Fraxel Laser and Long Term Damage?

The long term consequences of Fraxel therapy are really unknown at this time. IT may take us 10--20 years to really discover the effects of this intervention.

HI Fraxel girl,
Fraxel repair has been used for the past 4 years (2 1/2 years of pre-release patient testing, and 1 1/2 years since it's release to the public). There have not been long term problems with skin in patients who did not have complications with their treatment.
As with any laser, there is the possibility of burns, scars, and hyperpigmentation. These adverse events are very rare, but you must be informed of them to make an educated decision about having the treatment. Ultimately you must decide if the benefits of the treatment far out weigh the risks.
Choose a physician who is well trained, skilled, and experienced in the laser use.
Good luck and be well.
Dr. P

First, your question and information about Accutane use leads me to assume you are considering Fraxel for acne scarring. This response will pertain to the Fraxel Restore since to date this laser is still seen as the most effective for acne scarring. The Fraxel Repair is more efficient at skin problems relating to sun damage such as wrinkles, pigmentation and poor skin quality.
The available studies don't focus on skin damage, they focus on safety and performance of claimed effect. Is there a perfect laser? No, but the newer technology has resulted in patient-friendly treatments to provide improvements in skin appearance that we've never had before - and particulalry so with acne scarring.The Fraxel Restore has FDA clearance for a number of skin treatments.

Photodamage
Mild to moderate periorbital wrinkles
Acne scars
Surgical scars
Melasma
Actinic Keratosis

The most noted potential negative effect of Fraxel (of short term duration) is occasional hyperpigmentation which is usually easily treatable with topicals. Why is there risk of pigmentation? When skin is super-heated, those with higher concentrations of melanin in their skin run a risk of temporary hyperpigmentation. That in itself is one reason anyone who has a gene pool that includes darker skin types should be quite selective in the choice of physicians.
Pick a Fraxel physician who has plenty of experience with your genetic skin type and be sure to mention any pigmentations issues you've had in the past. You may need to pretreat with a melanin suppressor such as hydroquinone.
Long term negative effects from laser treatments such as scarring would typically be a result of overly aggressive treatment or noncompliance by the patient in post procedure self-care. As far as your skin looking "worse" following laser treatments, in my personal experience with patients that's not happened.
How does Fraxel affect scarred skin?
The purpose of the Fraxel Restore is to create collagen changes. It does so by heating the skin in microscopic columns, thus causing new collagen production from adjacent untreated skin. Because it is a fairly noninvasive procedure, to see appreciable changes, you'll need a series of treatments. Each treatment builds a successive and accumulative collagen benefit.
Acne scars are the most difficult because generally the scars cover relatively large areas and are of varying depths. The scars represent loss of tissue destroyed by acne bacteria. Rebuilding new tissue to help level out the skin takes time and multiple treatments.
No physician can promise you 100% smooth skin if you have acne scars. At best you will enjoy a pleasing visible and tactile improvement over the course of months. At worst you may be somewhat disappointed that all the scars didn't simply go away. Gear your expectations to what is possible and be selective as to your physician choice.

You should go to a physician very experienced in ALL aspects of skin care (board certified plastic surgeon, facial plastic surgeon or dermatologist) and laser use. Much of the damage that occurs with laser usage is due to inexperience or with physicians who have little experience in the proper evaluation and treatment of skin problems and the use of various lasers. The laser manufacturers will sell the laser to any physician who has the money and regardless of their background training, qualifications, or board certification. That is why you must do your homework. Remember the old saying: "If all you have is a hammer, the whole world looks like a nail". If the only "tool" that a physician has is a laser then he will try to fit that to all of your skin problems regardless of the best treatment alternative. An experienced physician will examine your skin, determine your goals and expectations, discuss with you all alternatives (ranging from topical skin care, to microdermabrasions, to full dermabrasions, to chemical or laser peels of varying depths, to laser ablation - full or fractional, to surgery!). He/she should explain to you all of the pros and cons of each as well as the potential risks and complications of each. He will then assist you to determine what would be best for you under your circumstances (skin problems along with goals and expectations). He will also discuss the limitations of any procedure and the long term consequences as well. Do your homework, become informed and do not hesitate to ask questions. If there is still concern, get a second opinion.
Lasers are only "tools" of the physician and he must determine which tool works best for you.
Finally - there appears to be no long term detrimental effects of the Fraxel and it can be repeated by an experienced laser physician and with good safety.