Q: What are the pros and cons of Fraxel?

Pros Fraxel laser downtime can be less than a week (unless you’re treated with the ablative Fraxel Re:pair). Patients see fresher, firmer, smoother, and more evenly toned skin just a few weeks post-procedure, so better skin is attainable relatively quickly. Results continue to improve for six months afterward. The treatment harnesses the skin’s natural healing process to produce healthy new skin cells and increased collagen. Beyond your face and neck, it can also resurface the hands, neck, and décolletage. The Food and Drug Administration (FDA) cleared the first non-ablative Fraxel laser in 2003, so this is a tried-and-true treatment that many providers have used for at least a decade. Cons Fraxel treatments can result in burns or scarring, in the hands of an inexperienced provider. It can make melasma worse and more difficult to remove, according to Dr. Green. It's not a good option for people with tan, brown, or deep skin tones, who are at higher risk of post-inflammatory hyperpigmentation. While fractional lasers can treat light to moderate acne scars, patients with severe pitted acne scarring may need more significant skin resurfacing. While the majority of RealSelf members who've written Fraxel treatment reviews said it was “Worth It,” it has a lower rating than some similar treatments, like the CO2 Laser . Those who said it was "Not Worth It" found the treatment very painful or said it had left their skin looking worse than before.

Question 1

What is Fraxel laser treatment?

Accepted Answer

Fraxel is the most widely known brand of fractional laser treatments used for skin resurfacing and rejuvenation—so popular that many people refer to any fractionated laser treatment as Fraxel.

In the early days of laser skin resurfacing, all facial laser technology ablated (removed the surface layer of) the entire treated area. These treatments often required weeks of downtime and had a high risk of side effects, including infection, hyperpigmentation, and scarring. Fraxel treatments are still able to induce new collagen growth, with far fewer risks and less recovery time.

New York City-based dermatologic surgeon Dr. Ronald Shelton explains that with Fraxel Re:store and Fraxel Dual, “instead of treating 100% of the skin’s surface area with laser energy, the beam is broken up into fractions” that target 25% to 40% of the skin’s surface and leave the rest intact—a process known as fractional photothermolysis.

The intact skin supports the healing process of the treated areas. “Because of this, the downtime and redness are less intense and don’t last as long as with ablative laser treatments,” says Dr. Shelton.

By causing micro-injuries to the skin, it accelerates the production of collagen and new skin cells, to replace older, damaged ones. This means that the repair-and-healing stage is crucial to a good result: the laser is the catalyst, while the skin essentially treats itself as it recovers.

RealSelf Tip: Fraxel laser treatment works best on fair skin, Fitzpatrick skin types I-III. People with light brown or more deeply pigmented skin tones are at risk for increased hyperpigmentation, so there are better skin rejuvenation options for those with deep skin tones.

Question 2

What are the pros and cons of Fraxel?

Accepted Answer

Pros

Fraxel laser downtime can be less than a week (unless you’re treated with the ablative Fraxel Re:pair).
Patients see fresher, firmer, smoother, and more evenly toned skin just a few weeks post-procedure, so better skin is attainable relatively quickly.
Results continue to improve for six months afterward.
The treatment harnesses the skin’s natural healing process to produce healthy new skin cells and increased collagen.
Beyond your face and neck, it can also resurface the hands, neck, and décolletage.
The Food and Drug Administration (FDA) cleared the first non-ablative Fraxel laser in 2003, so this is a tried-and-true treatment that many providers have used for at least a decade.

Cons

Fraxel treatments can result in burns or scarring, in the hands of an inexperienced provider.
It can make melasma worse and more difficult to remove, according to Dr. Green.
It's not a good option for people with tan, brown, or deep skin tones, who are at higher risk of post-inflammatory hyperpigmentation.
While fractional lasers can treat light to moderate acne scars, patients with severe pitted acne scarring may need more significant skin resurfacing.
While the majority of RealSelf members who've written Fraxel treatment reviews said it was “Worth It,” it has a lower rating than some similar treatments, like the CO2 Laser. Those who said it was "Not Worth It" found the treatment very painful or said it had left their skin looking worse than before.

Question 3

How much does Fraxel laser cost?

