Fraxel Failed to Work on my Acne Scars

Hi. I have a question regarding Acne Scars. I have undergone six sessions of Fraxel Refine to minimize or make my scars disappear, which did not happen. The practitioner who did the procedure suggested Fraxel Repair but couldn't assure me that it'll work on my face. I was wondering how good of an improvement can you get out of Fraxel Repair. Will I see a huge difference? Thank you.

Doctor Answers 14

The real story on acne scars

Here's the deal with acne scars: no laser is really going to do all that much for them. Sorry, but acne scars are very difficult to treat and you are never going to go back to where you want with any laser alone. Even with the best of treatments, you are going to have about 50% improvement and that is with fillers such as restylane and perlane, which will be doing the heavy lifting.

Prior to having Fraxel, Cool Touch, Fraxel Re:pair and every other laser that has promised to improve acne scars but didn't, I performed full face CO2 lasers on patients with acne scars. The results were not all that impressive, despite the fact that patients went through 2 weeks of sheer torture during the recovery phase. That, on top of the price in the $4000 range that made it *seem* like something ought to have happened. Due to this fact, I stopped doing the older, CO2 laser and haven't missed it one bit.

Now, unfortunately, we have a whole new generation of doctors and quasi cosmetic surgeons (family practitioners, nurse practitioners, Ob Gyns, etc) who have now purchased these lasers for their medispas and are trying to generate some cash, along with laser companies that are desperate to sell their machines. So, the old concept of treating acne scars with a laser such as Fraxel is once again being trotted out and desperate patients are being duped once more.

The truth is that it does precious little for acne scars and typically not enough to make someone spend the money and recovery time to do the treatment. What I tell patients is that if the money is something that you care about and it is anywhere near a stretch to do the procedure, you don't want to do it for acne scars. Wrinkles are a whole different situation because it does work for these. Acne scars not so much. And the recovery time, if the scars are done correctly with it, is going to be about a week or two along with major downtime and oozing. So, think twice before doing this procedure, despite what the laser companies and many doctors are telling you!

Omaha Dermatologic Surgeon
4.8 out of 5 stars 40 reviews

Many types of fractional lasers and options for acne scars - none are a home-run

What concerns me is your use of the word "disappear".  No one should ever tell you that any procedure, no matter how many you do, will cause your scars to "disappear".

The problem with acne scars is that no matter what you do they will never be 100% gone.  You could do 20 Fraxel treatments and your scars wouldn't be 100% gone.  It's true that the more treatments you do, the better the results but there is a law of diminishing returns and for acne scars it's more a logarithmic curve--at some point, you do not get back as much as you put in and eventually the results just level out and don't keep getting significantly better.  The reason is that acne scars are holes or defects in the skin--the laser cannot remove the hole, the best it can do is to soften the shoulders of the hole so the drop-off isn't so apparent.  That's why fillers often work better than lasers on deep crater scars because they plump up the depression but it's very difficult to treat every scar on the face with fillers.  It's also very cost prohibitive to use temporary fillers because they have to constantly be redone to maintain the results.  A permanent filler such as Artefill might be appropriate for certain deep depressions or crater scars.  However, acne scarring has 4 types:  ice-pick, box car, rolling, and hypertrophic.  Each type of scar has to be addressed in a different way.  In addition, most people are more bothered by the discolorations than the actual depressions themselves.  

Now, if you're going to invest in a procedure, you need to know what to expect from all the different procedures and the options are wide and bewildering.  Noninvasive lasers such as KTP, Nd:YAG, pulsed dye, alexandrite, ruby, and IPL can address red and brown discolorations.  This can make the acne scars look significantly better without having to go thru the downtime and hassel of the invasive or ablative procedures.

In order to achieve textural improvement, one must turn to resurfacing procedures (which require some downtime, some less than others).  Dermabrasion and phenol peels are actually quite effective but have the downside of making the skin texture appear unnatural or waxy, and high risk of loss of pigmentation (hypopigmentation).

CO2 laser is the gold standard, most painful and invasive laser, but achieves the best results.  It is home-run for wrinkles but not so for acne scars.  At best, one may achieve on average 50-60% improvement after one CO2 laser.  That means there may be some scars (especially the deep pitted or ice-pick scars or box car or crater scars that do not respond at all).

