Fraxel Laser Skin Treatment

Thank you for discussing  of Fraxel treatment, called Fraxel DUAL 1550/ 1927 and after treatment.

Fraxel Laser Skin Treatment

Fraxel is a trademarked laser resurfacing therapy that is a popular aesthetic treatment used for photoaging, melasma, surgical and acne scarring. This laser technology was trademarked and patented in 2004 and the technology is based on fractional thermolysis. Fractional thermolysis (FT) lasers produce their resurfacing effects by producing microscopic thermal wounds at specific skin depths below the stratum corneum, which remains intact. Fractional thermolysis creates minimal side effects and has a short recovery time, which is beneficial due to minimal impact on quality of life. This laser treatment requires multiple treatments, usually between four to six, to see and maintain effects. Fraxel has received clearance for use from the Food and Drug Administration (FDA) for the treatment of soft tissue coagulation, treatment of periorbital wrinkles, pigmented lesions, melasma, skin resurfacing, and the treatment of surgical and acne scars (Geronemus R).

            The Fraxel treatment, called Fraxel DUAL 1550/ 1927 has two wavelengths that penetrate the dermal layers and create patterns of microscopic damage in the areas of concern without damaging the surrounding areas. When receiving Fraxel laser, the skin is cleaned beforehand, a topical anesthetic is applied up to an hour before, and the laser treatment itself takes up to 25 minutes. After completing treatment, aftercare is crucial to maintain benefits for as long as possible. Applying sunscreen of SPF 30 or greater for at least three months or more is highly recommended and wearing a wide brimmed hat while in the sun to promote rapid healing and prevent scarring and dyspigmentation after receiving Fraxel. Patients can experience some side effects, such as redness, swelling and some skin flaking, which are self- limiting and resolve up to a week after treatment (Fraxel Laser).

            The efficacy of Fraxel and other FT lasers has been studied in multiple clinical trials in comparison to other laser treatments. For periorbital lines and wrinkles, a 54 percent improvement was seen after one month of treatment. After three months of treatment, there was a 34 percent improvement in wrinkle appearance and a 47 percent improvement in skin texture. These clinical trials and studies report that Fraxel has better results for mild to moderated wrinkles and lines on the face and may not be effective for deeper lines. This speaks to the mechanism of FT lasers, which are nonablative, meaning that the stratum corneum remains intact and does not peel away after treatment (Gold M, Manstein D).

             Fraxel is a popular laser treatment that is beneficial for patients looking for minimally invasive cosmetic augmentations with high clinical efficacy. Moreover, Fraxel has been clinically studied and has received FDA clearance for a variety of uses with high safety and efficacy as well as minimal side effects. It is one of the preferred treatments in patients looking to treat wrinkles without surgery.

Citations:

“Fraxel Laser .” Fraxel, SoltaMedical, www.fraxel.com/#faq. Accessed 18 Apr. 2024. 

Geronemus R. G. (2006). Fractional photothermolysis: current and future applications. Lasers in surgery and medicine, 38(3), 169–176. https://doi.org/10.1002/lsm.20310

Gold M. (2010). Update on fractional laser technology. The Journal of clinical and aesthetic dermatology, 3(1), 42–50.

Manstein D, Herron GS, Sink RKH, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426–438.

What is Fraxel laser skin treatment and what is it used for?

Fraxel laser skin treatment, also known as fractional photothermolysis, is a process whereby precise, microscopic thermal wounds are created that selectively targets water-containing tissue to create small, well-defined areas of skin coagulation (microscopic thermal zones). This method, known as Fraxel resurfacing, is used to safely and effectively treat various skin concerns such as facial and non facial photodamage, atrophic acne scars, hypopigmented scars and dyspigmentation. Generally, Fraxel treatment is recommended in order to improve skin tone and texture and improve luminosity of the skin. To optimize clinical results from Fraxel treatment, it is recommended that fractional resurfacing sessions are scheduled regularly for about 3 to 6 treatments, scheduled approximately two to four weeks apart. 

What is the Fraxel laser machine composed of?

The machine that is used to conduct the fractional resurfacing process includes a number of technological systems to produce the desired results. One of the main features of the Fraxel dual 1550/1927 machine is dual fiber laser technology that is helpful in achieving deep and superficial resurfacing. Additionally, the laser is also comprised of a thulium wavelength which is essential in rapid clearance of dyspigmentation. In order to address patient comfort and consistent treatment, the machine also includes a cooling system to minimize any pain or discomfort as well as a continuous-motion tracking system to ensure treatment is even throughout the treatment area. Lastly, the machine itself has an easy to use and convenient touchscreen interface to allow for aestheticians to easily enter and adjust treatment settings for individual patients. 

What to expect after treatment and how to perform aftercare? 

After treatment, the patient can expect some mild and transient side effects. The most common side effects from Fraxel treatment are redness, swelling and a warm sensation on the skin. However, it is important to note these side effects also depend upon the sensitivity of each person’s skin. Most people will experience much of the redness and swelling on the first day post-treatment. These reactions can be minimized or treated through the use of ice packs or cold compresses every 10 minutes as needed. Your skin may also begin to peel after treatment at around day 3 and may continue from 3 to 5 days. 

