Question 1

What is a fractional laser?

Accepted Answer

Fractional (or fractionated) lasers resurface and rejuvenate skin to treat fine lines and wrinkles, scars, hyperpigmentation, uneven tone, and textural issues.

While a fully ablative laser removes the entire surface layer of skin in the treated area, fractional laser beams are broken up into smaller units, so they target between 25% and 40% of the skin’s surface, leaving the rest intact.

The surrounding intact skin helps jump-start healing, stimulating the production of new collagen and the turnover of new cells. Because a majority of the skin is left undamaged, fractional lasers offer a quicker recovery, so patients can get back to work and other normal activities faster.

Fraxel is the gold standard in the non-ablative category. “The original fractionated laser was Fraxel, and the first fractionated CO2 laser was ActiveFX,” explains Dr. Michael Persky, a plastic surgeon in Encino, California. “Fraxel Re:pair was the second fractionated laser. There are now more than 12 companies with fractionated CO2 lasers.” Other popular fractional lasers include ResurFX, SmartXide DOT, CO2RE Laser, Cortex, and DeepFX, a more powerful version of ActiveFX.

Every fractional laser is different, so it’s important to consult with a board-certified dermatologist or plastic surgeon in order to find the right laser treatment for your skin type and concerns.

Question 2

What are the pros and cons of a fractional laser treatment?

Accepted Answer

Pros

It can treat acne scars, age spots, and even wrinkles, often producing significant results after a single session.
Typical downtime is less than a week, with a shorter and easier recovery than from fully ablative lasers.
Most fractional lasers are equipped with a continuous cooling mechanism, to improve your comfort and reduce the risk of burns.
Post-procedure, most people see smoother skin within a few weeks—and results continue to improve for another six months.
There’s less risk of significant complications such as scarring and pigmentary changes with fractional lasers compared to fully ablative lasers.

Cons

People with severe pitted acne scars (which are difficult to treat) may need more than one treatment to be satisfied with their results.
You’ll need to avoid sun exposure for at least a week after a fractional laser treatment and be diligent about applying sunscreen every day, to maintain your results.
Some fractional lasers aren’t recommended for people with olive or brown skin, due to the risk of developing melasma or other types of hyperpigmentation.
Fractional laser treatments can result in burns or scarring when they’re performed by an inexperienced provider.

Question 3

How much does a fractional laser treatment cost?

Accepted Answer

Your cost will depend on which type of laser treatment you have, the size of the area you’re treating, your provider’s level of experience, and their practice location.

This is considered an elective cosmetic procedure, so your health insurance won’t cover the expense.

Question 4

Fractional laser before and after pictures

Accepted Answer

The fractional laser photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Who makes a good candidate for fractional laser resurfacing?

Accepted Answer

Optimal candidates have facial lines, wrinkles, scars, spots, or more extensive sun damage that they would like to treat. While there isn’t an age minimum or maximum, kids under 16 shouldn’t have laser treatment for facial rejuvenation. However, it is safe to treat scars and certain birthmarks.

People who have particularly sensitive skin or are prone to vitiligo, keloid scars, psoriasis, or scleroderma (a condition that rapidly increases collagen production) should skip the fractional laser or any other ablative laser, which will only irritate your skin further. The same goes for those who have been diagnosed with skin cancer—although lasers can provide significant improvement to scars once the cancer has been removed.

Typically, people with brown or deep skin tones are more at risk for melasma or hyperpigmentation, whereas those with fair to medium skin tones can tolerate the procedure well, barring no other contraindications.

Avoid laser treatments if you’re on medications that cause increased light sensitivity, such as Retin-A, or acne antibiotics like tetracycline, minocycline, doxycycline, or erythromycin. Fractional lasers also can’t be used on patients who have taken Accutane within the previous 12 months, as this can increase the chance of scarring.

There aren’t yet conclusive studies on laser resurfacing when you’re pregnant or breastfeeding, so it’s not recommended to undergo treatment if you’re expecting or nursing.

Question 6

What happens during a fractional laser treatment?

Accepted Answer

Before your treatment, make sure you’ve removed all makeup and taken off any jewelry. Your provider will apply numbing cream, which can take up to an hour to have the full effect. After the cream has fully penetrated the skin, they’ll wipe off the excess and clean your skin.

Then the laser will be passed across the treatment area. The number of passes depends on which fractional laser they’re using and how aggressive the treatment will ultimately be. The whole procedure takes about 20 to 30 minutes for the face and a bit longer for larger areas of the body.

When they’re done, your skin will feel hot and red. This can be cooled with a Zimmer cool air chiller, a cool mask, or an ice pack. Your provider will apply moisturizer and sunscreen and provide specific skin care instructions to take home.