Fractional CO2 laser has become a new gold standard for acne scarring but once again, not a home-run.  There are many different brands of fractional CO2 and they differ in the amount of energy, therefore effectiveness.  The Lumenis ActiveFX and DeepFX are the most powerful of the fractional CO2 lasers and capable of achieving the best results.  The Repair is less powerful than the ActiveFX and DeepFX.  The ActiveFX and DeepFX have the ability to be turned down to match the weakest of the fractional CO2 lasers--but the converse is not true--the other fractional CO2 lasers cannot be turned up to match the ActiveFX and DeepFX.  (ie: A Ferrari can be driven at the speed of a golf cart, but a golf cart cannot be driven at the speed of a Ferrari).  The CORE and Mixto lasers are also less powerful and less effective.

Having said that, even the best fractional CO2 laser only gives about 20-30% improvement per treatment if combining both ActiveFX and DeepFX together.  After 3 treatments of both, one can get about 50-60% improvement of their acne scars.  Doing more can give incrementally better results but at some point, one has to ask if it's really worth paying more money especially if doing even 6 more is not going to get you to 100%.

Fractionated Erbium lasers such as the Fraxel Restore or Refine or Pearl or Profractional or Affirm are even less effective than the fractional CO2 lasers so you would have to do many more treatments to even get decent results.  

Refine is the weakest of the fractional lasers--it was designed for use by nonskilled practitioners in order for them to not "get in trouble".  Unfortunately the lower power also makes the results from Refine almost not noticeable.  The Refine is MUCH weaker than the Repair so it's possible that you may get better results with the Repair...but not a lot better.  You will not see a "huge" difference.  

Most patients can be quite happy with any of these procedures as long as the physician properly helps to establish the right expectation level.  The question is always whether the results are worth the money and time you're investing.  There is no perfect procedure unfortunately that will make your acne scars completely gone. If someone asked me what the one best procedure to do is to get the best results for their acne scarring:  if discolorations are the primary issue, the best would be noninvasive lasers such as KTP and Nd:YAG, and IPL.  If the issue is textural irregularity such as depressions, I would say the one best laser is DeepFX, and if someone could afford it, to combine DeepFX with ActiveFX.  And then to follow up with fillers to the residual crater scars.



M. Christine Lee, MD
Walnut Creek Dermatologic Surgeon
4.3 out of 5 stars 16 reviews

Fraxel has many names

First beware that Fraxel is a name like Kleenex, they have many Fraxel lasers some good for acne scars some not so good.

  • For moderate to severe acne scars you need ablative lasers with downtime.
  • Erbium yag lasers that go deep such as sciton profractional can get results almost all acne scars in most skin types.
  • Fraxel Re:pair is the CO2 version that can also get results though with more downtime than the erbium yag lasers.
  • If your scarring is mild then you might consider nonablative fraxel or others but remember there is no free lunch and lasers with no downtime may need multiple treatments to achive results of more aggressive lasers

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

Acnes scars are challenging

Dr. Schlessinger has hit it on the head.

Fraxel (any generation) is great for fine wrinkles. Deep acne scars are more challenging. The key is improvement. Some ablative laser techniques can improve even deep acne scars but be prepared for significant downtime (think weeks at home with a hoodie and sunglasses).

The same applies for chemical peels and dermabrasion. Unfortunately scars are one of the most challenging things we face.

Be careful of marketing promises and be sure to consult a board certified Dermatologist, facial plastic surgeon or plastic surgeon.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Fraxel repair will have subtle improvements with each treatment

Fractioned lasers will gradually improve your scars. It also depends on how your scars look. Some scars need to be excised first before they actually can get really better. Other times require subcision techniques which require you to use different instruments, such as punch biopsies or needles to elevate depressed scars so that they match the surrounding levels of the skin. You may need more significant approaches for the scars such as co2 resurfacing as well to get the results that you really want. Also, some scars require excision and closure and further resurfacing to improve them.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 86 reviews

Fraxel laser and acne scars; Improvement of scars with fraxel pixelated laser.