In terms of aftercare, cleansing your skin at least twice daily with a gentle facial cleanser (such as Aveeno, Cetaphil, Cerave, etc.) is recommended. However, when washing your face, it is important to note that the face must be washed gently and must not be scrubbed. Additionally, the patient should also ensure to keep their skin as moisturized as possible, especially during the peeling process post-treatment. A commonly recommended product to ensure the skin is properly hydrated is Aquaphor healing ointment which is available over-the-counter. Lastly, make sure to use sunscreen! Using sun protection is crucial to prevent further discoloration and skin irritation from treatment. Chemical-free sunscreens are recommended with an SPF of over 30. For extra protection from the sun, putting on a hat and some sunglasses are also recommended. 

Resources: 

Laser Treatment with Fraxel. Baylor College of Medicine. Accessed April 11, 2024. https://www.bcm.edu/healthcare/specialties/dermatology/laser-surgery/laser-treatment-with-fraxel. 

Tanzi EL, Wanitphakdeedecha R, Alster TS. Fraxel laser indications and long-term follow-up. Aesthet Surg J. 2008;28(6):675-680. doi:10.1016/j.asj.2008.09.006

GRABER, EMMY M. MD*; TANZI, ELIZABETH L. MD*; ALSTER, TINA S. MD*. Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments. Dermatologic Surgery 34(3):p 301-307, March 2008.

Fraxel dual post-treatment instructions. Comprehensive Dermatology of Long Beach . Accessed April 11, 2024. https://longbeachdermdocs.com/wp-content/uploads/2017/02/FRAXEL-form.pdf. 

Yu Feng Lin & Fawziya Twam

Fraxel laser treatment is a popular cosmetic procedure used to improve the appearance of the skin. It is a form of fractional laser therapy that is often employed to address a variety of skin concerns, such as wrinkles, fine lines, age spots, sun damage, acne scars, and uneven skin texture. The treatment is based on the principles of evidence-based medicine, which means that its effectiveness and safety have been studied and supported by scientific research.

Fraxel laser treatment uses fractional laser technology to create thousands of tiny, controlled microthermal zones in the skin. This process stimulates the body's natural healing response, promoting the production of collagen and elastin, which are essential for healthy, youthful-looking skin. Fraxel laser treatment is a form of fractional photothermolysis, which is a precise and controlled laser therapy used to rejuvenate the skin. It involves the use of a 1550-nm erbium fiber laser that targets water-containing tissue to create microscopic thermal wounds in the skin. These wounds are known as "microscopic thermal zones," and they are sharply defined columns of treated skin. This approach is based on evidence-based medicine principles, and it has been shown to be safe and effective for addressing various skin concerns. Evidence-based studies have shown that Fraxel laser treatment can be effective for a range of skin conditions, including Fine lines and wrinkles, Age spots and sun damage, Acne scars and surgical scars, Melasma (uneven pigmentation), Enlarged pores, and Uneven skin texture and tone.

Fraxel laser treatment has been found to be generally safe when performed by trained and experienced practitioners. It is essential to follow post-treatment care instructions to minimize the risk of side effects, such as temporary redness, swelling, and peeling. The number of sessions required varies depending on the specific skin concern and the desired results. Typically, patients undergo a series of treatments, often spaced a few weeks apart, for optimal outcomes. Evidence-based guidelines recommend a personalized treatment plan based on individual needs. To achieve the best clinical improvement, a series of Fraxel treatments is typically recommended, usually consisting of 3 to 6 sessions spaced at 2- to 4-week intervals. This approach allows for gradual and controlled improvement in skin texture and appearance. Importantly, because only a fraction of the skin is treated during each session, the surrounding healthy tissue helps with the healing process, reducing downtime and risks associated with more aggressive procedures.

While recovery time can vary from person to person, evidence suggests that patients may experience redness, swelling, and peeling for several days to a week after each treatment. It's essential to protect the treated skin from the sun during this time. Evidence-based studies have shown that Fraxel laser treatment can lead to significant improvements in skin texture, tone, and the reduction of various skin imperfections. However, individual results may vary, and maintenance treatments may be needed to sustain the benefits.

Evidence-based medicine supports the importance of proper patient selection. Fraxel laser treatment may not be suitable for individuals with certain skin conditions or those with a history of keloid scarring. In some cases, evidence-based research suggests that combining Fraxel laser treatment with other cosmetic procedures or skincare regimens may enhance results. Your healthcare provider can provide personalized recommendations.

Side effects of fractional resurfacing are generally mild and temporary, typically including erythema (redness), periocular edema (swelling around the eyes), and a temporary darkening of the skin (bronzing) as the Microscopic Epidermal Necrotic Debris (MEND) desquamates (sheds). Compared to ablative laser skin resurfacing, the overall complication rate with fractional skin resurfacing is significantly lower.

