Fraxel laser resufacing vs. CO2 laser resurfacing

I’ve been doing some research on these topics lately, as I’ve decided that now is the time (finally) to do something about my acne scars. Why I’ve waited so long, I’m not really sure… I’ve had some other less successful treatments in the past, (CoolTouch Laser, “lunchtime” chemical peels), and I suppose I was a bit soured on the subject. Not that those treatments didn’t help a little… they just didn’t help a lot.

Last time I did any kind of serious online research on this topic, the main choices were Dermabrasion or Laser Resurfacing. Both techniques basically remove the entire top layers of your skin (via sanding off, in dermabrasion, or vaporizing, in laser resurfacing). You have significant downtime — at least 2 weeks in which you look like a burn victim, will scare small children and adults alike, and are pretty much confined to your house. Afterwards, you’re pretty pink for several months. People have some complications with dermabrasion, such as lightening of the skin, or a strange shiny texture that develops. Both are officially plastic surgery, (the term still makes me wince — I’ve never been under the knife for anything, elective or medically necessary). Both also require anesthesia, getting someone to drive you home after the procedure, etc.

At that time, the new trend was “non-ablative” lasers (i.e. they don’t damage the top layer of skin, so you don’t have any downtime), which were supposed to plump up the collagen in the skin from below. CoolTouch, N-Lite, and many other lasers were the new choice treatment. The upside: no downtime. The downside: no dramatic results, at least for my skin.

In the past 5 years or so, there’s been a new exciting development in the field of laser resurfacing, however - fractionated lasers, most commonly known as “Pixel” and “Fraxel” lasers. These lasers are considered to be “ablative,” and both go as deep as (or at least almost as deep as) the traditional Co2 laser, but don’t affect all of your skin at once — only a fraction of it. By damaging only some skin cells, but leaving them surrounded by healthy skin cells, they heal faster, there’s less risk of infection or complications, and your downtime is reduced to a day or two. You don’t have to get “put under,” or anything like that. Websites claim that its the new revolutionary treatment, and is as good as the old lasers, but even better with reduced downtime.

Not wanting to get caught up in “the new trend” again, I made appointments for consultations with two dermatologists/plastic surgeons. One offers a CO2, Erbium:Yag Combination laser, the other the Fraxel.

Meet with CO2 Erbium:Yag Combination doctor:
This guy seemed on a mission to defend his combination laser and its place in the world. He talked about all of the bad press that traditional laser resurfacing got a while ago, which prompted people to move toward the non-ablative lasers (which were much less effective.) He seemed almost defensive in describing how his combination laser was a third generation laser, which combines the best of the 1st and 2nd generation lasers, with much fewer complications. He told me that he puts all patients on a strict pre-treatment plan with Obagi products, and puts them on antibiotics and antiviral medication before the treatment. He talked about putting vaseline on your face after the surgery for several days, and the resistance that acne-scarring patients have toward that (not wanting to break out again). He reiterated that there is serious downtime, and that this is a real surery. I asked him how his procedure compared to the less scary-sounding pixel and fraxel treatments, and he said that he didn’t think that they were that good. But then he went on to say that they weren’t currently making the laser that he has anymore, and that he thought he would eventually have to move to Fraxel or Pixel treatments. He also happened to be going to a training class that night.. curious indeed…

He gave me a detailed cost quote, which includes a “surgeon’s fee,” “anesthesia fee,” and “OR fee,” which all sounds kind of scary to me. I was quoted at $5,255 for the whole procedure, plus $250 for the skincare products. He said that their results are usually a 40-60% improvement for the first treatment, 10-25% for the second, and 5-10% for the third, averaging out to a 50% improvement for one treatment, 68% for three (or a total of 55% to 95%). He says that people get good results, and that’s why they come back for second and third treatments (in which the surgeon’s fee is reduced by about $1500).

