Can Fraxel go wrong?

The most common side effects of Fraxel are pain, swelling, and redness, but they resolve quickly. Also, peeling is likely to occur when skin is healing post-procedure. “Infection is always a risk any time the skin barrier is compromised, as happens with laser treatments,” Dr. Marcus says.

byrdie.com - I Got Fraxel for the First Time—This Is My Brutally Honest, 5-Day Skin Diary

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If you've ever looked into getting a laser treatment, chances are you've stumbled upon a (seemingly magical) laser called Fraxel. Give it a Google and you'll quickly find that this do-it-all fractional laser can drastically improve the appearance of everything from fine lines to sunspots in just one treatment.

As a decades-long beauty editor, I've long-considered Fraxel as a way to treat my hyperpigmentation from too many summers at the Jersey Shore (regardless of how much sunscreen I applied)—plus, two pregnancies that cranked up my hyperpigmentation. But here's where my hesitation always came in: While most doctors and patients tell you the downtime is five days maximum, there wasn't enough information out there to fully manage my expectations. How much time would I really need to take off of work, and how long until my skin would actually return to normal? I'd seen the photos of scaly recoveries, but what did the day-by-day progression really look like, and would the results even be worth the downtime?

To find out just that, I turned to board-certified dermatologist and Sobel Skin founder Dr. Howard Sobel to finally try Fraxel for myself and get the answers I've always been in search of. Ahead, discover the benefits, cost, side effects, and my detailed before-and-after photos. Meet the Expert Howard Sobel, MD, is a board-certified dermatologist with over four decades of experience. He operates his own private practice, Sobel Skin, on the Upper East Side in New York City. Tracy Evans, MD, MPH, is a board-certified dermatologist and the medical director of Pacific Skin and Cosmetic Dermatology in California. Rebecca Marcus, MD, is a board-certified dermatologist with a special interest in skincare. Having completed residency training at Columbia University in New York, she now practices dermatology in Dallas, Texas.

What Is Fraxel?

“Fraxel is a brand of laser that performs fractional skin resurfacing,” says board-certified dermatologist Dr. Rebecca Marcus. Dr. Sobel adds that there are three different types of Fraxel: "The Fraxel 1927 (a.k.a. Fraxel Restore), which is a non-ablative laser for treating sun damage, and hyperpigmentation; the Fraxel 1550 (a.k.a. Fraxel Repair), which is also a non-ablative laser that uses a different wavelength to treat acne scars and wrinkles; and the Dual Fraxel, which features the wavelengths of the 1927 and 1550 to treat all of the above." Fraxel works by treating only a fraction of the skin, and therefore leaves the healthy skin in-between treated areas intact, which speeds healing and minimizes downtime, Dr. Marcus explains. Fraxel is popular for skin resurfacing as well as treatment of wrinkles, unwanted pigmentation, and scars.

Benefits of Fraxel

According to Dr. Sobel, Fraxel can help improve the appearance of unwanted texture, dark spots, uneven skin tone, fine lines, and acne or other scarring. He adds that compared to other more invasive treatments, the downtime for Fraxel is actually quite brief when you consider the dramatic results that it can produce. Most patients are back to their normal routines a week.

How to Prepare for Fraxel

Fraxel is not for every skin type, so the first thing you should do is have a consultation with a well-qualified medical professional before you commit to this procedure. “Be honest about your sun exposure,” says board-certified dermatologist Dr. Tracy Evans. “There can be real consequences to not reporting all of your exposures. If you have a history of herpes virus or cold sores, tell your laser specialist before they start the procedure, as the heat of the laser and disruption of the epidermis can result in an outbreak. We always pre-treat our patients with antivirals to prevent this.” It’s important to take prep seriously. “Preparing appropriately for the procedure makes a difference in your results,” Dr. Marcus says. “Patients should take care to avoid sun exposure for four weeks prior (and four weeks after) the procedure. Chemical peels and other exfoliating treatments should be avoided for two weeks prior as well.” Stop any topical treatments that can irritate the skin (such as retinoids, glycolic acid, and salicylic acid) 10 days before your Fraxel appointment. If a patient has active acne, it’s also best to postpone the procedure until the breakouts have cleared. Your provider may also have you stop (or start) certain skincare ingredients in preparation for your treatment. “To prepare for Fraxel, your provider may have you use a cream with hydroquinone or other brightening agents to [reduce] hyperpigmentation before you even start the laser,” Dr. Evans says. “We often stop tretinoin before the procedure for approximately one to two weeks.”