A retrospective evaluation of 961 successive 1550-nm Fraxel laser treatments, involving patients with various skin types, found that the reported complications occurred in 7.6% of cases. The most common complications included acneiform eruptions (1.87%), herpes simplex virus (HSV) outbreaks (1.77%), and erosions (1.35%). Less frequent side effects included postinflammatory hyperpigmentation (0.73%), prolonged erythema (0.83%), prolonged edema (0.62%), and dermatitis (0.21%). Patients with a history of herpes labialis were advised to take oral HSV prophylaxis to reduce the risk of HSV outbreaks. Acne-prone patients were more likely to experience post-treatment acne, possibly due to the disruption of follicular units during treatment and reepithelialization. The use of oral antibiotics, such as doxycycline (20 mg daily), during subsequent treatments helped prevent future outbreaks in these patients.

It's worth noting that to date, there have been no reports of permanent pigmentary alteration or scarring associated with fractional resurfacing. However, when an aggressive treatment protocol involving a high density of Microthermal Zones (MTZ) is used, there is an increased risk of visible epidermal ablation, as well as side effects and complications more commonly associated with ablative laser procedures. Therefore, the choice of treatment intensity should be carefully considered based on individual patient needs and risk factors.

Before considering Fraxel laser treatment, it's crucial to consult with a qualified dermatologist or skincare professional who can assess your specific needs, discuss potential risks and benefits, and develop a tailored treatment plan based on evidence-based guidelines. Additionally, be sure to ask about the latest research and clinical evidence pertaining to the procedure, as medical practices and guidelines can evolve over time.

References

Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg. 2007;33(3):295-299. doi:10.1111/j.1524-4725.2007.33059.x

Elizabeth L. Tanzi, Rungsima Wanitphakdeedecha, Tina S. Alster, Fraxel Laser Indications and Long-Term Follow-Up, Aesthetic Surgery Journal, Volume 28, Issue 6, November 2008, Pages 675–678, https://doi.org/10.1016/j.asj.2008.09.006

Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S. Clinical trial of a laser device called fractional photothermolysis system for acne scars. J Dermatol. 2006;33(9):623-627. doi:10.1111/j.1346-8138.2006.00143.x

WANNER, MOLLY MD; TANZI, ELIZABETH L. MD; ALSTER, TINA S. MD*. Fractional Photothermolysis: Treatment of Facial and Nonfacial Cutaneous Photodamage with a 1,550-nm Erbium-Doped Fiber Laser. Dermatologic Surgery 33(1):p 23-28, January 2007.

Fraxel Laser (Fractional photothermolysis)

Fractional photothermolysis is a “new skin resurfacing laser technology for treating rhytids (wrinkles), melanocytic pigmentation, scars, and photodamaged skin.” Not only is the procedure done with the use of lasers, but it has been improved for certain setbacks that were present when using cutaneous laser resurfacing (ablative), making this technique both safer and more effective. Fractional photothermolysis is “performed using a 1550-nm erbium fiber laser (Fraxel; Reliant Technologies, Mountain View, CA) that targets water-containing tissue to effect photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones (MTZs), at depths of 200 μm to 500 μm and spaced at 200- to 300-μm intervals.” However, as with any procedure, there are certain side effects and complications to be aware of. These side effects are mild, but can include “erythema and periocular edema, and a slight darkening of the skin (bronzing) as the MEND desquamate.” MEND is referring to the formation of microscopic epidermal necrotic debris, which begins to exfoliate days after the procedure. The process of the exfoliation gives the skin a darker or bronzed appearance, which is to be expected. Redness and swelling will result due to irritation and general uncomfortableness from the lasers, which is expected to resolve within days. There has not yet been any reports of permanent pigmentary alteration or scarring after the healing process has ended. Overall, the general complications are much less than those associated with the aftermath of ablative laser skin resurfacing. 

In the case of treating wrinkles and unwanted melanocytic pigmentation, visible improvements and changes were observed. After the treatment sessions, patients’ skin texture and color became more uniform throughout the target spot, showing results they were anxiously waiting to see. For those who wished to reduce the appearance of wrinkles, after treatment sessions with the fractional photothermolysis, the wrinkles began to become less noticeable. All these results were achieved with “minimal downtime for the patient” which is the optimal situation. According to the Aesthetic Surgery Journal, “Over the next several years, variations on the theme of fractional photothermolysis, including ablative fractional photothermolysis with highly advanced CO2 and Er:YAG laser systems, will continue to advance cutaneous laser resurfacing toward the ultimate goal of maximum clinical improvement coupled with minimal recovery and side effects.” Although the results obtained with the fractional photothermolysis are better than previous procedures, there is always room to improve and do better.

Tanzi, Elizabeth, and Rungsima Wanitphakdeedecha. “Fraxel Laser Indications and Long-Term Follow-Up.” Academic.Oup.Com, academic.oup.com/asj/article/28/6/675/225729?login=true. Accessed 16 Aug. 2023. 

SS;, Collawn. “Fraxel Skin Resurfacing.” Annals of Plastic Surgery, pubmed.ncbi.nlm.nih.gov/17471124/. Accessed 16 Aug. 2023.