This is an excellent question, and I'm glad you asked it. For those who have the patience to read my answer here, hopefully you'll learn a lot more than just about Pelleve and Fractora!There is so much confusion right now in the marketplace because technology is exploding, and so many devices are coming along. In addition, doctors, nurses, and even some non-licensed people are all scrambling to try and get the "latest and greatest" gadget to outdo their competitors and grab all of the money that they can. This can be a recipe for disaster if people - patients AND practitioners alike - aren't careful. Some of these devices are sound and work the way they're supposed to, and some work better on the "drawing board" and not so great in reality. Thus, it pays to understand a few simple principles when looking around for the right treatment for you. I'm going to give you some basics that apply to ALL of these treatments first, then I will give you my specific thoughts about Fractora and Pelleve.FIrst, you should have at least some understanding of how the proposed device is supposed to work. Second, you should understand what it is supposed to accomplish in the way of goals, especially for your specific case, and how it is supposed to do that based on the first principle above. If you can't understand the exact science behind it, that's OK, just get a reasonable explanation in layman's terms from a trusted source (more about that later), and be sure that the person that is doing the treatment has a handle on the science behind the device. Third, you need to understand both the credentials and expertise of the person doing the treatment on you as well as their command of the science and experience with the proposed specific treatment.So, let's talk about the first thing first. With all of the laser, ultrasound, infra-red, radiofrequency, plasma - and I'm sure there are others I'm missing - technologies out there, what the hell does a person do? Seriously. First relax, and realize that you're not alone. In fact, many well-trained medical professionals, some even using these devices, don't understand how they really work! That's scary! Next, understand it's not a footrace or a competition to see who on her block or in her office can be the first with the newest "revolutionary" treatment out there. Often, those are the people that regret things the most, as they jump on the bandwagon and make emotional decisions. Many of these device companies capitalize on that, as they want people to be excited about their machine without really understanding how it works. That's how everyone involved makes money. So, settle in and do your research (which it appears you are doing here - good for you!), and become as educated as you can about your options. Then when you find the right option for your specific problem, and the right person performing the treatment, you'll just know.With regard to how these things work, the most basic thing that you need to understand is that all rejuvenation treatments like this work by the same principle - they create a controlled injury of some degree to the tissues, forcing the tissues to repair themselves, and in so doing, creating a newer, more rejuvenated look. This often happens as a result of the production of collagen or elastic fibers in the dermis, formation of new glands in the dermis, thickening of some of the other nonliving parts of the dermis, stimulation of the blood supply to the skin or conversely destroying blood vessels which are too big and creating unsightly spots, ablating (removing) the top layer of the skin (epidermis) with any pigment or textural irregularities, or some combination of those types of things. It then follows that the device or treatment that does more of those things safer and more effectively will produce generally the best results. Often, especially lately, doing this with minimal downtime or destruction to the tissues is favored too. Thus, scientists and engineers are in a mad scramble to come up with the best ways to do these things. Chemical peels and dermabrasion have been around for decades, and they are fairly reliable at doing some of those things mentioned above. But they each create an injury - chemical burn of varying depths in the skin in the case of chemical peels with acids, or mechanical avulsion (removal) of the top layers of skin with a special "grinding wheel" in the case of dermabrasion - which is often more aggressive and extensive than we want or need, and which often results in unacceptable downtimes and other problems like pigment irregularities, "waxiness" of the skin, and sometimes scarring. Thus, while still used in some instances, they are largely moving out of favor as newer technologies arrive on the scene. It is still worth discussing them here though, not just for historical significance, as they really were the first skin rejuvenation treatments long before even the first lasers arrived on the scene, but they provide great context for how our current treatments actually work. Everything still works by causing an injury to the skin, it's just that now we have machines and computers and precise instruments that can cause a much more controlled injury, so our results are more reliable, safety is significantly enhanced, and recovery and downtime is much more acceptable.So, how do these things injure our tissues? Well, the main principle that almost every single device out there uses is thermal injury: heat. We know that if we create heat within a certain range in the skin and keep it there for a certain time, the skin will respond by contracting, thickening, and producing new collagen, blood supply, and epidermal cells. We can't have the heat too low, or nothing happens except pain - from the treatment itself in some instances as well as paying for something that didn't work! Likewise, if the heat is too high, we get uncontrolled injury, burns, loss of tissue, destruction of wanted blood supply, and the like. This creates pain and other problems too. Thus, our ideal system would find that "sweet spot" right in the middle where the heat was just high enough to get the changes we need, but not too high to cause unwanted levels of injury, and the changes would be very reliable and predictable, at least as much as we can make them. That is the ideal device, however, we must all accept that the perfect device and treatment really don't exist. Therefore, our goal really is to find the one that does what we want and need the best and the safest. Lasers and other light-based treatments like IPL (Intense Pulsed Light) and