Question 7

What is the healing process for a fractional laser treatment like?

Accepted Answer

Your downtime and healing process will depend on the intensity of your treatment, but most people experience swelling and redness for up to a week. Your skin should look and feel mostly healed by day six or seven. Before then, you can use cold compresses to help alleviate any discomfort. Sleeping with your head elevated can reduce swelling.

After more intense treatments at a higher setting, you may need a few extra days off work. You should be healed and presentable within 12 days, but your complexion may appear bronzed or flushed for about two weeks. Don’t pick or peel any flakes or scabs.

Avoid direct sun exposure for at least two to three months (ideally longer, to help preserve your results). When you’re outside, wear sunscreen with an SPF of 30 or higher and a wide-brimmed hat.

Question 8

When will you see results and how long will they last?

Accepted Answer

You’ll see your final results 8–12 weeks after your procedure. Results can last up to three years, and you can extend them with an occasional lighter laser treatment such as BroadBand Light (BBL) or IPL, or a chemical peel.

Question 9

Is fractional laser resurfacing safe?

Accepted Answer

Fractional lasers are FDA-cleared for safety in treating “periorbital wrinkles, acne scars, surgical scars, dyschromia, and pigmented lesions, such as age spots, sunspots, and melasma.” Additionally, a clinical study notes that fractional laser resurfacing is very safe “when used according to accepted parameters.” This means that they’re especially safe when you choose an experienced practitioner with a thorough knowledge of laser treatments and aftercare, who can effectively treat any complications.

Question 10

What are the risks and side effects of fractional laser treatments?

Accepted Answer

Fractional lasers intentionally injure your skin on a microscopic level, so the treatment can be uncomfortable—it can feel hot or like a pinch or the snap of a rubber band—but the level of pain you’ll feel will depend on your own tolerance and the intensity of the treatment. Swelling, redness, and tenderness can last anywhere from a few hours to several days to a few weeks, depending on the aggressiveness of your treatment and your skin sensitivity.

As you heal, watch for signs of infection or contact dermatitis. Acne, milia, and herpes cold sores can also flare up post-treatment. If you are prone to cold sores, it’s beneficial to begin an antiviral treatment two days prior to your treatment. You will have swelling, redness and mild discoloration of the skin with tiny dots on the skin following your treatment. Bleeding, oozing, crusting, and scabbing is uncommon with less intensive treatments. If you experience blisters, scabbing, or significant pain after your treatment, contact your physician. These could be indicators of an infection.

There’s some risk of scarring, which can be temporary or permanent and can lead to hypo- or hyperpigmentation. These risks are significantly less common with fractionated lasers but are still possible.

The best way to avoid these complications is by choosing a laser surgeon who’s experienced in laser treatments. It’s also important to prepare your skin and body prior to the treatment to avoid these complications. According to Dr. Hessler, “Antivirals can limit cold sore outbreaks, which can lead to scarring, and hydroquinone or similar treatments can prevent PIH (postinflammatory hyperpigmentation) in predisposed individuals.” Using a high-SPF sunscreen is extremely important after treatment to avoid pigmentary changes to the skin.

Your physician will also make sure that your eyes are protected during the treatment. Everything from the numbing cream to the laser itself can damage eyes.

Question 11

Sources & studies

Accepted Answer

“Fraxel Treatment Consent.” American Board of Laser Surgery, 2020.

Lapidoth, Moshe, et al. “Fractional CO2 Laser in the Treatment of Facial Scars in Children.” Lasers in Medical Science, U.S. National Library of Medicine, Mar. 2014.Ngan, Vanessa. “Fractional Laser Treatment.” Edited by Amanda Oakley, Fractional Laser Treatment | DermNet NZ, 2015.

Ramsdell, William M. “Fractional CO2 Laser Resurfacing Complications.” Seminars in Plastic Surgery, Thieme Medical Publishers, Aug. 2012.

“Update on Fractional Laser Technology.” Edited by Michael H. Gold, The Journal of Clinical and Aesthetic Dermatology, Matrix Medical Communications, Jan. 2010.

Waknine, Yael. “FDA Clears Fractional Laser System to Treat Age Spots.” Medscape, 20 Sept. 2010.

Wanitphakdeedecha, R, et al. “The Use of Sunscreen Starting on the First Day after Ablative Fractional Skin Resurfacing.” Journal of the European Academy of Dermatology and Venereology: JEADV, U.S. National Library of Medicine, Nov. 2014.

FRACTIONAL LASER

Jill Hessler, MD

Colleen Williams

Jill Hessler, MD

Colleen Williams

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