Fraxel Laser Treatment for Surgical Scars and Photodamage
Fraxel (fractional photothermolysis using 1550-nm erbium-doped fiber laser) is highly effective for treating both surgical scars and photodamage, requiring 3-6 treatment sessions spaced 2-4 weeks apart to achieve 51-75% clinical improvement with minimal downtime. 1, 2, 3
Treatment Protocol
Session Frequency and Parameters
- Perform 3-6 treatment sessions at 2-4 week intervals for optimal results, as single treatments provide insufficient improvement 1, 2
- Use pulse energy of 8 mJ with treatment density of 2000 MTZ/cm² for surgical scars 4
- Clinical improvement increases proportionately with each successive session, with nearly 90% of patients achieving 51-75% improvement after three monthly treatments 3
Expected Outcomes by Indication
For Surgical Scars:
- Greater than 75% clinical improvement can be achieved within 2 weeks after a single treatment for fresh surgical scars 4
- Depressed scars from Mohs surgery become nearly imperceptible after 5 treatments at 4-week intervals, with results persisting 18+ months 5
- Atrophic facial scars show mean improvement of 51-75% after 3 monthly sessions 3
For Photodamage:
- Skin color and texture become more homogeneous with decreased melanocytic pigmentation 1
- Fine wrinkles and rhytids decrease, though perioral laxity improvement may fall short compared to ablative resurfacing 2
- Treatment is safe and effective across skin phototypes I-V 3
Patient Downtime and Side Effects
Expected Recovery Timeline
- Erythema and edema persist for a few days post-treatment 1
- Light skin exfoliation occurs for several days following the initial inflammation 1
- Transient erythema and edema occur in most patients but resolve without intervention 3
Safety Profile
- No dyspigmentation, ulceration, or scarring has been reported in clinical studies 3
- No significant adverse effects noted even in darker skin phototypes 4, 3
- Results are independent of age, gender, or skin phototype 3
Critical Treatment Considerations
When Fraxel Falls Short
- Perioral laxity and deep rhytides often require ablative laser resurfacing rather than fractional photothermolysis, as Fraxel results for these indications are inferior to traditional ablative techniques 2
- Atrophic acne scars can achieve similar results to ablative resurfacing when using a full series of Fraxel treatments 2
Optimal Timing for Surgical Scars
- Treatment can begin as early as 8 weeks post-operatively for surgical scars 5
- Earlier intervention (within 2 months of surgery) may yield faster improvement compared to older scars 4, 5
Treatment Algorithm
Initial Assessment: Determine scar depth, photodamage severity, and skin phototype (all types I-V are suitable) 3
For Fresh Surgical Scars (<3 months): Begin treatment at 8 weeks post-op with 8 mJ pulse energy, 2000 MTZ/cm² density 4, 5
For Atrophic/Acne Scars: Plan 3-6 monthly sessions, adjusting parameters based on response 2, 3
For Photodamage: Initiate 3-6 treatments at 2-4 week intervals, focusing on pigmentation and texture 1, 2
Follow-up Assessment: Evaluate at 6 months post-final treatment to determine if additional sessions are needed 3