check the sunblock powder... I tried mineral makeup for the first time since I had the REPAIR [Nov 17] and it feels so dry and tight on my face. I have a function to go to tonight.. my real first 'public' outing, so I am hoping the lights will be very low! Most of my red patches are where the infection was.. the rest of my face esp. the undereye are is more dark pink. I also had my neck done and it cleared up fine. Let me know how you are doing.... I would send you photos if you were interested but I am not sure how to do it on this blog.
75 posts
12 Dec 2008
Cyn -- I read up on your pathogen. sounds like you dodged a bullet there, so good observation on your part. Can you describe better what the peeling difference was? As I told you, I am germ obsessive. I wonder whether I would ever notice something like that. From my reading, I learned that the risk factors for Enterobacter species include having taken antibiotics within the last 30 days, and having had an invasive procedure done within the past 72 hours. You had both. Also, most skin and soft tissue infections with this pathogen are hospital-acquired. You might have been exposed at your medical center. I'm glad to hear that you feel confident enough to go out socializing! Just smile a lot. It makes people smile back. I'd love to see any photos you took. You just have to click on my log-in, and follow the instructions to send a message. Thanks. So, my condition on day eight: from my eyes down I look like someone who has spent time in the sun and is somewhere between sunburned and bronzed. The skin texture is (close to) normal, and soft. I have a couple of pimples near my mouth (bummer), and some roughness and broken capillaries on the bottom of my chin and along my jawline (I did not have my neck done). But otherwise, the bottom portion of my face is looking close to normal. My cheeks are still slightly swollen, but it actually looks good (think Scuptra). The slight swelling around my mouth that did what line fillers used to do for me is deflating a bit (again, bummer), but not completely. Some of my acne scars have reemerged, though somewhat diminished. But... my forehead still looks like it has been peeled in strips. Dots of blood show through the skin -- sort of a flat road rash effect -- on the upper temples. I know the forehead skin has little or no fat under it, so perhaps that's the difference. It is slow to heal, and still feels tender. The dark discoloration I've been worried about (a disc of red laser dots) between my eyes hasn't budged, although the similar mark on my chin has faded. I still have some small, dark dots on my eyelids. The numbness in my temples might be a little better, more on one side than the other. Still numb, though, and occasionally I have a deep itch in the numb areas, which is really awful. Today is the first day I would feel comfortable enough to return to a job if I had to (I work from home). No one would be fooled if I tried to pass off my "tan" as the result of skiing, or a trip to Hawaii, but my skin is healed enough to accept a little makeup, and I wouldn't feel too freakish. So for me, initial recovery from Fraxel Re:Pair was a full week, but my crusty forehead is still far from being "whole". I'd estimate another week or ten days for cell turnover there, and I have no idea when the stripes will even out. Another product suggestion for post-Fraxel patients: Blue Lizard Sunscreen. It's chemical and fragrance-free, and SPF 30, good for UVA/UVB. It doesn't bother even the most tender skin. Goes on thick and white (titanium and zinc oxides), but calms down a bit when it dries.
75 posts
12 Dec 2008
Sah52, you must be a strong person to have just a topical for a laser treatment! And then drive home... yikes! I suspect that how long the facial redness lasts depends on how you heal, and how prone you are to facial flushing normally. I blush easily, and get red-faced in a hot room. I get dark red marks from scars. After Fraxel, my face was bright as a beet on day four -- redder than it was the day before -- and I was a bit depressed about it because I seemed to be going backward instead of getting better. For me, the redness started to lessen soon after I peeled. The vinegar water soaks helped a lot. whenever my face started to feel hot or itchy, I would do a vinegar water soak, then wash with Aquaphor if I could (not too good to wash with cleanser more than 3 times a day... too harsh) or just pat dry and reapply Cetaphil cream and sunblock if I couldn't. The vinegar seems to take the heat out of the skin -- maybe constricts the blood vessels a little. I'm washing my face in the steamy shower, but I turn the water to tepid for the water I actually use on my face, and I don't put my face under the full spray. I'm not exercising or taking hot baths. I'm generally acting as if I have severe rosacea. I see improvement daily on the lower part of my face, which is a pretty normal color today. My forehead is still ugly, alas. I am not recommending any of this, and all things should be okayed my your doctor and all that, but homemade sunburn remedies might take down the redness a bit. Cucumber, spent tea bags, egg white, yogurt, milk, apple cider vinegar... all kinds of things can be used as masks to help constrict the blood vessels. Always do a skin patch test. Google "sunburn remedies". I have read elsewhere that some doctors prescribe cortisone cream for post-procedure redness, but I'd avoid it. My sister used a cortisone cream on her face for years (her doc said she had rosacea, but I don't think she did... I was once told by a doctor that I had rosacea, and multiple doctors subsequently said I didn't), and her face is PURPLE now. The cortisone abuse permanently thinned her skin and damaged her blood vessels. Nasty stuff. And by the way, I was prescribed the topical steroid Clobetasol Cream for use before Fraxel, as is common practice for this procedure. But I am one of those people who always reads the package insert. And the insert for this product said --- not to be used on the face! Other observations about my skin on this, day nine: My skin is hypersensitive, especially my forehead. I cannot stand to have hair touch any part of my face, so I must keep my layered hair pulled back tightly in a band. The feeling, when a strand of hair strays, is like when you have an advanced case of poison oak, and the touch of clothing on the affected area triggers a deep itch that makes you want to claw the skin off. Vinegar soaks and Aquaphor ointment take the itch down at night. I do my best to avoid touching my face for any reason outside of washing, soaking and applying lotions. With my hair plastered back, and my stubbly hairline, I am a walking bad-hair-day. I have noticed that my healed skin, on the bottom part of my face, is surprisingly fragile. Just pressing too hard will break blood vessels and leave purple marks. I would not schedule dental appointments within a couple of months after a Fraxel treatment! I haven't worn my contacts since treatment because I haven't felt comfortable pulling down my lower eyelid to put the contacts in. I'm afraid I will bruise. On the first couple of days after Fraxel, I noticed that my eyeglasses left bruise marks on the bridge of my nose, so I went without glasses for three days. My forehead feels tight and dry, even under moisturizer, and some very small areas have opened up again so that raw skin is revealed. I don't know whether this is a second stage of peeling or whether I've been too vigorous in washing. Aside from the itching, there is no sign of inflammation or discoloring, so I am not suspecting infection. I've been treating this area with even more care, and applying Neosporin to any broken skin. The larger acne scars around my chin and mouth are getting back to where they were before Fraxel. I try to remind myself that the real skin repair takes months with Fraxel, but the truth is that this feels like failure to me. Oh, well. Thank heaven for line fillers. The texture of my healed skin is not as smooth as I had hoped for. It has a slight pebbled texture, which the doctor says is probably just the normal texture that lay beneath all the skin that peeled away. I do think that it is more taut overall, especially under the eyes. (I did not have any deep folds or huge sags before Fraxel, but I had some sun damage, and my skin was starting to show signs of laxity under my eyes, around my mouth, and on my cheeks.) I seem to have slightly more feeling in my temples. Good news there. Trying to remain calm and unemotional during recovery has been important for me. Keeping my face still helps to keep it comfortable. If I frown, my forehead itches. If I smile, my cheeks itch. I am concentrating on being inscrutable.