How Fraxel Works

Published: 16th July 2010
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Fractional laser is a technique of breaking up a single beam of laser light into lots of tinier beams. For instance, if a regular cosmetic laser beam spot size is 5 or 10 millimeters in diameter, then a single dot of a fractionated laser light is less than.5 mm. When a large spot laser is used to burn away the top layers of the skin, extreme care must be used so as not too cause too deep a burn and therefore scarring. With such traditional lasers, such as erbium:YAG or CO2, there is significant pain during treatment, so that IV sedation, if not general anesthesia, is required. Also, there is prolonged downtime, with redness and prolonged healing that can last for months.

Fraxel was the first laser brand to market a fractionated beam of erbium:YAG for laser resurfacing, in 2004. This first rendition of the Fraxel penetrated up to 750 micrometers into the skin and required blue dye for tracking. It was a huge marketing success and ushered in the age of fractional laser for anti-aging photo-rejuvenation, acne scars, scarring and pigment disorders. Subsequently, most other laser manufacturers released competitor products. Reliant came out with a more deeply penetrating Fraxel (to 1500 micrometers) that no longer required blue dye. Fractionated CO2 lasers were also brought to market, for even more aggressive results compared to erbium:YAG.

Fraxel works by showering the skin with thousands of individual pinpoints of laser light. There is space between them, so that usually about 20% of the skin surface is treated. The intervening unaffected skin quickly heals in the pinpoint areas that were wounded by the laser. The wounding stimulates a wound healing response that causes collagen growth and tightening of the surface of the skin. This way, superficial wrinkles and acne scars are smoothed out with each treatment. This even works on scars and stretch marks. Unlike traditional laser resurfacing, more than one Fraxel treatment is usually desirable since only a fraction of the skin is affected each time. Fraxel benefits are cumulative, so patients benefit most from several treatments. Alternatively, with fractionated CO2 (e.g. Fraxel Re:pair, to differentiate from the erbium:YAG Fraxel Re:store), effects are more extreme, closer to those with traditional CO2, but side-effects and downtime are also worse.

When considering whether to get Fraxel treatment, the severity of the underlying condition should be considered. For very mild sun damage or fine wrinkles, for instance, an IPL Photofacial or chemical peel may be just fine. For more severe sun damage, wrinkles or for acne scars with pitting, a more deeply-acting treatment like Fraxel is best. Prior to treatment, a medical consultation is necessary to rule out conditions that would preclude treatment, such as ongoing treatment with Accutane, Retin-A or recent tanning. Any skin conditions related to poor wound healing or problems with scarring are also relative contra-indications.

The treatment lasts between 20 minutes to an hour. An oral pain medication coupled with topical anesthetic is usually adequate for pain control for Fraxel, but fractionated CO2 lasers require deeper anesthesia. The Fraxel Re:store treatment itself feels warm and prickly and can be slowed down or sped up according to patient comfort. Downtime with Fraxel Re:store (Erbium:YAG, not CO2) is minimal, usually a few days of redness at most. Sun protection and avoidance are very important to prevent hyper-pigmentation. At least several weeks must go by before a Fraxel Re:store treatment can be repeated.

Fraxel and fractionated laser treatments in general are enjoying growing popularity due to their tolerability and effectiveness. This area of cosmetic laser treatment will continue to see technological innovation and improvement.

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