Usual Setting for Fraxel Restore?

Question

I have completed two Fraxel Restore sessions for facial scars, but I still have many scars on my face. The setting used on me was 45 mjoules. Is this enough, or too low? What is the usual setting for this procedure?

Michael A. Persky, MD · Answer

Hi gig,
It takes a series of Fraxel re:store treatments to get optimal results with the treatment of scars.  Often after only two treatments the improvement is minimal.  It usually takes 4 or more treatments, and sometimes even a few months after the treatment as collagen remodeling continues.
At 45 mj the laser reaches a depth of 1176 microns or 1.176 millimeter.  By increasing the energy setting to maximum 70 mj, the depth increases only about 0.2 of a millimeter (1359 microns, 1.359 millimeter).  
Fraxel re:pair can go deeper, and may take less treatments, but the wound care and downtime is greater.
The energy level of your treatment can be turned up a bit, but the biggest factor for you will be the number of times you have the treatment.  Good luck and be well.
Dr. P

William Groff, DO · Answer

Your physician can vary the settings, and we have found that the best results are achieved using high energy (50-70mJ and high density (25-35% coverage).  Your social downtime will increase with these settings, but most patients are willing to accept this to gain the better results.
If you have olive skin, your risk of developing brown discoloration (post inflammatory hyperpigmentation) will increase as well (we actually examined this in a clinical study and published the findings).  This is almost always a temporary side effect.
You may want to also consider the fraxel repair to address you concerns, as this  is an excellent choice to improve scarring (surgical, acne, and traumatic).
Take care,
Dr. Groff

Carl N. Williams, Jr., MD · Answer

In order to answer your question, I would first need to know a little bit more about your skin color, tone, texture and your age, as well as the overall condition of your skin to be treated and what you are trying to improve. The Fraxel Laser has multiple ways of implementing a treatment plan or perscription to achieve your desired results. 
I oversee all of the setting recommendations and also deliver the treatments myself.  My nurse provides all of the educational needs, pre and post procedure protocols.

Sirish Maddali, MD · Answer

Acne scarring and facial scars do need more intense treatment settings for better outcomes. Most of my acne scarring patients will have settings between 50-70 for the milli-joules. As already mentioned, it is NOT common to see a result after 2 treatments with the Fraxel restore. For scarring, it will take between 4-6 treatments for most patients. Even though most patients with facial scars need more intense treatment settings, there are patients that cannot tolerate those settings and will need to turn the settings down. These patients will likely not obtain optimal results and will likely need more treatments for better results.
I have had many patients start at 45 mJ on their first treatment and then I increase the settings on the subsequent treatments. It is hard to make a generalization that 45 mJ is bad for all patients, but it is a little low for scars.
The Fraxel repair laser can go deeper but will have a substantially longer "downtime." Good luck with your procedure.

Mary P. Lupo, MD · Answer

Have you discussed your concerns with your physician? In general, 70mj is the best for acne scars, but there may be a reason for your doctor to be treating you lower (skin type, pain threshold).
The other issue is the treatment level, which can be adjusted and will also impact results and pain perception.
Fractional CO2 may be an option for fewer treatments. One will give more of a result than 5 Restore treatments, but significant healing time and prolonged redness must be anticipated.
Good luck!

Usual Setting for Fraxel Restore?

Answers (5)

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