Fraxel (Fractional Photothermolysis) Laser Applications
The Fraxel laser is primarily effective for facial rejuvenation, treating wrinkles, pigmentation irregularities, acne scars, and photodamaged skin with minimal downtime compared to traditional ablative lasers. 1, 2
Mechanism and Technology
- Fractional photothermolysis creates multiple microscopic treatment zones (70-150 microns in diameter) surrounded by viable tissue, allowing for rapid healing while stimulating collagen remodeling 3
- The technology treats approximately 25% of the dermis per session, with collagen denaturization occurring at depths of 300-750 microns 3
- Treatment typically requires multiple sessions (usually 4) spaced 1-2 weeks apart for optimal results 3
Primary Clinical Applications
Skin Rejuvenation
- Improves skin texture and tone, creating more homogeneous appearance 2
- Reduces fine lines and wrinkles, though results are generally less dramatic than CO2 laser but with significantly less downtime 1
- Can be effectively used as an adjunct to facial surgical procedures like facelifts 3
Pigmentation Issues
- Effectively treats melanocytic pigmentation and sun damage 2
- Particularly useful for difficult-to-treat conditions like melasma 1
- Creates dramatic improvement in overall pigmented lesions 3
Acne Scarring
- Provides statistically significant improvement in acne scars 4
- Represents a useful modality for this traditionally difficult-to-treat condition 1
Expanded Treatment Areas
- Unlike traditional CO2 lasers which are limited to facial application, Fraxel can safely treat the neck, chest, and other body areas 1
- Particularly effective for neck wrinkling and upper chest hyperpigmentation 1
Advantages Over Traditional Ablative Lasers
- Minimal downtime (typically 2-4 days of erythema and edema followed by light exfoliation) 2, 3
- No open wounds requiring extensive healing 5
- Lower risk of complications, particularly hyperpigmentation and scarring 1
- Safe for all skin types, including darker skin tones (though Asian patients showed 55.5% post-inflammatory hyperpigmentation at 1 month, reducing to 11.1% at 6 months) 4
Treatment Protocol and Outcomes
- Typical protocol involves 2-6 treatments spaced 1-3 weeks apart 2
- Patient satisfaction is generally high, with 86% of patients reporting being satisfied to very satisfied in one study 4
- Results show statistically significant improvements in skin texture, laxity, wrinkles, enlarged pores, and overall appearance 4
Limitations and Considerations
- Results are not as dramatic as traditional CO2 laser resurfacing but still provide consistent, measurable improvement 1
- Post-inflammatory hyperpigmentation can occur, particularly in darker skin types, requiring careful patient selection and management 4
- Some patients may require combination therapy with other modalities for optimal results 5
Synergistic Combinations
- Can be effectively combined with platelet-rich plasma (PRP) treatment, which has been shown to reduce downtime and improve healing when applied after fractional laser treatment 6
- PRP application after laser treatment has demonstrated shorter duration of erythema, edema, and crusting compared to laser treatment alone 6