Dear Paula,
I am trying to find information on the Fraxel Laser. My dermatologist said I would be a good candidate for it around my eyes. Her office just installed the machine, so they are learning how to use it. Paula, you are the only one I trust to provide me with reliable information about this new procedure. My dermatologist made it sound so simple, but surely there must be a catch or something to be concerned about, right?

Marilyn, via email


Dear Marilyn,
Lasers of any kind are never simple and all types have risks, though some more than others. Personally, I'm intrigued by the new Fraxel Laser system for treating wrinkles and skin discolorations, but before I explain why, let me say that I am nervous that a doctor who is learning how to operate a new machine or procedure wants to use it on you and suggests the procedure is a piece of cake. Personally, I am never interested in being someone's guinea pig and don't encourage you to be either. After your doctor has performed a hundred or so treatments, and figures out what techniques work best or can possibly cause problems (and there are always problems), then he or she can call you to set up an appointment.

So will the Fraxel Laser eventually prove to be a great option? Quite possibly. Many types of lasers are now available for resurfacing skin. The two main types of lasers are categorized as either ablative (causing injury to the skin) or nonablative (not causing injury to the skin). It is well known that nonablative lasers have far less risk, but also have far less impressive results than ablative lasers. There is a much greater potential for improvement in your appearance with an ablative laser than with a nonablative laser. What makes the Fraxel Laser so interesting is that it performs something called Fractional Laser Resurfacing, a method that is meant to be the best of both the nonablative and ablative systems: significant improvement with minimal to no risk of injury to skin. Now that's what I call intriguing!

The term "fractional" refers to how small an area of the skin is being treated at any one time. The Fraxel Laser pinpoints tiny columns of skin (smaller than a human hair), wounding the underlying collagen. Unlike traditional ablative lasers, the Fraxel Laser creates no visible wound on the surface because only microscopically small areas are affected during the process. Typically, no more than 20% of the skin is treated during each session. Therefore, according to Reliant Technologies, the company that sells the Fraxel Laser, "Clinical studies suggest that an effective treatment regime is 3 to 5 sessions spaced 5 to 14 days apart" (Source: www.fraxel.com). But remember, this laser is a work in progress and more information is needed to know what methodology works best.

Although the Fraxel Laser is FDA-approved for skin discolorations and some types of wrinkles, it is assumed that it will work the same as ablative lasers for improving the appearance of acne scars, rosacea, and most types of wrinkling. However, it is important to understand that questions about how, where, and when to use the Fraxel Laser are still being researched. Many questions regarding which power settings work best for which kinds of problems or for different areas of the face have not yet been answered. And aside from the learning curve required for any new device such as this, there are risks to consider. Fractional Resurfacing can have problematic results similar to those from other types of lasers, such as scarring or potential skin lightening or darkening. All in all, I would wait at least a year before venturing into this new world, after more specifics are published and presented at dermatology or plastic surgery conferences (where doctors go to keep up with what's new and discuss what works and what doesn't) (Sources: http://www.mdlive.net/xfractional.htm; Photodermatology, Photoimmunology, and Photo-medicine, August 2005, pages 204–209; Journal of Cosmetic and Laser Therapy, May 2004, pages 11–15; Archives of Facial Plastic Surgery, November–December 2004, pages 398–409; Lasers in Surgery and Medicine, May 2004, pages 426–438; and Annals of Plastic Surgery, November 2001, pages 482–488).