Ahem: Everything You've Ever Wanted to Know About Fraxel Lasering
Let me guess: You’re currently thinking about getting a Fraxel laser treatment. Yeah, I'm not surprised. Ever since masks have been coming off and mascne is on the decline, everyone I know seems to be talking about Fraxel lately, and I get the allure: Nothing sounds better than waving a magical (laser) wand over your face and getting smoother, brighter skin after just one treatment. Buuuut it's not necessarily as simple as that (sorry; I'm your resident party pooper). Fraxel is one of the more ~intense~ lasers, which means before you make an appointment, we gotta talk about the pain level, the downtime, and the commitment.
You've got questions, and we've got answers from board-certified dermatologists Marnie Nussbaum, MD, and Ellen Marmur, MD, the founder of MMSkincare. If you've tried every anti-aging wrinkle cream or dark spot corrector, and you're hoping to find something that—let's face it—works better and faster, here's what to know about the skin-resurfacing laser treatment that has all your friends talking.
What is Fraxel?
Fraxel is a non-invasive, microscopic laser that quite literally changes the surface of your face by penetrating your skin to encourage new collagen and elastin growth. Fraxel only targets a fraction (fraction, Fraxel—get it?) of the skin at a time, which is why it's also known as a fractional skin resurfacing treatment.
What is Fraxel good for?
Fraxel smooths wrinkles and scars, fades brown spots and hyperpigmentation, and basically resurfaces your entire skin tone. Fraxel is one of the more aggressive lasers offered at most dermatologist offices (more on these other lasers below), which is how it's able to get rid of things like pockmarks (aka those pitted, indented acne scars known as ice pick, boxcar, and rolling scars).
Is Fraxel an ablative or non-ablative laser?
So there's one thing to get straight with resurfacing lasers (ok, one-million things, but let's take it slow), and that's the difference between ablative or non-ablative. The two types of resurfacing lasers:
Ablative:
Ablative lasers are considered "wounding" lasers because they remove the outer layer of your skin and heat up the tissue underneath to stimulate new collagen production and fresh skin growth. As your skin peels off and heals (yup, the week of downtime afterward is no joke), your face will look significantly smoother, tighter, and fresher—basically, it's a takes-years-off-your-face laser. Examples of ablative lasers include CO2 (carbon dioxide) lasering and Erbium (aka YAG) lasering.
Non-ablative:
Non-ablative lasers are considered "non-wounding" lasers because they only heat up the tissue beneath your skin (instead of also removing it) to stimulate new collagen growth, which, over time and multiple sessions, will help fade redness, acne scars, and hyperpigmentation, while helping to subtly tighten fine lines. Examples of non-ablative lasers include IPL (intense pulsed light) and PDL (pulsed dye).
Fraxel, however, can be both non-ablative and ablative, depending on which type of Fraxel you (and your dermatologist) choose. Which brings us to...
What is better, CO2 or Fraxel?
So considering Fraxel can be both ablative (aka a CO2 laser) and non-ablative, the answer is more about which type of Fraxel is better for your skin concerns. So let's walk through the two types of Fraxel, yes?
Fraxel Dual:
Fraxel Dual is a non-ablative laser that can be combined or used separately to address different skin concerns on the face, neck, chest, hands, legs—just about anywhere. The 1927 wavelength of Fraxel will lift away discoloration (hyperpigmentation, dark spots, sun damage, and pre-cancer spots), while the 1550 wavelength of Fraxel is designed to target and smooth your skin's texture (fine lines, wrinkles, and acne scarring). Don't worry about writing this down—your derm will decide the correct wavelengths for your skin.
Fraxel Repair:
Fraxel Repair is an ablative laser (like CO2 lasering) that works by vaporizing tissue to promote new collagen formation and essentially resurface your face—think: newborn-baby status. Because there is a risk for hyperpigmentation with any ablative laser (it's literally "wounding" your skin to work), Dr. Marmur doesn't recommend them for darker skin tones.
Basically, if you're looking for something milder and safer for more skin types that also requires less downtime (we're talkin' a day of some potential redness vs. a full week of redness, peeling, and sensitivity), Fraxel Dual would be your best bet.
Is Fraxel better than microneedling?
Fraxel and microneedling are similar in that both treatments use the idea of creating micro-injuries on your skin to help rebuild collagen, but the main difference is that Fraxel penetrates the skin more deeply than microneedling. For this reason, Dr. Marmur says Fraxel laser is better suited for patients with major skin issues (think: big scarring, hyperpigmentation, and texture issues), while microneedling would suffice for more mild concerns (some light acne scarring, discoloration, dark spots, etc.).
How do I prepare my skin for Fraxel?
Luckily, this treatment is a pretty low-maintenance—at least, beforehand (more on the aftermath later). According to Dr. Marmur, you'll need to stop using any product that can cause skin sensitivities a full 10 days before your treatment, along with 10 days after (that includes retinol, exfoliants, and acids, like glycolic acid or salicylic acid).
