Written by Aleksandra Agranovich
Fraxel Laser Indications for Skin Treatment
The Fraxel Laser, also known as fractional photothermolysis, is a dermatological tool that has been proven safe an effective for the treatment of facial photodamage, acne scaring, hypopigmentation, and dyspigmentation. Fractional photothermolysis works by creating “spatially precise microscopic thermal wounds (using a 1550-nm erbium fiber laser) that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones” (Tanzi, 2008). Treatment with the Fraxel Laser involves multiple sessions mainly because each session only treats a small portion of the skin. Typically, patients may return for additional sessions within a three to six-month course.
There are two different types of lasers that exist for fractional photothermolysis which include ablative and non-ablative therapy. Ablative lasers involve the use of carbon dioxide or erbium and are well tolerated for facial rejuvenation. However, over time, ablative lasers may cause loss of the cutaneous barrier function and prolonged recovery. Non-ablative systems, on the other hand, are a bit safer than ablative lasers, and have a reduced risk of skin cell damage. This technique involves the use of “1064- and 1320-nm Nd:YAG, intense pulsed light systems combined with epidermal surface cooling and infrared or near-infrared wavelengths” (Tanzi, 2008).
How to Take Care of your Skin After Fraxel Laser Treatment
After receiving a Fraxel Laser therapy session, it is important to stay hydrated and void smoking, alcohol consumption, heavy sweating, swimming, and sun exposure. The treated area needs to remain clean and free of makeup, alcohol-based products, and detergents. Post Fraxel Laser recovery tends to take about one full week and many patients may experience redness, burning, throbbing, and peeling of the skin within the first two days. Overall, the Fraxel Laser is a great technique that may rejuvenate the skin, remove acne scaring, and allow patients to feel confident about their appearance. The Fraxel laser was first introduced in 2003 and has become a very effective treatment for different types of facial conditions. The side effects of this procedure are typically mild and can result in erythema and a slight darkening of the skin. According to various Fraxel studies, severe complications are rare.
Resources
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
Janik JP, Markus JL, Al-Dujaili Z, Markus RF. Laser resurfacing. Semin Plast Surg. 2007;21(3):139-146. doi:10.1055/s-2007-991182
Bertossi D, Giampaoli G, Lucchese A, et al. The skin rejuvenation associated treatment-Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results. Lasers Med Sci. 2019;34(7):1449-1455. doi:10.1007/s10103-019-02738-z
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.