All Your Fraxel Questions, Answered


How will you know if someone’s had Fraxel? They’ll tell you. Lots of times—have you noticed how many times I’ve brought it up here already? It’s just too cool not to want to talk about it constantly! But it dawned on me recently: maybe, reader, you have no idea what the heck I’m talking about. Maybe you’ve never heard of Fraxel in your entire life. Or maybe you read Jhené Aiko’s Top Shelf where she talked about Fraxel’s micro-scabs, and you want to know more. So before I share my experience and results, I thought we should get a few things out of the way—namely, the whats, whys, and hows of this non-ablative laser treatment. I reached out to Dr. Claire Chang at Union Square Laser Dermatology who did my treatments, and we got to work on tackling your most burning questions. As to how much the laser itself burns? It does. But I’ll get to that.

First off, what is Fraxel?

“The Fraxel Repair Dual laser is one of the most popular resurfacing lasers,” explains Dr. Chang, and since it targets the deep layer of skin called the dermis, it’s a treatment that can only be performed by a doctor. Fraxel is named after the fact that it’s a fractional laser—it only targets a fraction of your skin at a time. And the “dual” is because your doctor will make two passes with the laser on two different wavelengths: one to combat texture, and one to target pigmentation. The laser works by making a microscopic grid of injuries to the skin, which therefore stimulate collagen production and cell turnover. In addition to evening skin tone and texture, Dr. Chang adds that Fraxel “has also been shown to treat of actinic keratoses," which are patches of flakiness caused by sun exposure, "and skin precancers.”

Is it the same as a Co2 laser?

Most commonly, when you hear someone talking about Fraxel they specifically mean the Fraxel Repair Dual laser. However, for more intense cases of scarring, your doctor might recommend the Co2 version of Fraxel, Repair. All you need to know is that a Co2 laser is stronger, with more downtime necessary after.

Am I a Fraxel candidate?

The short answer is: probably. “Fraxel can be started as early as in your teenage years, or it can be started later,” says Dr. Chang, depending on what you’re looking to treat. If you have deep acne scars (think ice pick marks) you can start Fraxel immediately. But for acne scars, it’s not exactly a preventative treatment—the damage (a zit) has to be done for Fraxel to work its magic. While it works on acne scars, it doesn’t clear up acne you currently have—your derm might put you on an antibiotic for that. Fraxel can also be a preventative treatment for fine lines (it stimulates collagen production), but can also help reverse both collagen loss and sun damage. If you have dark skin, melasma, or weak connective tissue, Fraxel might not be the best for you—but you should talk about it with your doctor to figure out for sure, if you’re interested, because the answer varies case by case.

What exactly will it help with? Acne scars?

“Acne can heal and leave many different types of scars,” explains Dr. Chang, and Fraxel can help with a lot of them. “It stimulates collagen to soften atrophic acne scars,” otherwise known as indented scars, “and can also help lighten brown spots left behind by acne.”

Pigmentation from the sun?

Yep—Fraxel treats these hyperpigmentation spots the same way as it treats PIH. Speaking personally, one treatment was enough to completely get rid of my freckles.

What about rosacea and redness?

While it’s helpful on post-acne red marks, Dr. Chang doesn’t recommend Fraxel if redness is your main concern. “Fraxel Dual is not a treatment for rosacea or facial redness,” but, she suggests, “other lasers like the Vbeam can help.”

OK, last one—how about tightening?

“Fraxel Dual can be used around the eyes to stimulate collagen and reduce the appearance of fine lines and wrinkles,” says Dr. Chang. But as with redness, it wouldn’t be her first line of defense if a patient is particularly concerned with skin laxity. “I prefer radiofrequency treatments like Thermage and radiofrequency microneedling around the eyes,” she adds.

Let’s say I go for it. What will I look like after?

You’ll definitely be red right after the treatment. “Expect redness and mild swelling for about three to five days,” says Dr. Chang, “with mild peeling after a few days.” But she emphasizes that the side effects and downtime are variable by patient—and this is super true. While I went right back into work after my treatments, and continued to go to work makeup-free in the healing period without getting any weird stares, this won’t be the case for everyone. Part of that comes down to age (the older you are, the more time it will take you to heal) with genetics and care making up the rest. “I recommend scheduling to have about one week of downtime for your first treatment,” says Dr. Chang, “in case you happen to be a slow healer.” If you can’t chill at home for a week, be strategic about the time you do take off: the first day will look like a bad sunburn, but by the third day you’ll start to look like you fell asleep on mesh. Choose wisely.

What skincare can I use after Fraxel?

Dr. Chang notes that post-care instructions will be given to you after your laser treatment, and that they might vary a little from doctor to doctor. “In general, it is important to use gentle skincare.” That means no retinols, chemical exfoliators, harsh scrubs, or facials for a few weeks after treatment (and about a week before your next). “While your skin is healing, it is more sensitive to skincare products and sun exposure. You have to be diligent with sun protection.” That means finding a sunblock with at least SPF 30 that you’ll actually wear every day. Dr. Chang adds, “I would not plan any sunny beach vacations for at least two weeks after treatment.”

What moisturizers do you recommend for sensitive post-treatment skin?

In general, look for something rich without fragrance, essential oils, or actives. “Gentle moisturizers for post-laser healing that I recommend include SkinMedica TNS Ceramide Cream and Alastin Skincare Regenerating Skin Nectar,” says Dr. Chang, and on the drugstore end, “CeraVe and Cetaphil creams.”

Is this a one and done situation?

You might see a big improvement after just one treatment, but in order to see full results, you’ll probably need a few. “The number of recommended treatments depends on the patient and the condition being treated,” says Dr. Chang, “as well as the patient’s goal endpoint.” You’ll probably want to do three to five treatments.

I’m intrigued, but I don’t think I’m ready for something so intense. Do similar lasers exist?

Yep! But you’ll probably need to do more sessions to achieve the same results. “Clear and Brilliant is a popular laser that is commonly used in our practice to help stimulate collagen and lighten brown spots, but with only a few hours to one day of redness,” offers Dr. Chang. (The treatment is often called “Baby Fraxel” because it uses the same technology, just less harshly—it can even be done by a medical aesthetician.) “For overall rejuvenation, brown spots, and photodamage, Intense Pulsed Light is another option with less downtime.”

Got all that? Or maybe you’re still wondering… is it really worth it? I think so, but you can judge for yourself from my before and after photos. Stay tuned!

—Ali Oshinsky

Photo via ITG