Which Laser is Best for Wrinkles and Sun Damage - Fraxel Re:pair, Fraxel Re:store or Pixel Laser?

I am a 44 year old female with a lot of sun damage and wrinkles around my eyes (crowsfeet and under eye wrinkles). Which laser procedure is best, or should I just get an upper and lower eye job??

Doctor Answers 7

Don't concentrate on the name of the laser, but rather its mechanism, and on the provider

Hi there-

The most important considerations in determining whether you will be happy with your outcome are the mechanism of action of the device, and most importantly, the provider doing the service for you.

I think that unfortunately the marketing folks have gotten this turned upside down, and nice people like yourself start to think that it is the particular device that is important, when this is not the case.

Even with the best technology, someone who is not well trained or experienced will not be safe or able to deliver the best outcomes. Conversely, in the right hands, there are many lasers which could give you a great outcome. In my opinion, the best devices currently available for treatment of sun damage are fractional CO2 lasers. This is my opinion because they have very low risk, achieve reliable and significant improvement usually with only one treatment, and the recovery is very short and relatively easy for most people.

There are several different devices that use this technology (the Fraxel Repair, the Dot, The Mixto SX, Active FX and Deep FX) and any of them would be a good option, but only IF the provider offering you the service is fascile with the device in question.

My best advice to you is to find a board certified plastic surgeon or dermatologist with experience treating the problems that are bothering you (ask your friends), and listen to their advice about what works best in their hands. It really is the carpenter, and not his tools (although good tools help), that will result in your satisfaction. I hope that helps you.

Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

Fraxel re: pair is a fractionated laser that treats a predetermined percentage of the skin

There is a brand new laser treatment called Fraxel re:pair™. It was debuted at the American Academy of Dermatology last week in San Antonio, Texas. On January 31, 2008 an impressive demonstration was highlighted on NBC’s Today Show.

The unique features of this treatment are that patients in their 30’s to 50’s can get face and neck tightening without a surgical facelift, as well as improving skin color and texture. Patients in their late 50’s to 70’s can have deep wrinkles removed without the downtime of surgery or more aggressive lasers.

Like the previous Fraxel technologies, Fraxel re: pair is a fractionated laser that treats a predetermined percentage of the skin while leaving normal surrounding skin to help with the healing process.

The laser is a carbon dioxide laser which actually removes tissue. The surrounding normal skin shifts to fill the void left by the lasered area. There is noticeable shrinkage and tightening of the skin during the procedure.

I am currently doing my due diligence to make sure that this promising technology delivers what it says, that both patient and physician satisfaction is high, and that there are few to no complications with the treatment.

The few physicians in the U.S. that have experience with the procedure are saying that Fraxel Repair is very safe, and that patients are very satisfied with the results. There is a longer recovery time (2-3 days of moist and scabbing skin, 7-10 days of redness), but the results are impressive.

For some patients there is more discomfort. These patients recieve local anesthesia nerve blocks.

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Lasers and doing the job

All the lasers you mentioned fit the bill, but the repair will do it more aggressively.  There are also may other lasers on the market that can handle what you want. Make sure you find the right doctor, and that they have a laser that can accomplish your needs.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Fraxel Re:Store or Re:Pair Best for Wrinkles and Sun Damage

Fraxel Re:Pair is an ablative CO2 laser that is appropriate for heavily sun-damaged and wrinkled skin. You will have redness for approximately two weeks after treatment. However, you may not need another session or may need perhaps just one more. Fraxel Re:Store is a milder, erbium, nonablative laser that can work on less severely damaged skin. Redness may persist for up to five days and there may be some mild flaking as well. Please consult a board-certified dermatologist to be evaluated for the right type of Fraxel to rejuvenate your skin.

Margaret Weiss, MD
Baltimore Dermatologic Surgeon
3.7 out of 5 stars 7 reviews

Fraxel re:store is very effective for improving skin texture, wrinkles and sun damage

All of the lasers that you listed will resurface the skin and improve wrinkles and sun damage. Pay more attention to the type of laser and how it works than the name of the machine. The Fraxel re:pair and the Pixel are carbon dioxide lasers which are more aggressive and require more downtime, and have some risk of side effects such as discoloration and scarring. The Fraxel re:store is nonablative, meaning it does not destroy the tissue. It will not require as much downtime and does not have the same risks of discoloration or scarring, but will require 4-6 treatments. I would probably recommend you try the Fraxel re:store, based on its excellent safety profile and extremely low risk, but you should discuss all of your options with your physician.

Jordana S. Gilman, MD
Washington Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Of the lasers you listed, Fraxel re:pair is the most aggressive.

The Fraxel re:pair is the most ablative and requires the most down-time, about 1 week. It has, however, the potential to give you the most dramatic improvement in the eyelid wrinkles.

Blepharoplasty can remove excess fat tissue of the upper and lower eyelids whereas the lasers cannot. Removal of too much fat in the upper or lower eyelids, however, can create a "hollow," gaunt appearance. On the other hand, the lasers will improve skin texture whereas blepharoplasty does not. It may be worthwhile to consult with a couple of practitioners who do both to help guide your decision.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

The C02 laser is best...


The CO2 laser is the strongest, but takes the longest afterward for recovery.  Eyelid surgery does not remove much sun damaged skin, but can limit its appearance. I tend to lean towards chemical peels and Retin A / Sunscreens to start in your age group.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 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.