Accepted Answer

The price you’ll pay for Fraxel will depend on the intensity of your treatment, size of the treatment area, your provider’s level of experience, and a few other key factors.

You can finance your treatment with CareCredit.

See our complete guide to Fraxel costs

Question 4

Fraxel laser before and after pictures

Accepted Answer

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

Question 5

What's the difference between Fraxel Re:store, Fraxel Dual, and Fraxel Re:pair?

Accepted Answer

There are three types of Fraxel lasers. Your doctor should recommend the best type of Fraxel laser to get the results you want, but these are the high-level differences.

Fraxel Re:store

This non-ablative laser treatment leaves most of the skin’s surface intact.
It treats sun damage and early signs of aging, like fine lines around the eyes.
Most patients need three to five gentle treatments to stimulate the growth of new cells and collagen—which can lead to smoother, fresher skin, with improved tone and texture.
You’ll need about six days of healing time after each session.

Fraxel Dual

Fraxel Re:pair

The most powerful laser of the three, Fraxel Re:pair is ablative, so it removes the top layer of skin.
It’s intended to treat more severe skin damage, deep wrinkles, and even surgical scars.
“You’ll have more rawness, and you might need to stay home for a couple of days. You should be fully healed in about 10–12 days,” says Shelton. You’ll typically see smoother texture and softened lines after just one treatment.

The settings on each of these lasers can be adjusted according to what your doctor thinks you need and can tolerate.

Question 6

What is Fraxel laser good for?

Accepted Answer

Fraxel can treat a variety of skin conditions, depending on the type of laser and setting your provider uses.

It’s especially good for treating signs of sun damage, including age spots, fine lines, and wrinkles
By stimulating collagen production, it can also mildly firm skin (though it’s not primarily a skin-tightening treatment) and even out skin texture and tone, while making it look more radiant.
The treatment can also treat stubborn acne scars that both over-the-counter and prescription creams aren’t powerful enough to improve.

People who are age 40 or older may see the most benefits, although people in their late 30s with extensive sun damage, wrinkles, or uneven tone can see improvement from skin rejuvenation with Fraxel, too.

As we mentioned earlier, it isn’t safe for all skin tones. Patients with medium to deep skin tones are at risk of developing melasma or other types of post-inflammatory hyperpigmentation from Fraxel treatments.

“Some people with deep skin tones do get improvement of melasma, but others get worse. I recommend doing a test area first and watching that over six weeks,” recommends Dr. Shelton.

Also avoid Fraxel if you’re on medications that cause increased light sensitivity.

Question 7

What happens during a Fraxel laser treatment?

Accepted Answer

Here’s what to expect during a Fraxel Dual treatment.

Your provider will apply a topical anesthetic to make you comfortable and less likely to feel the laser’s effects during the procedure.
You may need to wait up to an hour for the numbing cream to take effect.
Typically, the provider will perform four passes with the laser on each quadrant of the treatment area.
Most lasers also blow cold air on the treatment area as they work, though you may still feel heat. Some patients feel almost no pain, while others feel real discomfort (even with the numbing cream). Your experience will depend on your body’s tolerance and the intensity of the energy.
How long your treatment takes will depend on how many areas of your body are being treated, but Dr. Shelton clocks a facial treatment at about 20 minutes.

Question 8

How many sessions of Fraxel laser treatments are needed?

Accepted Answer

You'll see big benefits after a single treatment with Fraxel Dual or Re:pair, though some people do return for a second treatment, depending on their concerns and goals.

With Fraxel Re:store, most people need two to three to see a significant improvement in brown spots caused by sun damage, and three to five treatments for acne scars.

Question 9

How long does Fraxel recovery take?

Accepted Answer

Your recovery time will depend on the intensity of your Fraxel laser resurfacing treatment. You and your doctor can plan the best approach for you—based, in part, on how much recovery time you can spare.