What to Expect During a Fraxel Treatment

Fraxel is usually done in a doctor’s office. The procedure itself takes about 20 minutes. “Soothing serums and sunscreen may be applied afterwards, and you will go home looking flushed, and should avoid being in the sun,” Dr. Marcus says. Prior to the application of the actual laser, your provider will start by applying a numbing cream that will need to rest for 45 minutes. “Numbing is essential for a good treatment,” Dr. Evans says. “The procedure really cannot be performed effectively without it. If you are numbed appropriately with a topical cream, then it is very well-tolerated.” During my treatment, I was numbed accordingly and prescribed Prednisone, which I continued to take for three days (under the direction of Dr. Sobel) to prevent facial swelling. Dr. Sobel came in to assess and recommend the Fraxel power level—I told him I wanted as much power as I could safely get, so he suggested a Level 8 (out of 10). Then it was off to the races. The nurse ran a laser wand over my face for about 15 minutes, performing two to three passes over each zone (forehead, cheeks, nose, and chin). Fraxel is a "fractional" skin resurfacing treatment, which means it only targets part of the skin at a time. Think of your skin like a grid; to get the most thorough treatment of a section, you have to go over it multiple times. As far as what the laser actually feels like on your skin... it's hot, and the heat intensifies with each additional pass (although a cooling air hose helps counter some of that. I was gripping a stress ball most of the time to try to shift my focus. I have a pretty high pain tolerance even without numbing cream, so my opinion may be subjective—but to me, the treatment is definitely tolerable. There were a few brief moments when I wasn't sure I could keep going because it felt like my skin was burning off... and then the nurse would be done with that particular area and I would get a reprieve. It's important to keep in mind that the pain threshold also varies significantly from one person to another. “Fraxel can be somewhat uncomfortable, but it’s definitely tolerable, and the topical numbing cream helps a lot,” Dr. Marcus says.

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0:14 Fraxel Laser Treatment

After the nurse finished with the laser, Dr. Sobel came in to check everything over. He went over the tougher areas—mainly the large brown spot on my right cheek, along with some spots on my nose—with an extra pass of the laser. When the treatment was done, my face was burning far worse than a sunburn on my most careless days in the sun. I immediately was given ice packs to calm the swelling and bring some relief. It was very obvious where the laser hit and where it didn't—you can see the areas of my face that are not red (right around my lips, for example), which the laser didn't touch, but the vast majority of my face was pretty red.

My Day-by-Day Fraxel Diary

Immediately After

Leah Wyar/Design by Cristina Cianci

I experienced dryness within minutes, and the effects were obvious. As I mentioned, everything was red except the very few parts that the laser didn't touch (around my mouth, for instance—or the line from the outer corner of my left eye to my hairline, which was the from the safety glasses). Already, the pigment was starting to come to the surface.

Day Two

Leah Wyar/Design by Cristina Cianci

The next day, I saw more pigment, particularly on my cheeks. I could also start to se the "grid lines" forming from the laser; the microscopic dots show the exact path of the laser.

Day Three

Leah Wyar/Design by Cristina Cianci

At this point, grid lines were now obvious on my forehead, and much darker on the nose and cheeks (particularly that stubborn spot on my right side). The texture was a lot scratchier, too—it was rough and almost scab-like.

Leah Wyar/Design by Cristina Cianci

I woke up to a very rough texture and much darker pigment. On the flip side, some of the "scabbing" had lifted from my cheeks, showing a glimpse of fresh skin underneath.

