Fraxel Repair or Restore for Acne Scars?

Question

I have tried the regular Fraxel and the results are good, but I heard of this new invention, Fraxel Repair, where you undergo the treatment once and get amazing results. My main concern is finding out which would be better for acne scars--the regular Fraxel or Fraxel Repair? Thanks.

Michael A. Persky, MD · Answer

Hi Frank,
Fraxel re:store has been used for the past 4 years in the treatment of acne scars.  It usually takes anywhere from 4 to 8 treatments separated by 2 to 3 weeks each.  The downtime is minimal and the skin remains intact.  It is a gentler, less involved treatment that the new Fraxel re:pair.  Fraxel re:pair has amazed me with it's affect on acne scarring in a single treatment.  I do inform all acne scar patients that they may need between 1 to 3 Fraxel re:pair treatments for the best result. 
Yes, the downtime is greater, but the end result is beautiful.  To answer your question, Fraxel re:pair is better for acne scarring as long as the patient is aware of what is involved, and is willing to go through the process.  For those who do not wish to go through the more aggressive re:pair treatment, Fraxel re:store is an excellent treatment option.  Be well and good luck.
Dr. P

Raffy Karamanoukian, MD, FACS · Answer

Our office uses a combination of procedures for acne scars. We believe in the combination protocol of fractional laser for skin resurfacing and ematrix for deep collagen stimulation. Best, Dr. Karamanoukian

Ron Shelton, MD · Answer

Fraxel Repair uses a carbon dioxide wavelength and being fractional, creates less aggressive resurfacing than the first type of laser resurfacing that was fully ablative.  The Fraxel Repair usually produces a better result in one treatment than one Fraxel Restore, which is of an erbium wavelength.  The Fraxel  Restore is not designed to only deliver one treatment, but rather, a series of monthly treatments, for 5 or 6, or more sessions.  There is no rawness but redness, slight to moderate swelling for a few days and barely any flaking.  Most people are able to maintain their normal activities but people will notice what looks like a bad sunburn.  This is no comparison to the post operative recovery period of the Fraxel Repair laser that induces rawness that must be treated with special emollients and people are told not to leave the house for at least several days.  There is much involved with the recovery to make it go well.  Many patients in NYC find this recovery not conducive to their lifestyle as they can't afford downtime, even the redness and slight swelling of the Fraxel Restore can set a few people back, but it is more of an appealing treatment regimen for those that don't want to take days off work. The Fraxel Repair can be redone but many doctors wait for six months or more, but the Fraxel Restore can be done every three to four weeks. Both induce good changes in acne scars but neither can erase the scars completely.

Michele S. Green, MD · Answer

Fraxel repair is a CO2 based laser which is much more aggressive than the Fraxel restore. Most patients prefer the Fraxel restore since there is not much down time and the results improve with each session. I typically will do 5 sessions for acne scars and find the collagen is still building with new collagen formation several months later. For the best results please consult a board certified dermatologist with a great deal of experience with Fraxel.

Daniel Shapiro, MD · Answer

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel Repair. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Jordana S. Gilman, MD · Answer

Your choice of Fraxel lasers (re:store or re:pair) for treating acne scars depends on what your scars look like and what your tolerance is for downtime after the treatment. Fraxel re:pair is the more aggressive of the two, and will smooth acne scars, but requires 7-10 days of downtime. You may only need 1 or 2 treatments with the re:pair. The re:store also can give amazing results but as it is more gentle it only causes 2 to 3 days of downtime. However, you are trading less downtime and less risk for more treatments--you may need 6 or more treatments for your scars. The deeper your scars the more treatments you will need. Talk to your physician so she or he can evaluate your skin and the type of scars you have, and you can discuss your options.

David Goldberg, MD · Answer

Both lasers can improve acne scarring. You are correct that you need fewer treatments with Fraxel Repair. However, to expect just one session to give you complete results may be incorrect. It can require up to 3 sessions with Fraxel Repair. A new treatment that appears to be terrific for acne scars is known as the e-Matrix. This is actually not a laser but a radiofrequency device, and early results have been terrific in the treatment of acne scars. Many dermatologists, including our practice, have this device.

Michael Law, MD · Answer

I have used laser skin tightening with the Candela Gentlelase Laser with great success for acne scar reduction or removal and skin tightening. In other cases I may actually cut very deep scars out and sew together. Other acne scars can be treated very effectively by fat grafting.

	The most important factor to to prevent future acne, otherwise the treatments will likely not last. Not all acne resonds the same way. By pulling on the skin we can generally determine if Laser skin tightening could work. If a scar does not budge after being stretched, that scar likely requires excision followed by lasers to heal the area quickly.

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