2 days ago, had Fractora (1st time) w/PRP. Concerned over some side effects. Is this normal? (Photos)

Question

Swelling and redness are reducing but I have some vertical striations (feel scabby) in different treated areas. I'm told this is normal but there's very little info on line to validate. Seeking opinions / explanation of what these marks are. Assuming they are superficial and will go away? Please let me know & any advice to help facilitate faster healing. I have to go back to work and would like to look "normal". Taking a med-dose pack for swelling I was given. Please don't scare me though!

Joseph L. Grzeskiewicz, MD, FACS · Answer

You are only 2 days out from your procedure, so the first thing to recognize is that it is VERY early in your recovery period.  Your skin and even deeper tissues are swollen, red, crusting, and tender, and this is all completely normal and expected for this stage.  The small punctate craters that are neatly arranged in the stippled pattern you see on your skin are also very normal, as those are the puncture sites from the Fractora needles, and that is where the thermal injury to the skin largely occurred, or was supposed to.  The linear marks you have are not really supposed to be there, at least to any significant degree, and while they certainly can occur, especially here and there, and maybe in shorter length than what you see, in my opinion, they really should not.  What these look like to me, based upon the images you have shown, are "rail marks" left by both poor contact of the treatment tip and overexposure of those specific areas to the "rails" on the treatment head.
To understand this better, one must understand just a little about exactly how the Fractora works.  Basically, it has a squarish shaped treatment head with multiple needles (24 or 60, depending upon the type of treatment being done) arranged in an even grid across the square, and then on 2 sides of square, there are 2 straight linear metal electrodes, or "rails."  Take a look at this website for a picture of one and a short video clip which will help it all make better sense to you: inmodemd.com
The way the machine works then is that the electrical current goes out of each individual needle point (60 or 24 of them) into the skin, and then back through the rails on the sides which are in contact with the skin.  This completes the circuit and keeps the electrical energy confined and concentrated to that area.  Ideally, the tip would be pressed completely against the skin, making full contact of all electrodes with the skin and making the needles penetrate maximally, before the foot pedal is depressed activating the machine and delivering energy.  In addition, as each spot is treated and the tip advanced to cover the entire face and neck, it needs to be positioned properly and with care, for each site.  The doctor should overlap only about 30-40%, and more importantly, when the tip is advanced, it should be advanced in a way that the rails don't stay in the same path and overlap the place where they just were.  Think about someone walking with skis on:  they can either move forward, sliding their skis in the same path, creating a groove, or they can sidestep, placing each ski in an entirely new location with each side step.  This is how the treatment tip needs to be advanced when doing the treatment with the Fractora; this is CRUCIAL.  The tip must be lifted each time and pressed back down, overlapping approximately 30 % but more importantly making sure that the rail electrodes do not overlap the previous location where they were.  When this happens, heat builds very quickly and gets concentrated in that skin under those rails, it does so in a linear pattern, and it essentially overtreats that skin, and it does so at a level too superficial for this treatment, recalling that, especially with the 24 pin coated tip, which it looks like you might have been treated with, the intention is to keep the heat way down deep in the dermis, only at the tips of the needles.  In addition, when the tip is slightly lifted off the skin, which happens to all of us from time to time - when you think about it, if I typically do about 1000 pulses for a face and neck treatment, statistically one or two of those pulses may be less than ideal, but it should be minimized - this can cause a problem.  Usually this happens when the operator is going too quickly and not focused on proper tip position and control.  When the rails lift off of the skin surface, if they are still close enough it allows the electricity to jump or "arc" from the skin to the rail, and this superheats the gases in the space between the rail and the skin, and also gives uncontrolled heating, which leads to excessive thermal injury.  So, in summary, what you have here are really some burn injuries created by excessive heat buildup in the skin, most likely caused by those two mechanisms I outlined.  In a well-performed Fractora treatment, we would prefer not to see these things.
Now, that's the "what happened," and that's all interesting for the people that care about that sort of thing, but most people in your position really want to know "what do I do," and "what does this mean for me long term."  First, I'm going to do as you first asked and not scare you, but I am also going to impress upon you that there are a few very important things to do for your skin, if you aren't already doing them, that you need to do in order to avoid some problems down the line.  Even though I used the word "burn," understand that these are very small and very superficial partial thickness injuries to the skin, and they will heal.  These will pose no significant medical risk to you at all.  The thing we want to be sure of is that they heal well and don't cause other issues, mainly of a cosmetic nature.  It's hard to discern your ethnicity from these images, but you appear to have darker hair and maybe an olive Mediterranean, Latin, or Asian complexion, and if that is the case, the number one thing we need to be concerned about is what's called "postinflammatory hyperpigmentation" - PIH for short.  This is a condition that befalls mainly people in races with some pigment in their skin (my wife from Hungary and Yugoslavia being one!), and it causes some darkening at sites of even the most minor skin trauma.  This type of thing is notorious for causing it.  Typically it goes away with time, but that could mean a year or longer, and while it is present, especially on the face, it can be quite disconcerting.  The way we control this in my practice is to put all Fractora patients on a brief course - maybe 3 - 6 months of treatment with hydroquinone, minimum 4% concentration, and higher if needed.  We are also religious about wearing sunscreen EVERYWHERE, especially here in SoCal, as sun exposure to already damaged skin like this can definitely increase pigmentation.  I start my Fractora patients on these things at 2 - 3 days post procedure, depending upon how quickly their skin is healing, so pretty much right about where you are now.  If you are already doing these things, great.  If not, I highly suggest that you discuss this with your doctor that did your treatments so that your risk of pigmentation can be minimized.  Then it becomes a matter of observing how the skin itself is healing to be sure that you are not forming any thickened or raised scars at this sites of excess heat deposition.  In those events we might use things like topical silicone ointments, topical steroid creams, topical vitamin E, or even certain lasers depending upon what things look like.  So, in summary, this is not so much a terrible functional or medical issue, as it will heal.  It is more of an aesthetic concern as we would want to closely monitor the progress of the healing so that we can intervene early and manage any of the things I noted above.  Best of luck to you.

Richard E. Moore, MD · Answer

Thank you for your question and posting your pictures. It is expected for tiny scabs to form after a Fractora RF treatment and while the striations look to be a bit more than usual, I suspect they will resolve over the next 5-7 days without any problem. We counsel our patients that they will have 5-10 days of scabbing following Fractora so that they can make plans relative to their work schedule. If things are not improving significantly by 7 days out from your procedure I would follow up with the center where your procedure was performed. I hope this was helpful - Dr. Moore.

2 days ago, had Fractora (1st time) w/PRP. Concerned over some side effects. Is this normal? (Photos)

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2 days ago, had Fractora (1st time) w/PRP. Concerned over some side effects. Is this normal? (Photos)

Answers (2)

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Everything you need to know about Fractora RF

Our mission is to create a world where every investment in modern beauty is Worth It.