Note: If you're breaking out, your dermatologist may want to postpone until your zits have calmed down, so let the office know ahead of time if you find yourself in an acne showdown.
What is the cost of Fraxel laser treatment?
The cost of Fraxel varies depending on your skin condition, your insurance plan, and where you live, but Dr. Nussbaum says most often, Fraxel costs around $1,500 per treatment for just the face, and up to $2,000 if you add on the neck and chest.
How painful is Fraxel laser?
Listen, lasers don't exactly feel great, but the treatment itself is relatively quick—about 15 to 25 minutes, plus another 45 minutes for the topical anesthesia (numbing cream) to kick in before getting started. And since you'll be numbed up beforehand, Dr. Nussbaum says you'll likely only feel a little stinging. Of course, pain tolerance is subjective, and many people consider the ablative type of Fraxel to be quite intense and painful (some describe it as being stung by bees or feeling like your face is straight-up burning), even with the numbing cream.
How long is your face red after Fraxel?
The downtime to ablative Fraxel (so Fraxel Repair) is typically a week. During the first two days, you can expect redness, throbbing, and swelling (like a sunburn), then between days three to five, your skin will start to roughen up and peel. As tempting as it is to pick at the flakes, resist the urge and allow your skin to heal on its own or you'll risk scarring. And, as a note, the chest usually takes a little bit longer to recover, so don't be alarmed if the process seems slow.
Fraxel Dual, on the other hand, actually has minimal side effects and a less-intense downtime (at least, in comparison to ablative lasers), since it's non-ablative. Still, Dr. Nussbaum says a patient should expect some redness, swelling, and peeling afterward, but it settles in less than a week.
What are the side effects of Fraxel laser treatment?
Although the laser is safe for all skin tones, Dr. Nussbaum says it might not be the best option for those with melasma (a complex form of hyperpigmentation). For these patients, she recommends an even less aggressive laser called Clear + Brilliant. Of course, your dermatologist will let you know whether or not your skin can handle the laser, so definitely schedule a consultation regardless.
How long does Fraxel last?
According to Dr. Nussbaum, how long the results last depends on the patient’s hair color, eye color, and complexion (discoloration tends to return sooner on patients with blonde or red hair than on someone with darker hair). Generally, though, Dr. Marmur recommends yearly Fraxel treatments for continued results and regular touch-ups with its gentler counterpart, Clear + Brilliant.
How many sessions of Fraxel do you need?
With the 1927 wavelength (the one used for fading pigment), one treatment can decrease 80 percent of the discoloration. Dr. Nussbaum says you might need a touch-up with a Clear + Brilliant laser four to six months later, but usually one Fraxel session is enough to last you the year.
With the 1550 wavelength (the one for smoothing texture), you usually need three to five treatments spaced four weeks apart. Dr. Marmur stresses that your doctor will determine how many treatments are best for your particular skin type and concerns, but most patients wind up needing around two to six treatments to achieve their goals.
How can I make my Fraxel heal faster?
If you desperately need to put something on your face to alleviate some of the heat, Dr. Nussbaum recommends making a 50/50 mixture of whole milk (because the lactic acid and fat help heal the skin) and ice water (because it's naturally soothing). Dip a washcloth in the milky water and use it as a compress to cool yourself down.
For the first few days after treatment, wash your face twice a day with a gentle cleanser (that means absolutely no face scrubs!). In the morning, Dr. Nussbaum suggests applying a vitamin C serum, which will penetrate the skin even better after a treatment and following it up with a lightweight moisturizer three to four times a day. Dr. Marmur even suggests applying a very thin layer of petrolatum ointment, but note that the doctors used words like lightweight and thin. You don't want to load up on a thick, emollient cream, which can clog your vulnerable skin and cause milia. Instead, stick with light layers of non-irritating, non-clogging products for sensitive skin.
What can you not do after Fraxel laser?
Fraxel is a great treatment for your skin and a great excuse not to go to the gym for that first week, because working out will only worsen your hot, inflamed skin. If redness, peeling, and dark flakes is something you'd rather not deal with publicly, plan your appointment during a week when you can afford to take some time off, because makeup is also a no-go. Dr. Nussbaum says during those few days of healing, avoid putting any products on your face except for what we mentioned above.
Once you get a Fraxel treatment, it's SPF 30, a hat, and the shade for you (but you already do that anyway, right?). Dr. Marmur stresses how vital it is that you stay out of the sun for a few days after treatment and always apply sunscreen with broad-spectrum protection. Not only will your new skin be more vulnerable to the sun, but you'll also want to stay covered to prevent the pigment from coming right back. Two grand is way too much $$ just to waste on a day outside, unless you are literally made of money. And in that case, can I have some so I can finally try Fraxel, too?
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