Acne scars cannot be eliminated by any means. They can only be improved, regardless of the type of treatment. This discussion should take place with any consultation of acne scars. The improvement of acne scars can be qualitative and quantitative but is never predictable.

Fraxel laser works by subjecting the skin surface to pixelated beams of laser light. The depth of treatment is within the dermis and the amount of skin surface treated at any given time is less than 25%. Thus, four or five treatments can theoretically treat the whole skin surface.

Acne scars can be improved with Fraxel laser. Chemical peels and acne surgery can also improve the quality of acne scars on the face.

Discuss the nature and depth of your acne scars and more importantly, the quality of the surrounding skin with your doctor so as to form a practical goal for treatment.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Fraxel re:fine not for acne scars

Hi Frank,

Let's be frank Frank, Fraxel re:fine is the original Fraxel SR1500 but a much weaker version (limited energy and density). It was marketed to be a safe laser for very superficial fine lines and brown spots, not deep acne scars. Fraxel re:pair has been very successful with acne scarring, sometimes in a single treatment, but I always council patients that it may take 1 to 3 treatments depending upon the individual. You should see a huge difference with the Fraxel re:pair. Choose your treating physician carefully and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

There are two kinds of lasers: Ablative: Removes top...

There are two kinds of lasers:


  • Removes top layer of skin.
  • Requires one treatment.
  • Requires 3-4 weeks of downtime.

Non-ablative (Fraxel):

  • Doesn't remove the top layer and doesn't create a raw surface.
  • Requires multiple treatments.
  • Doesn't require downtime.

Fraxel is a non-ablative laser that only treats 20% of the area, and therefore requires 5 total treatments. Fraxel works by heating up tissue so the body can lay down collagen. You need to wait 2-3 weeks between treatments. And, because it is milder than an ablative treatment, you need to wait several month to see results.

Ablative CO2 laser resurfacing is considered the gold standard laser treatment. Ablative treatments tend to be cheaper, because they only require one treatment, but do require more downtime.

Ultimately, the patient needs to choose between faster results and more down time (ablative) or slower results and no downtime (non-ablative, Fraxel)

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 40 reviews

Combination Treatments

Unfortunately, Acne scars are a difficult concern to treat. When Fraxel alone does not solve the problem, we find that combining treatments will give the patient satisfactory results. The layout below is a standard plan we use to treat Acne Scars.

Step 1: Prior to any laser treatment we preform subcision on any present boxcar scars. Subcision is performed by using a needle to separate fibrotic strands that are tethering the scar to the underlying tissue. The area is numbed prior to treatment so the patient experiences little pain.

Step 2: We do a combination of Endymed Intensif, Fraxel and Platet-Rich-Plasma. Endymed is a combination of radio-frequency and mirconeedling. The energy promotes the body’s natural production of collagen and elastin, and overtime the targeted tissue is replaced by healthy, younger-looking skin. Following the EndyMed we treat patients with a Fraxel 1550. Fraxel 1550 causes controlled injuries to the skin which sends it into repair mode and speeds up cellular turnover.  Finally, Platelet-Rich-Plasma is applied and injected into the scars immediately post treatment. Patients experience mild redness and swelling for several days but discomfort is very minimal.

Step 3: Lastly, any remaining atrophic scars may be injected with Bellafil. Bellafil is an FDA approved PMMA (Polymethlinethacrylate) that can last up to 5 years.

Treatments should be separated monthly and may need several treatments in order to achieve optimal results.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 22 reviews

A series of Fraxel treatments can improve acne scars by 50 to 80%.

The reason is that acne scars are holes or defects in the skin--the laser cannot remove the hole, the best it can do is to soften the shoulders of the hole so the drop-off isn't so apparent.  Fraxel lasers can treat acne scarring very well. A series of Fraxel treatments can improve acne scars by 50 to 80%.However not everyone has the same reactions and results depending on the severity of the scars and the skin types. Fillers often work better than lasers on deep crater scars because they plump up the depression but it's very difficult to treat every scar on the face with fillers.You can always consult a certified physician for further recommendation.

Hardik Soni, MD
Summit Emergency Medicine Physician
5.0 out of 5 stars 45 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.