CARLSBAD, CALIF. The Fraxel laser is "not a panacea," but patients will see improvement, Dr. Elizabeth F. Rostan said at a symposium on laser and cosmetic surgery sponsored by SkinCare Physicians.
"Patients can achieve significant improvement in fine and deep lines, there's high patient satisfaction, and importantly, husbands, family members, and friends see improvement. Sometimes if we do a nonablative [procedure] with [intense pulsed light] they come back in and say 'my husband doesn't see any [difference],'" she said while explaining the pros and cons of fractional resurfacing for skin rejuvenation.
One negative is the pain caused by Fraxel treatment. This turns out to be a benefit, though, because any other procedure will probably be perceived as less painful by the patient. "I hear this all the time as I'm injecting filler into their faces: 'This is nothing compared to that Fraxel,'" she said.
Since many patients looking for improved appearance actually have significant photodamage, the "nonablative methods that we offer them really won't achieve everything that they want to achieve," said Dr. Rostan, a dermatologist who practices in Charlotte, N.C.
The Fraxel also is very effective for acne scars. "In fact, this is one of my primary mechanisms of treating acne scars, including younger patients," said Dr. Rostan, who disclosed that she has previously lectured about Fraxel on behalf of its manufacturer, Reliant Technologies Inc.
For patients who are not ideal candidates for ablative resurfacingincluding smokers, those with multiple medical problems, those on immunosuppressant medications, and those for whom close follow-up is not possiblethe Fraxel laser is a good option, especially since "I cannot give away CO2 resurfacing in my area," she said.
The side effects of ablative resurfacing, such as pigmentary lesions, poor wound healing, infection, and prolonged redness, "have not been fully observed in fractional resurfacing." On the downside, "there are limited results on lip lines and minimal skin tightening," Dr. Rostan said.
The procedure can be effective for melasma, but the results have been inconsistent. "I do have some patients who have not responded in a satisfactory way," she said.
It is, however, safe and effective for nonfacial rejuvenation. "You can get nice improvement on the neck, chest, and hands," but some areas are difficult to treat, including clavicles and the sternal notch.
Recovery downtime is minimal, but Dr. Rostan tells patients thatposttreatment redness and swelling can occur and last several days. Mild bronzing can last 314 days.
The need for multiple treatments can be a problem. For most patients, at least five treatments are required, and each visit involves applying the blue tint, anesthetic ointment, and time for cleanup.
This patient underwent Fraxel laser treatment for acne scars, lines, and wrinkles. At right is her outcome at 10 months after five treatments. Photos courtesy Dr. Elizabeth F. Rostan
