CO2 Laser Vs Fraxel Repair to Improve Skin Texture?

Question

Hello, I am 49, with large pores, a lot of Milia above and below eyes, sun damaged skin. I have had 3 Fraxel Restore treatments.I am really bothered by my skin not going out in social events during the day. I can see people looking at my chin, which has vertical lines. I have Rosacea but the redness is not a problem, it is the skin texture. Which would be better, the CO2 laser or Fraxel repair? A local plastic surgeon in my area will do the CO2 for around $3200.I am afraid of having it done on all areas of the face, but for the results I am after, I will do it. I will end up with skin like a baby's bottom!

John L. Burns Jr., MD · Answer

Your question is very good and brings up some points which can be confusing. First, not all Fraxel lasers are the same. The Fraxel brand makes 3 lasers:  ReFine, ReStore, and RePair.  
Fraxel is an innovator in the fractionated laser technology whereby the laser beam is broken up into tiny points called microthermal zones. These are similar in concept to a television screen where the picture is made up of thousands of tiny dots. The advantage of fractionated laser technology is more rapid healing time, less risk of scarring and pigmentary alterations in the skin, and arguably a more natural, less waxy appearance to the skin. Additionally, it can be used off the face and avoid a telltale sign of laser resurfacing where the face and neck do not match (line of demarkation).  
The Fraxel ReFine and ReStore laser utilize an Erbium glass laser and the Fraxel RePair uses the CO2 wavelength. My opinion is the the ReFine laser is underpowered and only recommend the ReStore or the RePair.  
The ReStore is an excellent skin maintenance laser which I recommend for patients who are tying to gain modest improvements in their skin or to ward off the aging process. It is an excellent dermatologic laser which improves skin tone, texture, pore size, and promotes a phenomenon called collagen remodeling which allows the skin to rejuvenate through repairing damaged collagen. It will also improve skin color making it more homogenous and with less irregular pigmentation (dyschromia). I primarily recommend the ReStore to patients in their 20s, 30s, and early 40s to maintain excellent skin and reverse early signs of aging.
The RePair is a much more aggressive laser and does require significantly more downtime. However, it is much more effective in treating more difficult problems such as skin tightening and problematic wrinkles (examples would be smokers lines around the mouth or crow's feet around the eyes). It will also do everything the ReStore laser will do usually in a single treatment. The ReStore laser generally requires 3 - 5 treatments. 
Fully ablative lasers such as the CO2 or Erbium YAG are not fractionated and require a significantly longer healing time and do have more risk in terms of permanent pigmentary alterations, scars, and waxy appearing skin. They also cannot be used off the face making it easy to discern between laser treated skin on the face and nontreated skin on the neck. However, they are more effective in improving wrinkles and tightening the skin.
Given your age and desire to improve skin wrinkles, I would go with the Fraxel RePair because it will do what you want it to do without the longer downtime and more risk associated with the ablative CO2 laser.

Michael A. Persky, MD · Answer

Hi Forever 28,
Fraxel repair fractionated CO2 laser treatment is the preferred treatment over the older traditional CO2 lasers for many reasons (2009 technology vs. 1990 technology). 
From your description it sounds as if you should be an excellent candidate for Fraxel repair with the properly selected physician.
Good luck and be well.  See you at your 29'th B-day.
Dr. P

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