Meet with Fraxel doctor:
They told me that “cases like mine are the reason that they bought the Fraxel laser.” They expect 50-70% improvement (closer to 70%) with 4-6 treatments. My skin is oily, light, and resilient, so they can be fairly aggressive with the treatment. A package of 6 treatments goes for $4000. For deeper depressions, they also suggested doing some silicone fillers (a permanent injectable product), which would be injected in 2-4 visits, for a total of up to $1400. Then the doctor suggested getting my mole removed, and getting some botox for my “angry eleven” lines on my forehead. I felt old, and kind of in over my head. He tells me Botox would be about $240/treatment; treatments last for 3 months. Hmm, that’s about $1000/year, probably for the rest of my life…. if I live to be 81, that’s about $50,000 spent on Botox (!) Hopefully I can hold off on the Botox for a while… One thing at a time…

I asked him how my results would be for Fraxel vs. a deep chemical peel, or traditional laser resurfacing. He said that Fraxel would go deeper than the chemical peel, and sort of defaulted to talking about dermabrasion, in place of the traditional laser resurfacing. He seemed to think that it had been pretty much entirely replaced by Fraxel at this point. I told him that I was talking to someone else who did the CO2 laser, and he thought it very odd that this doctor wasn’t doing Fraxel yet.

The verdict
On this doctor’s brochure, it says “The Fraxel laser is your skin resurfacing dream come true.” Hopefully it is, because I booked an appointment for the Fraxel today. I don’t know if I could do the whole “out for two weeks” routine once, much less several times, which could be involved with the traditional laser treatments… I want to do what’s best in the long run, of course, but I’m also kind of queasy about such an invasive procedure… This guy also seemed a little more into the technical aspects of the laser than on actually improving my overall appearance (which the Fraxel doctor was, even though I’m not sure that I want to part with my mole just yet). Cost-wise, 6 Fraxel treatments and the Silicone fillers should come to roughly what one laser surgery would cost, so price isn’t that big of a determinant (unless I were to need 2-3 laser surgeries, in which case the cost would go way up).


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i was wondering how your treatment is going?

lori added these pithy words on Nov 17 07 at 6:01 pm

I’ve had four treatments so far, and am seeing a definite improvement in my skin. The scars aren’t gone, but they are quite a bit less prominent. My pores are smaller, and the texture of my skin is much improved.

One thing I can tell you, though, that I wasn’t aware of before starting the treatments — it hurts. My aesthetician is doing very aggressive treatments, as deep as the laser will go, of course, so perhaps it doesn’t hurt as much with a less aggressive treatment. I have numbing cream on for an hour before the treatment, and also take 6 advil, but it’s still somewhat difficult to get through. They can do meds — valium or vicodin, but then they would require a driver. It is an option, though.

After the treatment, my face is quite swollen for a few days. I ice it, and use an ointment they sent me home with called Cicaplast, which helps to speed up the healing process. I generally get the treatments on Monday afternoons, and then plan on spending the next day or two working from home. After that, the swelling has gone down quite a bit, and I can cover the redness with makeup.

Overall, I’m pleased with the results so far. It isn’t quite as quick and easy as it may sound at first glance, but it still seems less scary than actual full-face laser surfacing… Being confined to my house for a day or two is enough for me — I can’t imagine doing it for two weeks.

admin added these pithy words on Jan 31 08 at 9:50 pm

What made you NOT go with dermabrasion? I too want to have work done and laser and dermabrasion are my two choices.

Dave added these pithy words on May 10 08 at 9:19 pm

I was curious after the whole process how much improvement you see and if you have any pics. I’m doing some reserach now. I have huge pores, scarring but I can’t have any downtime almost so I am trying to choose the best option for me. I’m tired of talking about it. My dermatologist wants to send me to the CO2 laser but thats $5000 and lots of downtime from what I understand. Any and all advice and feedback from your experience would be much appreciated.

Jenny added these pithy words on Jul 31 08 at 9:26 am

Sorry, no pics. I do feel, now that the procedure is over, that it was worth it. I don’t have perfect skin or anything, but I do see a significant improvement. The improvement seems to have continued, too, in the past 6 months or so since I finished up my Fraxels.

As far as dermabrasion — every doctor I talked to seemed to hold dermabrasion as an old-fashioned, more dangerous and less precise treatment. Lots of blood during the procedure, etc. Didn’t sound like a very attractive option, especially compared to something like Fraxel that you wouldn’t even need to be put under for.

All that said, I am still considering further treatment. I almost went through with a CO2 laser treatment, but decided that I didn’t want to be out of commission during the middle of the summer. In the meantime, another aesthetician has suggested to me that an Obagi blue peel could be almost as effective for me, at $500 vs. $5000 for an old-fashioned laser treatment. You still have 7-10 days of downtime, but the procedure sounds much less scary to me.

admin added these pithy words on Oct 07 08 at 12:53 pm

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