Is CO2 Laser Followed by Fraxel for Acne Scars the Same As CO2 Fractional Laser?

I have had three treatments of fraxel before (guessing it's restore because of the downtime) with minimul results. I went to a new dermatologist who recommended the CO2 laser followed by fraxel. When I asked which type of fraxel it is, she told me it was only fraxel and showed me the name on the machine to make sure (which only said fraxel). The CO2 was a machine that only goes directly on the individual scars leaving a net mark. Is this more efficient for scars? how many sessions would I need?

Doctor Answers 6

Fraxel confusion

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Many patients are confused by the same term "Fraxel" used to describe several devices which have very different downtimes.  There are on-line reviews which praise it and others that complain about it.  Fraxel has almost become a generic name for fractional laser.  The different "Fraxels" and their use are summarized

  • Fraxel RePair - CO2 ablative fractional - harshest Fraxel - redness for 2 weeks or longer
  • Fraxel ReStore - Erbium nonablative fractional - for wrinkles and scars - much milder
  • Fraxel ReStore Dual - Erbium plus Thulium nonablative fractional - best with pigmentation, pre-skin cancer - milder
  • Fraxel ReFine - very mild fractional - mostly sold in Asia

Your laser expert dermatologic surgeon can help explain which one is best for you.

Baltimore Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Fraxel restore is not the same as fractionated CO2 treatment(Fraxel repair)

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There are many reasons why you may not have received optimal results for acne scarring utilizing the original Fraxel- namely Fraxel restore. 1) perhaps they have the older model which doesn't allow you to go as deep as it only went to 40 while the newer one goes to 70 . 2) as with all laser procedures the experience of the laser surgeon can make a big difference 3) some patients don't notice the improvement since it is occurring over 3 to 5 treatments. In reference to the old Co2 treatments , there is a longer healing time with a greater risk for permanent discoloration .personally I like a very high powered Pixel unit( 80 watts) to treat acne scarring in those patients who dont mind 3-7 days of downtime and want quick results in only one treatment.the Pixel is one of many fractionated Co2 lasers. We get great results with ours. See some of our results at Our web site and some here on this web site. Most patients get very good results with Fraxel Restore but it can take up to 5 treatments for maximal results.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

CO2 laser is effective for acne scars.

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CO2 fractional ( I use Active FX and Deep FX together for best result) is very effective for acne scars.  The number of treatments and expected outcome will depend on the type (rolling, ice pick or box car) scars that you have and the depth and extent of the scars.  Additional small procedures such as subcision (tiny cuts under the scar to elevate it) or fillers improve results with some scars.  I also use Fraxel Restore for milder acne scars and on people who do not want the longer recovery time.  My best results, in fact, have come from Active FX/Deep Fx combination.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.6 out of 5 stars 36 reviews

Fraxel Repair is not the older CO2 laser followed by Fraxel Restore

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Fraxel Repair, a fractional delivery of carbon dioxide laser, can not be duplicated by the older non-fractional, entirely alative over the whole surface treated, followed by fractional non-ablative Fraxel Restore.  The Fractional ablative Repair has less risk of scarring, and delayed hypopigmentation than the ablative carbon dioxide non-fractional laser. Carbon dioxide non-fractional laser is still done by some physicians for acne scarring with good results, as is dermabrasion, but the downtime and risks are greater than the newer technologies. Sometimes, though, the results can be better with more aggressive treatment but the risks are greater.  Fraxel restore, done many times, can give wonderful results for acne scars in some patients, with less down-time and risk.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

CO2 Laser Followed by Fraxel is Not the Same as Fractionated CO2

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Hi Nafia,

CO2 laser followed by Fraxel is not the same as fractionated CO2 laser.  There are 3 different Fraxel lasers, all of which may say "Fraxel" on the machine; Fraxel restore, Fraxel Dual, and Fraxel repair (fractionated CO2).  It sounds as if your derm is treating individual acne scars with CO2, and then is treating the rest of your skin with Fraxel restore (if they had Fraxel repair, then it would be used on your entire face without the CO2 first).  The danger of using CO2 laser in spots is that there can be spot hypopigmentation and lines of demarcation.  I would recommend Fraxel repair (fractionated CO2) as the best choice for the treatment of acne scars.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Fraxel Repair IS fractional CO2

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It sounds like you are being confused about the brand names and the various technologies. Fraxel is the brand name of fractional laser technology. There is Refine (minimal results), Restore (better especially if done aggressively and safest for darker skin), Dual (even better because of the thullium ablation of irregular pigment), and Repair which is the most aggressive and is CO 2. Patients usually need 3-5 Dual sessions to give the results close to one Repair. Patients with severe scars often need 3-5 Restore or Dual treatments or 1-2 Repair treatments. Sometimes we do a Repair, followed by a Dual or Restore after 6 months to allow full treatment results to be realized. Of course, I am generalizing. Every case is unique. Good luck.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 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.