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 48

Fraxel is very good for acne scars

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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

Method not the machine.

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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. 

Fraxel for acne scarring doesn't work very well.

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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.

Fraxel for Acne and Scars

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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

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

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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
4.9 out of 5 stars 33 reviews

Fraxel repair for acne scarring

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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 22 reviews

New Fraxel Re:pair treats skin the deepest, may be most effective on acne scars

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Both Fraxel lasers can treat acne scarring very well. The newer Fraxel re:pair CO2 ablative laser penetrates up to 1600 nanometers (1.6mm) deep (as compared to 300nm (0.3) for Active FX, and 600nm (0.6mm) for Deep FX).

Good luck and be well.
Dr. P

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

Acne scar reduction using Fraxel laser, Fraxel Restore, Fraxel Repair

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There are many types of acne scars and the ones that are not ice-pick or box- car scars, such as crater scars, can respond very nicely to a series of Fraxel Restore or one Fraxel Repair laser.
Fractional laser reduces healing time and risk.  The Fraxel Restore erbium laser helps smoothen scars but the result is seen for months after the last of several (often 5 to 6) laser treatments and the Fraxel Repair, which uses a carbon dioxide wavelength, is done once, although it can be retreated at six or twelve months.   The latter has a downtime of a week and a half or more, whereas the Fraxel Restore does not force someone to stay at home taking care of their face.
Patients with acne scarring, often see me in my NYC practice, for Fraxel Restore resurfacing of their scars because they can't afford to be out of commission.  There is some swelling and redness, but makeup, or skin-tone sunblock can be applied that same day to help hide the redness.  It looks like a sunburn. After five days, rarely more, this is gone.  The Fraxel is repeated every three to four weeks during the series of treatments.
Realistic expectations are important.  Virtually no patient gets rid of every last scar.  Most scars improve but persist to some extent, even if slightly visible. Some scars need other treatments prior to the laser to get the best result. This is evaluated during a consultation and a treatment plan is generated.

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

Fraxel for acne scars

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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

YES. Fraxel is a top choice for acne scarring

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Fraxel Restore/Dual is one of my most trusted devices for consistently reliable and safe improvement of acne scars in all skin types. Most people need more than one session, but the safety and the ability to treat darker skin types makes this device indispensible in my practice.

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.