What if we told you there was a type of treatment that could fight a range of signs of aging—we’re talking dark spots, fine lines, and more—without any needles or much pain? Yep, it really does exist and it’s called Fraxel.
If you've been wondering about the magic of lasers, Fraxel is a prime example of how this technology can transform and repair your skin. “Fraxel is a fractional laser that causes columns of photothermalysis in the skin to improve fine lines and wrinkles as well as improve hyperpigmentation,” explains board-certified dermatologist Dr. Tracy Evans. We spoke to Evans and two other dermatologists—even getting the treatment from one of them, Dr. Howard Sobel of Sobel Skin—to bring you a full overview of Fraxel, from why you might choose it to what to expect in each step of the process.
Meet the Expert
- 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. Marcus is kicking off the launch of Maei MD with Serum 6, a multi-function skincare superstar crafted to streamline overly complicated daily regimens.
- Howard Sobel, MD, is a board-certified dermatologist with over four decades of experience. He has pioneered or been part of the development process of many cosmetic dermatology procedures over the years, including Fraxel, Botox, and micro-liposuction, among others. He operates his own private practice, Sobel Skin, on the Upper East Side in New York City.
I have contemplated Fraxel as a way to treat my pigmentation (from too many summers at the Jersey shore, regardless of how much sunscreen I apply; along with two pregnancies that cranked up my pigmentation) for years. The problem: While most doctors and patients tell you the downtime is five days max, there wasn't enough information out there to fully manage my expectations (e.g. How much time did I really need to take off work?). So while I wanted to do this treatment for me, I also wanted to do it to fully document day by day what actually happens to skin.
I chose Dr. Sobel for a few reasons. First, I've known him for two decades as a beauty editor and trust him—while I always want to trust the professional, I was doing this treatment the week of Thanksgiving and definitely didn't want to take any chances with someone I'm less familiar with, knowing I was having a family dinner a few days after. He also recently documented his own experience with Fraxel, and his before and after was pretty remarkable. On his Instagram documentation, he talked about how he does the treatment annually after summer to "clean the slate" (or some version of that)—and he also talks about how this can rid the skin of pre-cancers. While sunscreen and getting checked regularly remain key no matter what, it's exciting that a cosmetic treatment like this may also have some added health benefits.
To give you the scoop on Fraxel, we went straight to the pros, in addition to documenting our own experience. Keep reading for everything you need to know about Fraxel before you schedule an appointment.
What Is Fraxel?
“Fraxel is a brand of laser that performs fractional skin resurfacing,” says board-certified dermatologist Dr. Rebecca Marcus. “There are two types of Fraxel: Fraxel Dual, a non-ablative laser, and Fraxel Repair, an ablative laser. Although there are several lasers on the market that offer fractional resurfacing, ‘Fraxel’ is often used to broadly describe them, just as ‘Kleenex’ refers to tissues and ‘Xerox’ refers to copy machines.”
Fraxel works by treating only a fraction of the skin, and therefore leaves 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
Fraxel helps with skin tightening as well as quality and texture, including the evenness of pigmentation, according to Dr. Evans. It can also help with acne scars or other scarring.
“Fraxel Dual versus Repair will be chosen based on treatment goals and tolerance for downtime,” Dr. Marcus says. “Wavelength can be adjusted on the Fraxel Dual to target either wrinkles or pigmentation.”
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,” Dr. Evans says. “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.
“To prepare for Fraxel, your provider may have you use a lightening 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.
Plan on arriving early so that numbing cream can be applied for about 45 minutes beforehand. “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 topical cream, then it is very well-tolerated.”
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. “Fraxel Repair is more painful than Fraxel Dual.”
Before beginning treatment, the nurse covered my face in numbing cream for about 20 minutes and gave me a Prednisone (FYI: I continued taking these for three days to prevent my face from swelling up). Dr. Sobel came in to access 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, I believe).
The nurse ran a laser wand over my face for about 15 minutes; she did 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—it's like a grid, so to get the most thorough treatment of a section, you have to go over it multiple times. The feeling is hot and intensifies with additional passes (although a cooling air hose helps counter some of that); I was gripping a stress ball a lot 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—it's tolerable, but there are 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.
Fraxel Laser Treatment
Next, 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—an extra time. Note: The nurse mentioned that the dark, pronounced spot on my cheek might not actually go away with this treatment, and it may require a Pico 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
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.
The next day, I saw more pigment, particularly on my cheeks. I also could start to see the "grid lines" forming from the "fractional" laser; the microscopic dots show the exact path of the laser.
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, almost scab-like.
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.
I took a shower right before Thanksgiving 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, like the motion was lifting the scabs, which the 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.
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.
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 vs. Other Similar Procedures
“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. 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.
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.”
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 mentioning the importance of frequently moisturizing throughout the day—patting, not rubbing, the product in so not to peel away the rough, scab-like skin that would soon form ("don't pick!" was repeated—otherwise I'd risk scarring). 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 pigmentation.
Being a beauty editor for a long time, I know the importance of layering various types of moisturizer, so this is what I did:
- 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 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. “In general, more intense procedures with more downtime produce more dramatic results. So, if you choose Fraxel Dual, keep in mind that the effects will be more subtle and multiple treatments will likely be needed for wrinkle reduction—pigment correction can be achieved with fewer treatments, sometimes even just one. If you choose Repair, make sure you are prepared for 10 days of social downtime and a more intense healing process.”
Results from Fraxel Dual should last for about a year, and longer for Fraxel Repair, according to Dr. Marcus. “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" (honestly, I really only avoided going out in public for one or two of those days). I'll absolutely be penciling this into my calendar each fall, as Dr. Sobel does.