Fraxel re:pair CO2 Laser - All Your Questions Answered


The Fraxel re:pair is the most technologically advanced laser ever made for cosmetic procedures. It is classified as a Fractional Microablative CO2 laser. In laymans terms, this means that the laser vaporizes microscopic columns of tissue (microthermal zones or MTZ), each less than 1/10th the diameter of a hair, and then vacuums this tissue away. The result is removal of tissue that amounts to up to 25% of what a face lift would remove surgically, but in all areas of the face, not just around the ears. Although some severely aged skin might need 2 treatments, in general, this is considered a "ONE AND DONE" procedure. Using fractional technology, the Fraxel CO2 laser has much less downtime than its CO2 predecessors, with only 5-7 days of wound care.

Fractionated Deep Dermal Ablation (FDDA), which the Fraxel re:pair uses, results in only a portion of the skin being ablated, from 5-70%, depending on the degree of correction needed. Leaving portions of unaffected tissue, allows for much faster healing of the adjacent thermally injured tissue. This is compared to the previous CO2 lasers which caused total ablation of the upper layer of skin, resulting in prolonged healing and increased risks of scarring and pigmentation problems. Also, FDDA technology allows for much deeper penetration of the laser, 1.6 millimeters versus 0.3 millimeters (with the older technology). Deeper penetration means better corrections of wrinkles, scars, and pigment.

The procedure is done in the office with topical anesthesia, and oral medications for sedation and pain control. Typical times to do a complete face are about 30 minutes. The laser is also approved for treatment of neck, chest, hands, and other areas. Treatments can also be limited to around the eyes or mouth area. When doing the procedure around the eyes, numbing drops are placed into the eye, followed by a metal corneal shield. This allows for treatment to include the upper and lower eyelids in addition to the lower eye wrinkles, and excess tissue overhanging into the eye area. This is included when the entire face is treated.

Frequently asked questions:

What is the difference between the Fraxel re:pair and the Fraxel re:store?

The Fraxel re:pair is a CO2 laser and the re:store is an erbium laser. The re:pair requires usually only one treatment, whereas the re:store is usually a series of 4-6 treatments. The re:pair will tighten the skin, the restore will minimally tighten, even after 6 treatments. Wrinkle control is also far superior with the re:pair over the restore. The reason that the re:pair causes more wrinkle control and tightening is because it actually removes tissue, whereas the re:store thermally heats the tissue. Also, CO2 lasers cause more thermal injury to the surrounding tissue which leads to more collagen and better wrinkle control. The cost of 4 or more treatments with the Fraxel re:store is more than the cost of 1 Fraxel re:pair treatment. The Fraxel re:pair was introduced at the American Academy of Dermatology on January 31, 2008. The Fraxel re:store received FDA clearance July, 2004.

Why not get a facelift instead of a Fraxel re:pair treatment?

A facelift usually is done in the operating room under general anesthesia. The re:pair is done in the office with oral medications and nerve blocks (injections). A facelift has difficulty (little or no effect) correcting the areas around the mouth (including smokers lines) and chin area, and without also doing a blepharoplasty (eye surgery), does very little to the eye area. The Fraxel re:pair removes tissue from the entire facial skin, thus improving all areas of the face, including the eye area. A facelift will do nothing to improve the quality of the skin of the face - pigmentation, vessels, texture - and the Fraxel re:pair will improve all these conditions. The costs are less for the Fraxel re:pair than for the facelift as well. While nothing can last forever, the results from CO2 lasers in the past have been noted to be from 5-10 years, comparable to a full facelift, and better than those "mini-lifts".

What is done for pain control?

Prior to starting the procedure, a topical cream is place to numb the skin. Also clients are given an oral pain medication and sedative. They are also given a shot of Ketorolac (a medication similar to Motrin). Just as we start the procedure, additional pain control is obtained by injected numbing medication to several areas of the face (nerve blocks). Our clients now describe the pain as a 3 - 7 (out of 10) during the procedure. Afterwards, universally, there has been no pain, and no need for any medication prescribed other than Tylenol.

