Can You Spot Treat Crows Feet with Fraxel, or Does the Entire Face Need to Be Done?

Question

Looking for an alternative to Botox for crows feet. Is it ok to spot treat with Fraxel, or would the entire face need to be done to prevent unevenness?

Chad K. Wheeler, MD · Answer

Fraxel is a relatively new technology that employs a laser to burn and tighten the skin in a discontinuous pattern.  This is similar to aerating your lawn.  To understand its benefits and limitations we must first understand how it works. The laser burns a tiny spot in the skin of a specific diameter and depth.  The clinician sets these parameters on the laser prior to treatment.  The deeper the burn the greater the tightening effect.  The wider the diameter of the burn the longer it takes to recover, but the more superficial changes that may be seen, examples being a reduction of hyperpigmentation.  The uninjured skin directly next to the skin affected by the laser can rapidly heal the wound (similar to lawn plugs).  This technology allows a much more rapid healing of the skin as compared to full facial resurfacing.  The affected spots can be spaced far apart or very close together, but in general only 20% to 50% of any treated area is burned.  The smaller the percentage, the shorter the recovery, but the less dramatic result that the patient may see.   For this reason, multiple treatments are suggested, spaced far apart enough to allow healing in between. 

	So to answer the question: fractioned lasers can be used to treat crow&rsquo;s feet (or any other area), but it would need to be blended into the surrounding tissue.  Aggressively treating one area to achieve a desired effect may result in a visible difference in the skin of this area versus surrounding areas unless treatment of the surrounding skin is used to blend treated and untreated areas

Ron Shelton, MD · Answer

Although Fraxel Restore can be done limited to a cosmetic unit, laser resurfacing is not the best treatment for crows feet when done as a solitary treatment because these are lines of muscle movement and will come back to some extent soon after healing even if more aggressive laser were done. If the more aggressive Fraxel Repair (fractional ablative CO2) can also be used to treat regions, but the rest of the face should be treated by either Fraxel Restore or a chemical peel to blend the results over the face. Botox is a great adjunct to Fraxel for crows feet if the Botox itself doesn't make the lines disappear during the time of muscle relaxation.

Kenneth D. Steinsapir, MD · Answer

With Fraxel it is possible to do a subtle enough treatment that there will not be any demarcation with the untreated areas.  The key is avoiding over aggressive treatment.

Grant Stevens, MD · Answer

Technically, yes.  However, it is always best to treat the entire face so there is less risk of lines of demarcations in skin coloring and irregularities with textures after a treatment. 

	 

	Hope this helps.  Good luck.

	Dr. Grant Stevens

E. Ronald Finger, MD · Answer

Yes, you can use the Fraxel laser for treatment of the crow's feet, and they will be improved. For animation wrinkles such as these, however, the CO2 Fraxel (Repair) will yield the best result. The problem with spot treatments is the possibility of a lighter color resulting at the treated areas compared to the surrounding areas. The best and safest method is treating the entire face. A different approach would be several treatments with the milder Erbium Fraxel laser. This may take 3-4 treatments.

	Alternative treatments, of course, are Botox injections and injectable fillers, such as fat transfer, Juvederm. Restylane or Sculptra. Additionally, a good skin care program can do wonders for your fine lines and wrinkles. I am bias, but I like New Youth Cosmeceuticals, and it does diminish wrinkles among other aging features. 

	Usually it takes a combination of different treatments to stay ahead of wrinkles, such as Crow's feet and the wrinkles around the mouth.

Tal T. Roudner, MD, FACS · Answer

The simple answer is yes. But to obtain good results the treatment may need to be an aggressive one and may creat a different skin tone between the area treated and not treated. If you want to avoid that another option is to do multiple treatments with a non-ablative fractional laser or a completely different method using ultherapy. Using Botox before the treatments to soften the crow's feet may improve on the results!

	 

	Good luck

Benjamin Barankin, MD, FRCPC · Answer

I would suggest probably doing 2 spot treatments, and possibly 1 overall fractionated laser resurfacing (e.g. Profractional, Fraxel) to blend in the results. At the same time, I would consider some botox or fillers in this area.

Edward Szachowicz, MD, PhD · Answer

Fraxel repair (CO2) is best for the crow's feet when the entire face is done at one sitting. Anytime thereafter, touch-ups can be done around the eyes, and the re-treated skin then blends in well to the rejuvenated skin. Crow's feet generally extend well onto the temple and cheek.

	Studies have also shown that the addition of either Botox or Dysport to the crow's feet region before each Fraxel laser skin resurfacing is very beneficial to an overall smoother result.

Remus Repta, MD · Answer

Hello,

Yes, spot treatment with laser resurfacing or any type of resurfacing can be done but aggressive spot treatment should be avoided since the treated area quo look different from the pigment and texture standpoint compared to the non treated area.

All the best,

Dr Remus Repta

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