How Do Doctors Decide on Laser Treatment Settings?

I have found out through personal consultation that many doctors who perform Fraxel Restore, Fraxel Repair, and V Beam laser always use charts provided by the corresponding manufacturer as their only reference to determine the settings to be used on every single patient they treat. Is this how all doctors decide which settings to use on each patient and case? Could this be one of the reasons for their treatments to achieve very little to no results with these 3 different lasers, but also no complications?

Doctor Answers 4

This are no "cookbook" settings for Fraxel Repair or Restore

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Hi Violeta,

I agree 100% with Dr. Lupo. In addition, every patient is a unique case and settings should vary depending on age, skin type, condition being treated, desired downtime, etc. This is why you should see any experienced dermatologist that does these procedures everyday. I have never had a patient not see improvement after treatment with these devices. Another issue is that often times it is best to use multiple lasers in one treatment session to get the best result. If you look at the photos that I have posted on RealSelf, you will see that using the correct lasers in the right combination will yield great results. Take care, Dr. Groff

San Diego Dermatologist
4.9 out of 5 stars 51 reviews

Fraxel Laser Settings

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Hi Violeta,
Fraxel restore does not give as dramatic results as the "Wow!" results of Fraxel repair. Dr. Lupo and Groff have answered your question very well. "All physicians" do not use the same recommended settings, nor do all patients receive the same settings.
Great results with Fraxel repair not only depend on the "tool", but more importantly excellence depends on the "craftsman".
That is why we all recommend choosing your treating physician most carefully with these very effective but powerful laser treatments.
Good luck and be well.
Dr. P

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

How do doctors choose laser settings?

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The manufacturer does provide recommendations on the settings that should be used with a specific laser. This is based on the research they have performed prior to FDA approval. However, it is experience that teaches us what settings to use on a given patient. Think of this as a recipe when you are learning how to cook. The first time you try it, you try to do EXACTLY what the recipe says. Once you like the food, you think of ways to make it better. You alter the recipe and try again. Sometimes, the food turns out to not be quite as good as the original, so you change the recipe again or go back to the original.

This tried-and-true method is exactly what most well-qualified physicians would do. I feel it is important that your doctor performs the treatment personally. This is the only way to improve on the "recipe." The "recipe" I use now is based on numerous procedures and modifications. In general, the settings I use are a lot stronger than the manufacturer's recommendations. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

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I'd be very curious to know if you are seeing board certified dermatologists and plastic surgeons. The manufacturer often prints very conservative settings because any kind of MD (i.e., even those with no cosmetic training) can legally buy a laser. The company does not want to harm the patient, so ultra-conservative setting are suggested. Experienced core aesthetic physicians are comfortable "tweeking" those setting to get better results. The use of advanced settings, however, does increase the risk of complications, but good dermatologists and other core aesthetic physicians know how to MANAGE complications. This is a very important difference in care that every patient should consider when choosing their treating physician. Good Luck.

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.