Fraxel Failed to Work on my 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!

Thank you for the question. 
There are several different Fraxel lasers on the market.

Fraxel re: fine™: Fractional, non-ablative treatment which delivers a gentle yet effective option for skin rejuvenation and resurfacing. 
Fraxel re: store™: (The main or flagship Fraxel system). Fractional, non-ablative treatment for skin resurfacing and rejuvenation. 
Fraxel re: pair®: Fractional, ablative treatment using a CO2 laser is an aggressive treatment for moderate to severe photodamage.
These are very different lasers which different results and different recoveries.  Please see a board certified laser expert to discuss the best laser for you.  Also, note that acne treatment should be multimodal for best results.  A combination of resurfacing lasers (Fraxel or Lumenis Ultrapulse), PRP, microneedling, subcision, filler, chemical peel, and surgery may be needed for optimal improvement. Multiple treatments are generally needed to give the best possible cosmetic result.

As a patient, it can be really hard to figure out which of the treatments that are recommended at medical spas will actually work. The questions to ask yourself:Does this clinic have a range of options available to choose from, or are they recommending what they have (lasers are expensive)?Did the treatment provider set my expectations properly about what improvement can be achieved? The fact that you expected your scars to "disappear" indicates that perhaps you were not well consulted.Acne scars are very hard to treat. An improvement (but not perfection) can be expected with certain laser technologies.

I am not surprised that you didn't receive benefit in acne scarring with Fraxel Refine. This laser was developed for the spas and not for physician treatment, therefore it is not expected to penetrate deep enough to affect acne scars. Multiple Fraxel Restore treatments often provide my patients with better acne treatment results than the old fashioned carbon dioxide laser treatment.  Fraxel Repair is the most aggressive laser and it can help acne scars also. See a laser specialist who has a significant experience in the treatment of different types of acne scars.

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.

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.

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

Thank you for your question! 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 have 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. Best of luck!

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.

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.