What other lasers are similar, and why would you want to choose the Fraxel re:pair?

There are a couple lasers on the market now that are fractional ablative CO2 lasers. These are the Lumenis Deep Fx (satisfaction rating of 70% on and the Lasering Mixto. Both of these lasers have minimal research behind them. They are riding on the coattails of the research that Fraxel has done. One cannot assume that the research of over 2 years of clinical data from Fraxel can be applied to these lasers. The Aesthetic Clinique feels extremely confident in Fraxel, the company, the number one recognized aesthetic laser company in the world. The Lasering Mixto has been FDA approved only for Fine Lines.

The Deep FX has been approved only for soft tissue coagulation. The Fraxel re:pair has been approved for 4 different indications -- wrinkles, pigment, textural problems, and vascular abnormalities and will most likely be approved for scars (as its other laser, the re:store was, after the initial FDA clearance). It is very difficult, time consuming, and unusual for a laser to be approved for multiple indications.

Fraxel has gone above and beyond what other laser companies have done by getting approved for several indications. Most companies get approval for a single indication, and then the laser is used "off label" for all the other indications. The depth of penetration is deeper with the Fraxel than the other 2 lasers (Mixto is 0.4 mm, and the Deep Fx is 1 mm - the Fraxel is 1.6mm) making its treatments most effective. Also, the density of treatment (the amount of tissue affected) is variable for the Fraxel re:pair - from 5-70%. For the Mixto, this is fixed at only 25%, and for the Deep Fx, its upper limit is 30%. It's your face, why take a chance, go with the research, go with more density and deeper treatments, and go with the Fraxel re:pair.

What is the post procedure care?

For the first 2 days, there are dressing changes about every 2-3 hours (including waking up at night). This consists of putting moisten guaze (water and vinegar mixture) on the skin for 5-10 minutes. You then gently wipe the skin of any old, dried blood, down to the pink skin. Then a vasoline type emollient (Aquaphor) is placed on the skin. It is recommended that you sleep as upright as possible for 2 days to minimize swelling. After the first 2 days, the dressing changes are done about every 6-8 hours for another 24-48 hours and then stopped. You can take a shower after 48 hours. Most people convert over from Aquaphor to Cetaphil lotion at about day 3 to keep the skin lubricated. It is extremely important that the skin does not dry out. Peeling begins about day 4-5 on the face. Makeup can also be place at this time. By day 5-7, most people have peeled and are a healthy pink color. The pink will last 6-8 weeks normally, but can be up to 3 months. Sun precautions are absolutely necessary for 4 months. Skincare products can be restarted only after consulting with your physician. Typically, Retin A is held for at least 1 month.

During the first 7 days, you must keep all clothing off the treated area, including hats, glasses, scarfs, and collars from shirts. Sterility is key, with handwashing very important. You must stay at home except for doctor's visits, for the first 5-7 days.

How long do the results last for the Fraxel re:pair CO2 resurfacing laser?

We see results that take 5-10 years off our client's appearance. With good skin care, sun protection, and not smoking, we expect that you will get 5-10 years of improvement. This is consistent with the older CO2 lasers which have been around for over 15 years.

Do some people need more than one treatment?

Acne scarring and upper lip lines (smoker's lines) are often very difficult to treat. For these 2 conditions, a second treatment might be needed after about 4-6 months.

Does insurance pay for Fraxel re:pair?

There has been some physicians reporting that this is possibly covered by insurance. Insurance does not cover cosmetic procedures. If you doctor is billing insurance for "destruction of pre-cancerous or cancerous lesions - any method", the laser is not indicated for that purpose and not FDA approved to do this. Also, if you are medicare eligible and the physician bills medicare, than they can't bill you above and beyond the charges which are submitted to medicare.

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Panama City Facial Plastic Surgeon