BBL (Broad Band Light), cause heat in the tissues by introducing light energy. This is like when we shine sunlight through a magnifying glass on paper and ignite it into a fire. Lasers/light treatments are controlled by computers which enhances their safety, but they have to be applied from the surface of the skin (there are lasers used under the skin too, but largely those aren't really in this discussion). Then, there are ultrasound devices, like Ulthera, which create extremely fast sound vibrations in the tissues - like tens of thousands of vibrations a second - and this creates friction and heat from motion at the level of molecules in our tissues, much like your hand gets hot when you rapidly rub fabric like corduroy. Again, while there are ultrasound devices that can deliver this energy under the skin, like the lasers that do that, those don't really enter into this specific discussion. This type of ultrasound device has to be applied from the surface of the skin too. Then, there are the radiofrequency devices. This pretty much means that an electric current is being delivered through the device and into the tissues, including the tissues in the "circuit" for the electric current or flow, and much the same as when your electric burner heats up on your stove and glows red from passing an electric current through it, or even our bodies can sustain an electrical burn if we're not careful and touch an electrified wire, we can produce controlled heat in tissues with properly applied electricity. Doctors have been using electrical current on tissues for decades, so this is by no means a new concept, however, the engineers are starting to understand new ways of enhancing precision and delivering electricity in the right amounts more accurately, and computers are being integrated into the systems to provide that much needed control that just touching an electrical probe to the skin won't provide. That's the basic rundown of how ALL of these devices work in general. Let's cover the other two general topics next, as they are pretty straightforward in light of what we've discussed so far, then we'll finish up by answering the real question you had about what those specific devices do and how they compare.As I noted above, in addition to understanding how the basic device works, it's important to understand how it will work on YOU in relation to the specific problem you have. The good and bad about these devices is that they are becoming much more highly specialized, meaning they are getting really good at doing one or just a few things really, really well. So they are becoming much more focused, and that enhances safety, control, reliability, and the like. On the flip side, though, there is no one single tool that does all things for all people. We have to really evaluate what each person's needs and goals are, and then be sure that we recommend the RIGHT device for the job - even if we don't have that device in our own office. We should not be recommending treatments for people when we know darn well that it isn't the optimal treatment for them. This is just common sense and good medicine. There is no longer "one size that fits all" - actually, there never really was, we just had to accept more mediocrity in our results before our technology improved. What I am getting at here is that if a person has laxity and sagging of their jowls or tissues of the neck, it is highly unlikely that ANY surface type treatment designed to tighten the surface of the skin - lasers, Ultherapy, Fractora, etc - will address that. The surface of the skin may look better with such treatments, with less wrinkly, crepey texture or better pigment and smoothness, and if this is all they're looking for, then that's probably a good solution for them. But if they want to lose their jowls or their "turkey waddle," and that is what is meant by "skin tightening," they will likely be disappointed. Surface treatments are rarely if ever successful at producing real honest-to-goodness tightening of the tissues below the skin, because in order to hit that temperature "sweet spot" we spoke of above at that depth, they must also heat the surface skin too, and sometimes that is undesirable and will limit the ability of that particular device to do its job on the deeper layers. Thus, it pays to understand what you really want to accomplish, what the different devices being proposed will ACTUALLY do to accomplish that, and how the treating practitioner intends to use the device to accomplish the goal.This leads us to the last basic topic, and that regards the person doing the procedure. This issue is maybe more important to discuss in this conversation about non-invasive or minimally invasive devices than even surgery, because I think more unqualified people are more likely to use these devices without proper credentials than to do surgery. However, if not respected, these devices can still cause problems. In the best case scenario, that could be a painful but ineffective treatment, while in the worst, you could wind up with permanent issues like scars from burns, permanent pigment changes, contour deformities and contractures, and the like. In my own opinion, the only people that should be doing these treatments are those properly certified in a core aesthetic specialty - plastic surgery, dermatology, facial plastic surgery, occuloplastic surgery - recognized by the American Board of Medical Specialties, or someone who has been properly trained and is appropriately supervised by a core aesthetic physician. That's it. There are enough of those around, and you should have no problem getting treated by one and no reason, except maybe to save a few bucks, to go to someone who is not properly credentialed. Remember, training and exams to get and maintain certification to prove to you, the public who we care for, that we are properly educated to perform these treatments, cost money, and it is often the case that those offering the lowest prices haven't gone the extra mile to be properly credentialed. That's how they save money and then pass those savings off to you, or at least those who are primarily looking for a cheap deal. If you're comfortable with that, then have at it, but as the saying goes, "caveat emptor." One last word about training and experience, because it's an important detail. If a doctor doesn't have a lot of experience with a particular device, that may be OK, because as I noted above, new devices are always coming out, and everyone has to start somewhere. Sometimes the doctor is skilled and experienced with similar procedures