Leah Wyar/Design by Cristina Cianci

I took a shower right before dinner and noticed a big difference in the scabbed layer. Each time I'd use circular motions to wash my face, I could see some scabby bits on the tips of my fingers, indicating that the circular motions were lifting the scabs (which the shower steam had softened). Emerging from the shower revealed an incredibly fresh layer of skin on much of my cheeks. It was definitely red, but it was the first real glimpse of how effective this treatment can be.

Day Four

Leah Wyar/Design by Cristina Cianci

Most of the brown scabs had faded, though my nose plus the perimeter of my face and hairline was still spotty. The big brown spot was now very red.

Day Five

Leah Wyar/Design by Cristina Cianci

The five-day rule I had heard about for so long was almost true. I was definitely almost in the clear—the spots, which once took up 90% of my face had faded to take up just about 10%. The big red (once brown) spot was starting to lighten up a bit, and the fresh areas had faded from red to pink. The overall glow was more intense than I had ever imagined. It was as though the light was reflecting perfectly off my face without any diffraction from pigment. “Fraxel is the gold standard of skin resurfacing without prolonged downtime and minimal risks,” Dr. Evans says. It’s important to know how the different versions work. “As a non-ablative laser, Fraxel Dual works by heating up the tissue underneath the skin to stimulate collagen production while leaving the top layer of the skin intact,” Dr. Marcus says. “Fraxel Repair, an ablative laser, on the other hand, removes the top layer of skin. The main difference in fractional versus non-fractional laser is that Fraxel treats only a fraction of the total surface of the skin, and therefore allows healthy skin to remain, speeding healing and minimizing downtime. Fraxel Dual is an effective but relatively gentle laser, and multiple treatments are usually needed to achieve results. Fraxel Repair will produce more dramatic results with a single treatment, but with significant recovery time and increased risks of infection and scarring.” Though the results are long-lasting, Dr. Evans recommends a series of three to five treatments. “As this is a fractional laser, it only works by doing several treatments to receive the full benefit,” she says.

Potential Side Effects

“Please see a board-certified dermatologist for your treatment,” Dr. Evans says. “Lasers can be very dangerous in the wrong hands, and it’s imperative that you choose a well-trained provider who understands the structure of the skin as well as laser mechanics in order to get a safe and effective treatment. Whenever a laser touches your skin, it can burn the skin. Hyperpigmentation in darker skin types can be seen.” The most common side effects of Fraxel are pain, swelling, and redness, but they resolve quickly. Also, peeling is likely to occur when skin is healing post-procedure. “Infection is always a risk any time the skin barrier is compromised, as happens with laser treatments,” Dr. Marcus says. “If someone has acne at the time of treatment, it can temporarily be worse after treatment. Scarring is another potential risk with Fraxel—or really any laser.” To minimize potential side effects, follow pre- and post-treatment guidelines as directed by your physician. Dr. Marcus advises that it’s particularly important to stay out of the sun for the recommended period of time, as freshly treated skin is more susceptible to hyperpigmentation. It’s also a good idea to avoid excessive exercise and heat for a few days after, and be sure to wear sunscreen (as always).

Who Can Perform Fraxel?

For the best results and minimal chance of risk, you should always select a board-certified dermatologist to perform your Fraxel treatment. I personally went with Dr. Sobel for a few reasons. First, as a board-certified dermatologist who I have worked with many times as a beauty editor, I trust him. (His office, Sobel Skin, is based in New York City if you want to book an appointment, BTW.) He also recently documented his own experience with Fraxel, and his before and after was pretty remarkable. A dermatologist who trusts the treatment on their own skin is good enough for me.

The Cost

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The price of Fraxel can widely vary depending on your geographic location and the area being treated. However, a rough estimate would be around $750 for a small area, $1500 for a full facial treatment, and $2000 for face and neck for Fraxel Dual, according to Dr. Marcus. “Fraxel Repair is usually more expensive since it’s a more intense treatment—maybe add $1000 to each of those price points for Fraxel Repair,” she says. “Most of the time, a series of at least three treatments will be recommended for Fraxel Dual (possibly fewer if pigment correction is the main goal), whereas Fraxel Repair produces noticeable and often dramatic results in a single treatment.”

