Can different Fraxel settings give you bad and good results?

I have melasma and had fraxel under the melasma setting. Excellent results. The melasma did come back and another expert told me I had pigmentation, therefore had fraxel under the pigmentation setting. Red, itchy skin as a result, not good at all. Why do different fraxel settings give excellent or bad results?

Doctor Answers 5

Fraxel results can be different for all the patients

As with any laser, different Fraxel setting can yield different results, while we cannot specifically address your circumstances, it has been published in the medical literature that Fraxel treatment for melasma has mixed results. In some patients, it works better than peels and bleaching cream, while in others it clears the spots for a month or 2, then they "rebound" worse than before. This can even vary from treatment to treatment in the same person, based on recent sun exposure and hormonal factors. If you are not happy with any single Fraxel treatment, then stick with light chemical peels and bleaching creams, no matter how slow the progress or constant the maintenance must be. Cosmetic Dermatologists all understand that melisma is a frustrating problem...

Miami Dermatologist
5.0 out of 5 stars 9 reviews

Melasma and Fraxel

Melasma is very difficult to treat, even in expert hands. Settings are very important in treating this medical condition. If I have exhausted topical treatments and chemical peels, I will use very low setting with Fraxel. High settings can certainly make the condition worse.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews


Melasma is a difficult condition to treat.  There are times that Cosmelan  or chemical peels are the preferred treatment for a patient.  The different settings can give you different results and the pigmentation setting may not be good for a patient with melasma.  For the best cosmetic results please consult a board certified dermatologist with experience in Fraxel.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Treating skin with Melasma

Melasma is a difficult skin condition to treat; it can be easily aggravated causing a flare up. It is a common skin condition and usually appears on the face, cheeks, bridge of nose, forehead, chin and upper lip in dark patches. Most Melasma occurs in women, but 10% of those affected are men. People with darker skin tones including Latin, Asian, Indian, Middle Eastern, Mediterranean and North African descent tend to have Melasma more than others.

The cause is unknown but pregnancy, birth control pills, cosmetics, hormone therapy, and sun exposure often trigger Melasma. The more pigmentation your skin has the more melanocytes you have. Production of melanocytes is increased when the skin is irritated or exposed to rising hormones and the sun. In fact, even a small amount of sun exposure is the main reason Melasma returns after fading.

It’s possible that the “pigmentation” setting was more aggressive than the “melasma” setting and caused the unfavorable result. With any laser, different settings will yield different results. Generally the more energy used the more aggressive the treatment with more downtime. This is an example of more not always being better especially when Melasma is involved.

For Melasma treatment it is important to consult with a Board Certified Dermatologist with plenty of experience treating this condition.

For more information on Fraxel click link below:

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.7 out of 5 stars 19 reviews

Fraxel settings

Knowledge of the correct Fraxel settings is critical to obtaining the best outcomes. Melasma is difficult to treat, and control of the condition rather than complete cure is the target outcome. I usually suggest a combination of therapies, including Fraxel, for best results. Too high an energy setting on Fraxel can definitely worsen melasma. Choose a surgeon or skin expert with extensive Fraxel experience for the best chance of successfully treating your condition.

Paul G. Gerarchi, MBBS, FRACS
Sydney Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.