that they have been doing for awhile, but they just got a new device and are just getting started with that specific new treatment. Usually, there is basic training and education that all of us go through to familiarize ourselves with any new device we use, so even though we may not have a lot of actual cases under our belts or thousands of before and after pictures to show of a specific treatment, that doesn't always mean that we aren't properly trained, competent, and capable of providing a good, safe treatment with a new device. This just requires a bit of judgment on your part and developing a trust or rapport with the doctor to be sure that what they tell you is honest and accurate. Recommendations from trusted friends and other similar sources, referrals or endorsements of the doctor from the actual device manufacturers, and a good general reputation and track record of treating people fairly with good results over the years may come in handy when making this assessment of a particular doctor for these treatments.So, finally we're here at what you really wanted to know, but I think a lot of that background is very important to be able to understand why I am telling you what I am telling you about these specific devices; otherwise, I'm just another guy giving you his opinion about something, and how would you know if it was worth anything or not? Recalling that we discussed heating of the tissues as a therapeutic method, and radiofrequency as a way to create that heat, both Pelleve and Fractora are radiofrequency devices. Pelleve is noninvasive, which means that energy is applied to the skin from the surface by moving an electrified probe in contact with the surface of the skin while the circuit is completed by a grounding pad applied somewhere else on the body. More about that in a second. Fractora is minimally invasive in that the treatment heads have a whole bunch of tiny needle-like protrusions, each of which gets its own electric current, and the circuit is completed by a thin metal "rail" also on the treatment head which contacts the skin. Thus, all of the electrical current is contained and concentrated right there in the space between the tips of the "needles" and the "rail" electrode, as opposed to Pelleve, or its older radiofrequency cousin Thermage, which create more of a dissipated, unfocused and thus uncontrolled, heating. Furthermore, some of the treatment heads for Fractora come with those needles coated with a silicone sleeve which keeps the electrical current even more focused only at the very tips of the needles and completely off of the surface of the skin. Thus, we can have preferential and exact heating of the very deepest part of the dermis while totally avoiding any heat energy to the surface. So there is maximal effect deep, yet there is no peeling or crusting like we get in a laser treatment. This, to me, is a significant difference between Fractora and ALL other treatments in this category. Lumping them all together, when we talk about the "surface treatments" - laser/light-based treatments, Ultherapy, Thermage, and yes, Pelleve - I find that they are limited by the fact that the energy has to first go through the epidermis and skin surface before it reaches the actual location where you want it. So, with those, you're stuck between running a risk of injury to the top layer you may not want, or erring on the side of safety and not risking injury to the top, but recognizing then that if you aren't heating the top, you're probably not going to heat the deeper layers sufficiently either with that particular type of device. More potential for dissipation and uncontrolled "wandering" of the electrical energy translates to less focus, in my book, and that in turn leads to either uncontrolled heating and injury or loss of energy focus and less efficacy. Either one is undesirable to me. Fractora can heat the top layers too if desired, because if you recall, there is a non-coated treatment head too, so you can essentially mimic a Fraxel laser if you wanted. You just don't have to. I find this to be a huge advantage. Then, when you couple this with the control of a computer, I think you get a much safer, more reliable treatment. We can treat actual active acne lesions with Fractora, because the electrical current and heat cause cauterization of the affected glands and kill the bacteria causing the lesions. It can also improve deep level scarring, like acne scarring, because it penetrates deeper with its energy more safely. Devices like Pelleve and Ultherapy are designed to "focus" the energy to the right depth of the tissues, again, akin to that focusing effect of the magnifying glass, and this is how they try to get around this issue, but as I said above, some of these devices work better on the drawing board than they do in real life. Just check out some of the ratings on each treatment to see what other people have to say about their them. This is not to say that Fractora is perfect and none of the other devices can deliver good results in the right patients. Clearly, that is not true. This is more of an issue of all of these devices doing very similar things, and us needing to pick the one that does that thing most safely and more reliably for the greater number of people. That's why I put my money on the Fractora, and it hasn't disappointed. Many of my colleagues are actually setting their lasers aside now and using mainly Fractora. This effect on skin can be used other places where we want improved skin tone and texture, too, as it doesn't have to be used just on the face or neck. It can be used on hands, chests, including breasts and nipples, tummies, buttocks, and we are even using it on the external female genitalia in conjunction with internal vaginal rejuvenation treatments to improve skin laxity there. One final thing to say about Fractora is that you must remember it is a SKIN treatment, and any problems like laxity or excess of the tissues BELOW the skin - the fatty layer, the platysma muscle of the neck, and the like - will likely not be improved with Fractora and will need another type of device, or even surgery. Fortunately, InMode, the maker of Fractora also has a great solution for that problem too, called FaceTite/NeckTite for the face and neck areas and BodyTite for the body, but that discussion is for another day! I hope this was not too much more than what you bargained for and that you find at least something useful in this discussion. Good luck in finding the best treatment to help with your goals and the right doctor to perform it for you.
