Fractional photothermolysis (Fraxel™ laser*) is a revolutionary new
concept in laser treatment in which the skin is resurfaced fractionally at one
time. A Fraxel laser beam creates numerous microscopic thermal treatment zones
surrounded by islands of normal skin. The uppermost layer of skin
remains intact during treatment and acts as a natural bandage. Areas are treated
in a pixelated fashion (15 to 20%), leaving the majority of the skin undamaged
to facilitate rapid repair and minimise healing time. Patients typically receive
four to five treatments spaced 14 to 21 days apart.
Conditions such as skin splotchiness, melasma, brownish discoloration,
freckles, age spots, and acne and surgical scars, stretch marks, photo aging,
wrinkles and skin crepiness of the face, neck, chest and arms can all be
Prior to the procedure the skin is cleaned and topical anaesthetic applied.
A water-soluble blue tint acts as a tracking guide for the laser system. Skin
is treated with the laser in increasing fractionated doses. Post operatively
patients experience mild pinkness for 1-2 days, followed by 2- 3 days of skin
bronzing and slight peeling. Recovery time is minimal, and makeup can be worn a
few hours after the procedure.
The most effective treatment of facial wrinkles and photo damage is carbon
dioxide laser resurfacing. However this procedure is associated with prolonged
recovery time. A series of Fraxel treatments significantly and safely improves
texture, dyschromia, lines and wrinkles of the face, neck and chest, tightening
the skin and resulting in a dramatic difference. Biopsy results confirm the presence
of new collagen.
Melasma, a splotchy brownish discoloration of the skin, is a condition often
resistant to topical creams, chemical peels, and intense pulsed light (IPL).
Q-switched, carbon dioxide or erbium laser treatments for melasma are not usually
recommended given their high incidence of hyper pigmentation (temporary skin
darkening) and long recovery times. In resistant cases, Fraxel is an effective
and safe treatment for the removal of pigmentation associated
Current laser treatment of acne scars utilises both invasive and non-invasive
approaches. The former is limited by prolonged recovery time, the latter by subtle
and gradual rate of improvement. A series of Fraxel treatments can result in
significant improvement in skin texture, appearance and contour of acne scars.
Hypertrophic scars are a common complication after surgery, removal of skin
cancers, and traumatic wounds and are of cosmetic concern, especially on the
face. They are elevated, firm and pink to red due to increased microvasculature
supplying nutrients necessary for growth. Fraxel allows a light penetration
of about 1000 um into skin, which makes the targeting of deeply located blood
vessels effective. Its ‘fractional’ nature of treatments avoids bulk
heating, reducing the risk of irreversible non-specific thermal injury to the
skin, which may worsen scars.
Fraxel is a safe and effective technique for treatment of stretch marks, significantly
improving appearance and texture.
There are numerous advantages to the technique of fractional resurfacing.
Patients do not have open wounds therefore recovery time and complications such
as infection are minimised. Areas that would be highly prone to scarring with
traditional resurfacing lasers, such as neck, chest, and arms can be safely treated.
Carbon dioxide resurfacing targets approximately 200 to 400 microns of tissue
ablated during multiple-pass procedures. Using Fraxel, tissue can be penetrated
more deeply, safely, because removal of the entire skin surface does not occur.
Significant collagen is stimulated resulting in an improvement in skin texture,
lines and wrinkles. The 1550nm wavelength of Fraxel targets tissue water not
melanin making this treatment modality safe for patients of all skin types.
Fraxel Resurfacing Workshop, Treating Physician - Australian
College of Cosmetic Surgery, Adelaide, Australia, May 2006
Fraxel Workshop, Treating Physician - Eighth Annual Mount
Sinai Winter Symposium, Advances in Medical and Surgical Dermatology, New York,
N.Y., December 2005
(Reliant Technologies, Palo Alto, CA, USA)