Fraxel Acne Scars- Does it Work?

Heard a lot about Fraxel laser. Acne is a problem for many people, as well as scarring — can Fraxel treat acne scarring on the face?

Doctor Answers 42

Fraxel is very good for acne scars

I use the Fraxel restore for acne scarring routinely. The results can be variable. If the treatment settings used are the same as the settings for patients with sun damage and fine lines, then the results are very marginal. However, if settings such as 70mJ (a high setting) are used, then the results are much more impressive.

Acne scarring requires a higher intensity of treatment than other conditions. It is very important to seek out a very competent physician to perform the treatment. High settings can have higher side effects and longer "down-times," and are not suitable for all individuals. If you decide to use Fraxel for acne scarring, make sure to go to someone recommended on, have a consultation, make sure the physician does his/her own treatments, and then go for it.

Portland Plastic Surgeon

Fraxel for Acne and Scars

First of all your acne should be under control before embarking on laser treatments for acne scarring or you may:

  1. Have acne breakouts from the treatment and post treatmnet wound care.
  2. Continue to have scarring acne and need further treatments down the road with additional costs.

Secondly, the generic term Fraxel can be very misleading as there are 3 new "Fraxels" out there, none of which are created equal.

  • The original Fraxel is nonablative
  • The next generation are re:store re:fine and re:pair, the last of which is abalative and as for the "Fraxel" family is clearly their best laser at treating acne scars.
  • The other great laser for treating acne scars in the Sciton Profractional laser. It is an erbium yag laser (not CO2), heals quicker and is less painful than the Fraxel re:pair CO2.

So, the technology is out there to treat scars quickly and safely with minimal downtime. The only downside is the high likelihood of the need for more than one treatment with some of these devices, especially the non-ablative Fraxels.

Lastly, there is the gold standard full ablation lasers by Coherent CO2 or Sciton Erb Yag that will get great results in one treatment, but require wound care for 10-14 days. These results are far better than any of the other treatments discussed... when it comes to lasers, remember there is no "free lunch," i.e. more downtime = better results but higher chance of complications versus little to no downtime = need for multiple treatments and lower risk of complications.

Ask your doctor what he or she thinks is best....and be weary that although the rolled scars may do great with lasers, the "ice pick" type scars do not do very well with any of these lasers; they often need small punch excisions with or without a stitch to fully improve their appearance. This can be done at the end of your laser treatment series.

Good luck and be sure if acne is still active to get the acne under control with medications, etc. before starting any of these treatments!

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

Acne Scars Respond Well To A Combined Treatment Approach Consisting of Volumizing, Subcision & Medical Microneedling

Over the years, I have found that combining and tailoring a variety of therapies is the best overall approach to treating acne scars and is the one most likely to yield consistently gratifying results. All acne scars are not the same (there are pits, box scars, atrophic scars, etc.), so the approach to treating them should not be one of all we have is a hammer so everything must be a nail.

In my experience, fraxel lasers have unforuntely not proven particularly successful in this arena. While there may be some improvement in skin glow and surface texture, I have not been impressed with their value for actually improving the acne scars. I prefer instead to tailor my treatments to the specific types of scars that are present.

 I usually find that the cheeks of those individuals with significant acne scars, especially those with maturing skin, need to be first volumized in order to smooth and contour the skin and to diminish that otten sunken appearance that often accompanies significant mid-facial acne scars. Injectable volumizing agents, such as Radiesse or Radiesse combined with Juvederm UltraPlus XC work well for this purpose. Such volumization often gives immediate stretching and smoothing of the scars (by eliminating some of the age and scar related volume loss that is characteristic of this condition--especially in mature individuals). It also provides a smoother surface for subsequent treatment with medical microneedling.

Next, subcision can be used to to lift larger saucerized and atrophic scars (The results obtained via subcision are permanent,  since the procedure encourages native, new collagen production). Deeper scars may need to have this procedure repeated two or more times at six week intervals in order to achieve optimal improvement.

Thereafter, and only then, if any further work is still deemed necessary for additional blending and smoothing,  medical microneedling, using either the Dermaroller or Dermapen, can be considered (The results of this, too, are permanent also due to the stimulation of native collagen production). Medical microneedling typically requires a series of two to four treatments to achieve maximal collagen induction.

Through the years, I have found the results of this combined approach to acne scarring, when tailored to the specific needs and goals of the individual, to be consistently satisfying. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 20 reviews

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Fraxel for acne scarring doesn't work very well.