With Fraxel Re:store, you should need only one day of downtime and be fully healed in six days. According to Dr. Shelton, some swelling, rough brown dots, and redness (similar to a sunburn) start to show three to four days after this gentler treatment, then heal by day six or seven.
The Fraxel Dual has two different settings. The stronger 1927 setting for pigmentation usually produces initial redness, followed by peeling and dry skin for up to 7 days, while the 1550 setting usually only has 48 hours of redness and swelling, says Dr. Green.
Fraxel Re:pair treatments are more intense, so you may need a few days of at-home recovery and 10–12 days before you’re fully healed.

You can ensure healthy healing by taking good care of your skin post-treatment. Use a gentle cleanser and simple moisturizer. Skin-care products with active ingredients like retinol and alpha hydroxy acids can irritate vulnerable, healing skin, so it’s best to stick to gentle basics. See what doctors recommend.

Your skin will be more sun-sensitive after your treatment, so avoid direct sun exposure and wear a wide-brimmed hat outdoors, as well as broad-spectrum SPF 30 sunscreen, like the ClarityRx Skin Defense Environmental Protection SPF 30.

Question 10

How long does it take to see results from Fraxel?

Accepted Answer

You’ll see somewhat of a difference once you’ve healed (especially if you had Fraxel Re:pair), but the lasers' manufacturer says optimal results usually show up 8–12 weeks after your procedure.

“Because only a fraction of the skin is treated during a single session, a series (typically three to six treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement,” reports a study published in Aesthetic Surgery Journal. Results continue to improve with each additional treatment, with optimal results three months after your last treatment.

Laser resurfacing results last about three years. You may be able to extend that time with an occasional chemical peel, a “mini-Fraxel” with Clear + Brilliant laser, a healthy skin-care routine, and daily use of sunscreen with an SPF of 30+.

“I often use the Fraxel laser treatment as a time to review the correct skin care with my patients,” says Dr. Green. “This usually includes adding a vitamin C serum, retinols, or alpha hydroxy acids.”

Question 11

Is Fraxel laser safe?

Accepted Answer

Fraxel is FDA-cleared and widely considered to be safe. Fraxel laser side effects tend to result from provider inexperience. Burning, scarring, and pigmentation issues can result from treatments that are too aggressive. Some RealSelf reviewers have also reported facial fat loss.

Doctors on RealSelf say side effects like scarring are uncommon with the Fraxel laser, though they’re more likely if you have a more aggressive treatment or if you don't have fair skin color.

Question 12

What are some alternatives to Fraxel laser?

Accepted Answer

You may want to consider these other popular resurfacing treatments for sun damage, signs of aging, or acne scars.

Chemical peels use an acidic solution to remove damaged top layers of the skin and reveal a brighter, more radiant complexion and help reduce sun spots, fine lines, and wrinkles. These in-office treatments are stronger versions of at-home acids and exfoliators. Just be aware that you'll probably need a series of multiple peels to get the same benefits of one Fraxel treatment.
Microneedling treatments, especially those that involve radiofrequency energy (like Vivace), also induce new collagen formation to treat many of the same skin concerns. Again, multiple treatments are needed for optimal results.
IPL (Intense Pulsed Light) is a versatile and effective treatment that can help remedy issues like sun damage, liver spots, broken capillaries, rosacea, and birthmarks on the face, hands, neck, and chest. It’s also less expensive than Fraxel laser treatments.

Question 13

Sources & studies

Accepted Answer

Bass, L. “Rejuvenation of the Aging Face Using Fraxel Laser Treatment.” Aesthetic Surgery Journal, vol. 25, no. 3, May 2005.

Manstein, Dieter, et al. “Fractional Photothermolysis: A New Concept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury.” Lasers in Surgery and Medicine, vol. 34, no. 5, June 2004.

Tanzi, E, et al. “Fraxel Laser Indications and Long-Term Follow-Up.” Aesthetic Surgery Journal, vol. 28, no. 6, 2008.

FRAXEL LASER

Michele S. Green, MD

Julie Ricevuto

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	Chemical Peel nonsurgical	Microneedling nonsurgical	IPL nonsurgical
Worth It Rating	84%	84%	81%
Average Cost	$429	$887	$791
Downtime	Up to 2 weeks of downtime	1–3 days of downtime	One week of social downtime
Anesthesia	No anesthesia	Topical anesthesia	No anesthesia

Michele S. Green, MD

Julie Ricevuto

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