Ablative V. Non Ablative Fractional Laser (Fraxel, Mixto, Active, Etc.)

The recovery for Fraxel Restore is a more easy few day healing then the type of healing with Repair. There is also some more risk with adverse events with the Repair, so you can't easily compare them. If your skin may benefit from the semi-ablative Fraxel Repair, then you may not reach the same good result if you were to do several Fraxel Restore treatments. There may be more tightening of the skin lines with the Repair than the Restore. Interestingly, for some acne scars, we do get better eventual results with a multitude of Restore treatments but you are limited in how many Repair treatments you can have done. Brown spots may improve more with the Repair than the Restore, but Fraxel Dual is the Restore with a pigment laser (Thurium, 1927nm.) that can improve these sunspots or freckles in one treatment, but that has a week of healing, unless done more gently and then a couple or a few treatments.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

I have the artisan system by palomar. I use the non ablative for tightening effect, scars, you usually needs 3-4 treatments with little or no down time. treatments are performed every 4 weeks. laser light is put deep into the skin, skipping the superficial surface so little down time. The ablative treatment is used for wrinkle lines. I perform a combo of both with very nice results. need about 4 days down time.

I find the artisan gets the same results as CO2. I was a long time CO2 user and thought erbium did not do it. but combo treatments are getting the same results with less down time, less pain and quicker recovery.

Your age and location level of your sun damage are two important factors to consider.  Ablative technologies work better for wrinkles and superficial sun damage such as brown spots and can be effective with just one treatment.  Younger patients (30-40's)  may benefit from nonablative treatments when wrinkles are mild, but you will have to do multiple treatments to get similar results to a gentle ablative treatment.  Thermal spread can be achieved with either technology depending on the experience of the physician.  

The way that non-ablative and ablative lasers improve skin is similar if you look at the histology.  They both create zones of thermal damage that serve to "extrude"  the bad stuff in your skin.  The ablative lasers, especially the CO2 lasers, do a much better job at collagen remodeling and tightening and will be better for your fine lines.  If you have the time to recover, the CO2 fractional laser is the way to go in my opinion.  Keep in mind that "folds" as you describe in your post generally won't improve with any of these lasers.