I see patients fairly often that have had Fraxel treament for acne scars or for skin "tightening" that are disappointed in the results.  RealSelf's poll shows a very low "worth it" percentage (50%).  I would be very careful before spending money on this painful treatment.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

Fraxel repair for acne scarring

The Fraxel repair as well as most fractionated co2 devices ( Fraxel restore and Pixel among others) as well as Smooth Beam Laser can all effectively treat acne scarring . but you must identify which situation you fit into. 1)Namely, do you still have active acne? - you might consider smooth beam laser as it can put acne into remission for 4 to 12 months. 2) if you don't want any or hardly any down time but don't have active disease - or if you have darker skin color then the Fraxel may be best for you. 3) if downtime is not an issue and you are fair skinned individual then fractionated Co2 may be best.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 17 reviews

Method not the machine.

Yes, it does, but Fraxel is a good 'overall treatment' for acne scars. If you want the BEST treatment, you should concentrate on finding the correct treatment for your acne scars. 
Fractional lasers such as Fraxel RESTORE or REPAIR can be good for rolling, mixed, and atrophic (mlld atrophic scars), however acne scar revision should be targeted on the scar type, and never ever the device. 

For example, deep ice pick scars are best treated with TCA CROSS or punch excision and not a laser. 

Atrophic scars can be filled with Bellafill or Juvederm

Tethered and anchored scars should be surgically subcised. 

For mixed scars, I tend to now use INFINI RF, as it has less downtime than lasers, including fractional laser resurfacing with Fraxel. IMO the results are better as well. 

All the best, 
Dr Davin Lim 
Laser and aesthetic dermatologist
BRISBANE, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 43 reviews

Fraxel is the Solution for Acne Scars

If you want to successfully treat your acne scars, Fraxel is my preferred method of treatment. Fraxel will soften and smooth your skin reducing scarring to a noticeable degree. In order to achieve this, I tend to recommend 3-4 treatments to achieve the optimal results. In addition, there is no down time for healing. My goal when treating patients with Fraxel is to rejuvenate their face, chest and neck by reducing acne scars and wrinkles.

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Fraxel for acne scars

A series of Fraxel treatments can improve acne scars by 50 to 80%.  The non-ablative Fraxel restore has a few days of minimal downtime and requires about 5 treatments, 4 to 6 weeks apart. The ablative Fraxel repair has about 6 days' downtime and requires 2 to 3 treatments, about 3 months apart.  Subcision is often required before the laser treatments for an enhanced result.  Avoid tanning after any laser procedure.

Your acne should be under control before your laser treatments and ensure you are being treated by a board certified dermatologist or plastic surgeon.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 20 reviews

Fraxel is the treatment of choice for acne scars

Both Fraxel Re:Pair (CO2 Fraxel) and Fraxel Re:Store (nonablative Fraxel ) are very effective in treating acne scars.Fraxel Re:Store always requires a series of treatments (2-6) but has no downtime needed for healing.Both lasers have a very small beam that penetrates very deeply in the skin to get to the base of the scar and work by stimulating your body to make new collagen fibers. This basically rebuilds the skin that has been scarred by acne. Fraxel Re:Pair is more aggressive , requires 5-8 days downtime for initial healing but gives results equivalent to 3 or 4 treatments with Fraxel Re:Store.It can be repeated for even more dramatic improvement. The average amount of improvement is around 50% .

Richard Fitzpatrick, MD (in memoriam)
San Diego Dermatologic Surgeon
4.5 out of 5 stars 12 reviews

Fraxel laser will improve acne scars.

Fraxel laser will improve acne scars. Either the Fraxel Restore or the Fraxel Repair will offer great improvement of acne scarring. Multiple sessions ( 3 to 5 ) are recommended for best results. They can be performed once monthly. There are many types if acne scars that can be present. Additional treatments that can be done in conjunction with the Fraxel laser (but not during the same session) include: excision of pitted scars (the sharp small deep scars are removed via a small punch excision and a stitch is placed, that is later on removed in seven days), as well as subcision of rolling scars ( the not-so-deep but larger and indented scars). The latter technique helps free the scar from fibrous bands that are underneath it and that pull them down to the deeper skin layers. After this, a natural filler (like a hyaluronic acid gel) can be injected to restore volume and 'bring up' the indented scar. Fraxel may be done before or after these procedures. My preference is to do Fraxel after, particularly if excision of pitted scars is performed. I hope this information is helpful. Dr. Leyda Bowes.

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.