Fractional Laser: What You Need to Know

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.

• Average Cost:
• $1,525

• Range:
• $150 - $3,000

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.

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

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.

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.

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.

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.

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.

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.