In-depth discussion of Fraxel Repair risks and results
It seems the there are several issues which need to be addressed regarding the Fraxel re:pair laser. First and foremost, anyone that has experience any long lasting adverse effect from having any cosmetic procedure is a problem for our profession. As it states in the Hippocratic Oath – “Do no harm”.
However, to think that having any cosmetic procedure (besides maybe LED therapy) has no risk is not being realistic. Take a look thru RealSelf and you will see several commonly performed procedures that have had some documented bad outcomes (BOTOX, Juvederm, Radiesse, Laser Lipo). These procedures are generally safe, will continue to be performed and shouldn’t be pulled from the market.
BOTOX being the most popular cosmetic procedure in the US, has a “Was it Worth it Rating” very similar to the Fraxel re:pair. Juvederm, Radiesse, and Restylane are lower than the re:pair.
Let’s digress a little. Medicine is not the lucrative profession it was. Doctors are generally making less money each year. For some physicians, they try to supplement their incomes with cash paying cosmetic patients. Unfortunately, this can lead to poorly trained physicians performing these procedures. Some of these physicians are very talented – good hands, artistic - but some are not. Although bad outcomes can occur with even the highest trained physicians, it is my belief that the more experienced the physician is with the anatomy, pitfalls, and emergencies, the less likely these will occur.
So when I and Dr. Persky discuss experience of physicians being important, it’s because we both have extensive knowledge of the Head and Neck area. We have both spent decades of our life doing surgery all over the face – sinuses, jaw, nose, orbit, neck and ears. We have both studied extensively the anatomy of the vessels and nerves in this region, and seen them during surgeries. We have used lasers since we started our residencies and are familiar with laser safety and wound healing from laser surgery.
To market the laser to physicians which have very little experience with lasers is a travesty, particularly the CO2 laser, the most powerful skin laser on the market. If this is being done, shame on the company. I will agree with the criticism that the company underscored the risks of the Fraxel re:pair.
To promote that a CO2 laser has minimal risk and minimal downtime is not accurate. A more accurate selling point is that it is a much safer laser than the traditional totally ablative CO2 lasers with much less downtime. The traditional CO2 laser had a 15-20% hypopigmentation rate. There are hundreds, if not thousands of patients walking around hypopigmented from these lasers and they are still on the market.
The Fraxel re:pair is much less than that (but not zero). In the pre approval studies of the Fraxel re:pair there were no episodes of hypopigmentation (By the way, there was 2.5 years of data prior to FDA approval which is much more than is required by the FDA). In my consent, and in the one from the company, it stated that this was a potential risk.
Wound care lasted for weeks with the older CO2, and the Fraxel re:pair is down to less than a week in most cases. Hyperpigmentation has occurred in 3 of my patients, and they have all resolved with topical medication very quickly, with no long term issues.
The biggest risk I see with this laser is infection. Despite giving patients (literally) the antivirals and antibiotics, some people develop infections. Some have had obvious breaks from the dressing protocols extensively explained to them while others have no real good explanation. All have been treated very aggressively with antibiotics, hyperbaric oxygen therapy, and twice a day office checks.
To my knowledge, all have had no residual issues. There have been 4 infections. I believe that early recognition of the infection, aggressive treatment, and my experience with these issues has led to good outcomes for these patients.
In addressing acne or surgical scarring, I have had very good success with the Fraxel re:pair. My acne scarring clients are extremely happy with their results. I don’t think there is a better treatment currently available for acne scars.
The ice pick scars need treatment prior to the re:pair with either punch excision or TCA CROSS. I’m upfront with these clients explaining that complete resolution is not achievable, and more than one might be necessary to achieve their desired results. I try to present accurate representations of my results on this site.
Unfortunately, there are constraints related to the file size which can affect the way the pictures appear. I can assure you that the pictures have not been doctored in any way. The company has used many of my photos in their webinars.
I think that much of the dissatisfaction with this laser is related to poor pre-op counseling and unrealistic expectations. This is partly to blame on the company, and partly on the physician. There are risks and there is downtime. It is a good 5-7 days in the house for most people. Some require an extra week of social downtime.
IN CONCULSION: The results of the Fraxel re:pair, from my point of view, are unsurpassed by any single cosmetic procedure for achieving a 5-10 year improvement in facial appearance.