How many Fraxel Restore treatments are needed to see results for acne scars? (photos)

I just got 3 Fraxel Restore treatments done on my face. The settings my doctor use was 45mj energy level, Treatment level 8 and 8 passes. These were the settings used for all of my 3 treatments. My doctor kept the setting low because I am olive skin and I am at the risk of hyper pigmentation. Its been more than a month after my 3rd treatment and I have not seen any noticeable results, the scars are still deep. I just want to know that how many treatment I will need to see results.

Here is a link to my previous question with photos.

Doctor Answers 3

Fraxel Dual (Restore) for Acne Scars in Darker Skinned Patients

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Dear John,

I will try to answer your question without having a photo of your skin and scars available.

Fraxel Restore treatments are very effective for most acne scars.  Very deep scars may need a combination approach which would include dermal fillers and possibly subcision.

To answer your Fraxel Restore question, the more treatments you have the more results you will see.  I find that 3 treatments is typically not enough to see a dramatic result.  I also find it helpful to compare pre and post treatment photos as often times patients don't appreciate the changes until the photos are compared because the improvement is gradual overtime which is not as easy visualize when one looks in the mirror on a daily basis.

When it comes to laser settings, there are three parameters that can be adjusted.
1.  PASSES.  This is typically 8 passes regardless of skin type.  Patients who have a low pain tolerance can have more passes, such as 10 to 12 which distributes the same amount of pulses in the end but does so more spread out so there is less pain. 
2.  JOULES.   The greater the Joule count the deeper the laser penetrates into the skin.  If one is treating pigment, I will typically set the Fraxel Dual (newer version to the older Fraxel Restore) to 10J and use the Fraxel 1927.  For deeper problems, such as scars and deeper wrinkles, I will use the Fraxel Dual 1550 (the old Restore) and set it to 60 to 70 Joules around the cheeks for scars and deeper lip lines.   Patients with darker skin color will not need a lower Joule setting.
3.  DENSITY.   The treatment level (density) defines what % of the skin is treated.  The higher the density, the more aggressive the treatment.  Patients with darker skin should have a lower treatment densities to avoid a common risk of laser, hyper pigmentation. 

John, in summary, you may want to ask your doctor to increase the depth (Joules) of your treatment as this will add to your results.  With patients of darker skin types, I will often go below a treatment level of 8, as low as 5 or 6, with double the amount of treatments to get the same results in the end without the risks.  I am attaching an article for your review that demonstrated this approach- go deep, i.e. high Joules, but low on the density i.e. treatment level, double the amount of treatments, safer, with equal results in Asians.

Hope this was helpful

Ran Y. Rubinstein, MD
Board Certified Facial Plastic Surgery, Newburgh,  New York
Assistant Clinical Professor, New York Presbyterian Hospital
Education Faculty for Solta Medical- manufacturer of Fraxel, Clear & Brilliant, and Thermage.

Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Fraxel for Acne Scars

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The Fraxel (1550) for acne scars is a great treatment and each time you have the laser performed you will see increased improvement.  It is very difficult to predict how many treatments you will need.  If you have little results you can go higher on the next treatment, depending on your skin type.  Without photos, it is difficult to give an opinion.  Please make sure you seek out a board certified dermatologist for the best results.

Acne scar treatment with Fraxel Restore

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Typically, deep acne scaring requires aggressive settings, meaning high energy settings and greater density to get more dramatic effects, and while you do have darker skin tones this wavelength is well tolerated. A combination of lower and higher settings may also benefit to target at different depths of the skin. Realistically, anticipate at least six sessions.  Concomitant treatment with pigment modulators are a good idea. Lasers alone may not be sufficient, combining a laser treatment with dermal infiltration with platelet rich plasma can enhance the repair process.  

Arthur N. Falk, MD
Albany Facial Plastic Surgeon

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.