Definition and Overview

Fraxel is a cosmetic device that is used in performing fractional laser treatment for various skin conditions including but not limited to age spots, wrinkles, and sun damage. It combines the benefits of ablative (affecting the epidermis) and non-ablative (affecting the dermis) techniques.

The skin is composed of three different layers. The topmost is called the epidermis, which contains the melanocytes, the cells that produce the pigments. Underneath it is the dermis, which makes up the structure of the skin since it has elastin and collagen. The last one is the subcutaneous layer, which contains the fat.

In traditional laser treatments, the skin is treated as one large area and either the upper layer is ablated to promote the growth of new skin cells or the dermis is stimulated to produce more collagen and elastin to stretch the skin and make wrinkles and other signs of skin aging less visible. However, this can lead to longer downtime, and healthy tissues may be damaged in the process.

On the other hand, Fraxel uses fractional laser, which delivers vertical columns of laser per area of the skin called MTZ (microthermal treatment zone). The laser causes the removal of the old pigmented skin cells while penetrating the dermis, encouraging the remodeling and production of collagen.

So far, there are three types of Fraxel treatments: Fraxelre:pair SST is the ablative device to treat fine lines, wrinkles, and furrows. Fraxel Dual 1550/1927 is used for skin resurfacing and treatment of photo damage like age spots and freckles. Re:fine is meant for maintenance.

Who Needs It and Expected Results

Fraxel is FDA approved for the treatment of wrinkles, melasma, redness due to sun exposure, irregular texture, fine lines, furrows, age spots, wrinkles, and acne and surgical scars. The device may be used on various parts of the body, although it’s more commonly used on the face, neck, and chest.

The best candidates depend on the specific Fraxel treatment desired. For skin resurfacing, it’s best for patients with mild to moderate wrinkles, scarring, and sun damage. On the other hand, a much deeper treatment that uses CO2 laser may be recommended for older patients with more significant signs of aging and scarring.

Each treatment lasts for at least 2 hours, and it may take 1 to 4 sessions to see significant improvements. A complete treatment plan, however, may take three to six months.

Unlike other laser treatments that require intensive maintenance, Fraxel may be performed just once a year after the first few rounds of treatment, provided the patient has also taken care of the skin, including spending less time in the sun and applying sunscreen twice a day.

The treatment may also be combined with other dermatological services for a much better result. Moreover, since the device is used only in the targeted areas, downtime and recovery are significantly shorter.

However, Fraxel may not be ideal for those who are looking for a complete skin transformation as it does not have a lifting or tightening effect.

How Does the Procedure Work?

First, the technician cleans the skin before applying a topical numbing agent to the targeted area. The technician then begins the process by using a microphone-like wand that is placed over the problem areas to deliver pinpoint laser beams that eliminate damaged skin cells.

Fraxel doesn’t require general anesthesia, although relaxants may be given depending on the patient’s anxiety level. It also does not need any special preparation, and since the procedure is outpatient, the patient can immediately return to his or her daily activities right after the procedure.

Possible Risks and Complications

Some may experience minor discomfort, especially since the device delivers a sunburn-like sensation to the skin. There will also be redness, but it should subside within the next few days. Other possible complications include changes in the pigmentation, scarring, crusting, and scabbing. Wounds may also take time to heal, which means that the skin will become more prone to infection. Edema (the buildup of excess fluid in the tissues) can also be a complication. Burning effect may be seen in people who have darker skin.

To minimize these risks and complications, patients should approach only certified doctors and technicians who have the experience and training in performing the procedure. Further, skin evaluation should be part of the process to determine whether the treatment is safe and effective for the patient.

Reference:

  • Tanzi EL, Alster TS (2008). Skin resurfacing: Ablative lasers, chemical peels, and dermabrasion. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 2364–2371. New York: McGraw-Hill Medical.
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