Aftercare

Gentle skincare is a must! Since intense moisturizing is key to combat dryness post-treatment and help with healing, Dr. Evans says that slugging can help. Dr. Sobel told me to keep the skin clean by washing with a gentle cleanser once each evening; he also mentioned the importance of frequently moisturizing throughout the day by patting—not rubbing—the product into the skin. By far, the most important rule was to wear sunscreen every single day—with my top layers gone, further burning or excess sun would cause UV damage and loads more hyperpigmentation.

Here's the exact skincare routine I followed:

Cetaphil Gentle Face Cleanser: This gentle, gold-standard cleanser was an easy choice to get me through the healing process. Dr. Lara Devgan Scientific Beauty Hyaluronic Serum: Hyaluronic acid is crucial to keeping the skin super moisturized, so I applied this after cleansing, while my skin was still damp. Sobel Skin RX Bio Hyaluronic Moisturizing Cream: This lightweight formula is highly effective and gave my dry, healing skin the hydration boost it needed. Tammy Fender Quintessential Serum: This is part of my normal daily routine because it's so nourishing, so i just kept it going by applying it right after the cream. Aquaphor: Even with all the layering, my face felt like sandpaper and was so tight—lips included. So I applied this several times throughout the day. I honestly think this extra barrier made the biggest difference in keeping my face from drying out even further. Sobel Skin 100% Mineral-Based Sunscreen: Mineral sunscreen is key after Fraxel, as since the treatment disrupts your barrier, you'll want to steer clear from too many products that absorb into the skin, as chemical sunscreens do. This sunscreen worked incredibly as a surface shield, and it's amazing as a makeup primer, too—I still use it every day. “Post-care varies quite a bit for Fraxel Dual versus Fraxel Repair,” Dr. Marcus says. “For Dual, you should plan to take a few days off from your regular skincare routine, and even makeup, while skin heals. A gentle cleanser should be used twice a day, and vitamin C serum may be applied. Maei MD's Serum 6 would be an excellent choice starting the day after the procedure, as it features a very well-tolerated, non-irritating form of vitamin C as well as hyaluronic acid and several anti-inflammatory and soothing ingredients.” Moisturizer should be applied after serum, and be sure to always wear sunscreen. Avoid the sun and wear a hat whenever outdoors for the first week or two while the skin recovers. “Fraxel Repair has much stricter post-care instructions and people should plan to follow their doctor’s specific instructions with precision and great care,” Dr. Marcus says. “In general, though, post-care after Fraxel Repair will involve staying home for several days to minimize risk of infection, a few days of vinegar soaks, frequent application of a thin layer of Aquaphor or Vaseline to protect skin while its top layer regenerates, and strict avoidance of the sun for four to six weeks post-procedure. With either Fraxel Dual or Fraxel Repair, I can’t stress enough how important it is to follow your doctor’s instructions, as they know your specific skin type and history, and can best guide you to maximize results and minimize the risk of side effects.”

The Final Takeaway

“Fraxel is a fantastic treatment for the right candidate,” Dr. Marcus says. “Results from Fraxel Dual should last for about a year, and longer for Fraxel Repair. We lose collagen every year starting around age 30, and stimulating new collagen helps to make up for this loss,” she says. “So, it’s not like a Botox treatment where the results are expected to last three to four months and then quickly fade, but rather I think of it more like turning back the clock a little.” About three months out from my treatment, the intense glow has faded a bit (though still youthful for sure, especially after a nice layer of moisturizer followed by some Aquaphor slugging). That said, I could use another round. My nose—and oddly the high point of my cheek just under my eyes—still has some speckles, and that brown spot on my cheek, while much better than it's been in over a decade, is starting to piece itself back together. I'm so pleased with the treatment though, and I love that it truly was only five days of "downtime." I'll absolutely be penciling this into my calendar each fall, as Dr. Sobel does.

byrdie.com - I Got Fraxel for the First Time—This Is My Brutally Honest, 5-Day Skin Diary

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