Active FX Vs. Fraxel Laser Treatments - Which is Better?

It seems like Fraxel and ActiveFX are both supposed to treat the same problems, but which one is better? 

Doctor Answers 12

Active FX vs. Fraxel - it is more complicated

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Excellent answers from other doctors. I'll just add a couple of little clarifications that many of our patients ask for.

1. There are currently two types of Fraxel lasers, two totally different machines: Restore is Erbium-based, and Repair is CO2-based.
They offer different treatments. Restore is the one that needs several (usually 5) treatments, and Repair is more powerful, usually one treatment with more downtime.

2. Active FX and Deep FX are different heads (attachments)for one laser (Lumenis Ultrapulse Encore). It is a CO2 laser.
We, as most doctors, utilize both heads for almost every patient. Deep FX head is better for treating wrinkles, scars, acne scars and similar "deeper" lesions. Active FX head is better for dyschromias (pigment, sun damage) and similar superficial lesions. We also use it for removing pre-cancerous lesions and sometimes skin cancer.


Seattle Facial Plastic Surgeon

Fraxel Re:store or Fraxel Re:pair versus Active FX

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Fraxel re:store involves a series of 3 to 5 treatments while Active Fx involves a single, sometimes a second treatment. They both give good results. Active FX is a very superficial treatment for sun damaged skin.

Fraxel re:pair in a single treatment gives much better results than Active FX. To get results similar to Fraxel re:pair, a Deep FX treatment needs to be added to the Active FX treatment. Be well.

Dr. P

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

Skin tightening only with CO2 Laser

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The most important difference between the Fraxel and the CO2 Fractional laser is that there is skin tightening only with the CO2 laser.  The fractional CO2 allows treatment with minimizing the two side effects which were a problem with the ultrapulse CO2 hypopigmentaion and scarring.  The fractional CO2 is usually only one treatment instead of a series as well.

David J. Sire, MD
Fullerton Dermatologic Surgeon

Total FX provides more dramatic results

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I have used both the Fraxel:repair and the Active Fx for similar conditions. I feel the Active Fx is superior and far superior when combined with Deep Fx (which is Total Fx treatment.)

I always combine the active and deep fx because the downtime is minimally increased (1-2 days) but the results are more dramatic. Also, the patients who receive Fraxel:repair stay red for much longer but with inferior results.

Carla R. Retief, MD
Nashville Dermatologic Surgeon

Active FX is better than other fractionated lasers

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The Active (and Deep) FX lasers are more powerful than ALL other fractionated lasers. More power means quicker healing and less pain with possible less side effects. The Active/Deep FX laser is more expensive than ALL other lasers. That is why most doctors have the cheaper lasers. You only have one face, make sure the best laser is used.

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 26 reviews

Fractional CO2 Lasers work the best (Active FX and Fraxel re:pair)

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First and foremost, you must know what “type” of Fraxel laser would be used for your treatment. There are two types of Fraxel lasers: Fraxel re:pair (a fractional CO2 laser) and Fraxel re:store (an Erbium laser, which is non ablative and is less powerful). Generally, CO2 lasers are considered more effective, so I would highly suggest using a Fraxel re:pair laser OR Active FX instead of a Fraxel re:store laser, if possible. Recovery time with either of those CO2 lasers will be longer than with a Fraxel re:store treatment, but that is because laser treatment with a CO2 laser is more powerful, and as a result, is more effective. Fraxel re:store is NOT a CO2 laser.
It is also very important to also take into consideration how much power the laser generates (meaning the energy that is delivered). A high powered laser works better, since it is more controlled and typically causes less pain and trauma to the tissue. A good power is around 240 quats of energy. Active FX laser has that much power.

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 44 reviews

While both Fraxel and ActiveFX laser technologies...

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While both Fraxel and ActiveFX laser technologies function in a similar manner, they are two distinctively different lasers. Fraxel technology delivers fractionated Erbium laser energy while ActiveFX utlizes fractionated energy from a carbon dioxide laser. Even though the two are similar, the increased heat provided by the ActiveFX appears to result in more effective skin tightening and, overall, better results.

Laser education 101

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Let me start by saying that not all skin types (pigment) are safe for all lasers.  Fraxel laser was, in its day, a breakthrough device in the world of fractional lasers.  Fractional lasers, instead of treating the entire surface, instead puts individual beams of laser energy into the tissue.  Depending of the wavelength of the laser, different things will happen.  Fraxel (brand name of a fractional laser) helped get fractional treatments started, but it is a wavelength that really can’t achieve a whole lot.  It requires multiple treatments, is rather painful, and the results are mild to moderate.

Active FX is also a fractional laser (as opposed to full field), and uses the ablative fractionated CO2 wavelength.  Active FX and Deep FX are much more precise than the old full field and fractional CO2 lasers.  Historically, CO2 lasers were not a good choice for patients with medium or darker pigment.  Too much heat, resulting in complications such as PIHP (post inflammatory hyperpigmentation) and/or scarring.  The newer fractional CO2 layers have greatly sped up the delivery of the laser energy, thereby reducing many of the complications previously associated with CO2 lasers.

Depending on the skin type of the patient, the issues we’re addressing, etc, determines which laser I use.  Often I use the Active FX and Deep FX, but many times I’ll choose erbium fractional laser or the Halo laser by Sciton, which incorporates erbium (ablative laser that sees water only), and the 1470nm laser that heats, but does not vaporize tissue.  The Halo is colorblind, and the outcomes are fantastic for a variety of issues for almost all patients.

I feel it is imperative to understand the skin physiology of all patients, and have a number of energy based tools and devices that can be used individually, or in combination, to give stunning results.

I  sometimes give patients this analogy:  you can take a Steinway grand piano, and an average pianist, and get a so so outcome.  Or,  you can take a concert pianist and put them on an old upright piano, and also get a so so outcome.  But, if you put a concert pianist on a Steinway grand piano, the result can be amazing.  Excellent technology, combined with a skilled medical laser specialist, yields the best and safest results, and the highest patient satisfaction



Robert D. Wilcox, MD
Dallas Plastic Surgeon
4.1 out of 5 stars 22 reviews

Fraxel Vs. Active FX

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The "original" fraxel was an erbium-based laser, and gave results no where near the Ultrapulse (Active and Total FX Laser) with a single treatment. The newer fraxel "repair" is a CO2 laser (like the Ultrapulse) and gives closer results with a single treatment. The Ultrapulse is unique in having the Active FX and Total FX modalities which give a "complete" treatment, and many of us feel that makes it superior.

Roy A. David, MD
San Diego Facial Plastic Surgeon

Fraxel and Active Fx are both outstanding lasers for resurfacing.

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I love both the Fraxel and Active Fx.  The Active Fx and Deep Fx are my CO2 fractional lasers for deep lines wrinkles and severe sundamage.  Fraxel does make a CO2 laser (Fraxel Repair) however I use the Fraxel Restore.  The Fraxel Restore is an Erbium based laser and is designed to treat lines, wrinkles and scars with multiple treatments with less recovery time.  It is the perfect "weekend" procedure.  I can offer my patients the pros and cons of each procedure and tailor a treatment plan that addresses their specific needs and lifestyle.  I would not give up either laser.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.6 out of 5 stars 36 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.