Facial Plastic Surgery Blog

January 31, 2007

Fractionated Laser Peels (such as Fraxel, Pixel, and CO2 lasers…)

Filed under: Lasers, Minimally Invasive, Peels — drmost @ 8:17 pm

Fractionated laser treatments (updated 8/4/08)
A lot of excitement has been generated by the introduction of the ‘fractionated’ laser treatment. There are a few different varieties of fractionated laser, such as PIXEL and FRAXEL. The reason for the excitement is that these lasers offer the opportunity for reduced ‘downtime’ after treatment.
The idea (simplified here) is that with each laser pass, the amount of skin actually ‘hit’ with the laser is only a ‘fraction’ of the area covered. That is, a single pass with the laser may only actually ‘hit’ 25% of the skin. The benefit is that the surrounding, unaffected skin can more quickly heal over the affected areas. This is in distinction to standard ‘resurfacing’ laser techniques, whereby the entire surface of the skin is affected. The earliest fractionated lasers are non-CO2 (e.g., Erbium-based). These fractionated lasers may require several treatments to see results. At the Mid-Winter meeting in Vail, Colorado in January 2007 and 2008, some of these results were presented (though not by me). While these early fractionated lasers show some results, treatment of rhytids (wrinkles) is not as effective as one may like. Interestingly, more than one speaker mentioned that we are ‘going back’ to CO2 laser treatments. A new laser has been introduced which combines fractionation technology with CO2.

I already have begun using fractionated lasers in patients, and it seems that these patients are seeing some nice results. The recovery is typically a few days (versus weeks or months with standard CO2 laser). It is perhaps not as effective as a standard CO2 laser or deep chemical peel, but the risks appear to be lower.

Newer, higher powered fractionated CO2 and erbium lasers hold the promise of improved results.

If you have questions about fractionated laser treatment, feel free to post here or email info@drmost.com.

For more information, visit www.drmost.com


  1. Hello,
    I am currently looking into my options for treating acne scars. Right now I have been suggested two different techniques by two different physicians: 1) CO2/Erbium combination; and, 2) Fraxel treatment. While both options have their benefits I am looking for the route that will provide the most dramatic results. Downtime is not a problem for me so both options are valid. From your experience, which route would you suggest for a patient looking to treat moderate acne scarring (mainly atrophic scars with hyperpigmentation)?
    Thanks in advance,

    Comment by JR — February 18, 2007 @ 7:54 pm

  2. JR,
    Thanks for the question. First, I would say that without examining you I cannot give true medical advice, and this comment is not medical advice. However, in my experience the ablative lasers generally give more consistent results. No technique will give you ‘dramatic’ improvement, however. Both techniques can give some improvement, and some have had good success with each. You should find a physician experienced in both, who can examine you and give you advice on what would work best for your situation.

    Comment by drmost — February 19, 2007 @ 12:29 pm

  3. Hello,
    What a Godsend to have somewhere to direct questions of this nature to! I have been for a Pixel consultation and am considering going ahead as my skin laxity in the neck area is not sufficient to warrant a full neck lift yet. However, I do not know if Pixel is the more effective CO2 combination that you seem to favour or not. Please can you advise. Is there some other form of skin tightening treatment out there for me to consider before committing to this one? Many thanks. Suzi

    Comment by Suzi — March 9, 2007 @ 10:08 am

  4. Suzi,
    Thanks for your question. While I have not used this particular laser myself, here’s what I know: the Pixel uses a fractionated beam of erbium. It creates a ‘fractional ablation’ of the skin. It requires multiple treatments and the results gradually develop over time. From what I’ve heard, the results are comparable to Fraxel treatment. Unlike the CO2 laser, it can be used on any portion of the body (the traditional CO2 laser is quite effective, but cannot be used on the neck). Having not examined you in person, I cannot give you any particular advice about which technique(s) would be best for you…..

    Comment by drmost — March 9, 2007 @ 3:02 pm

  5. I recently had C02 lazer treatment done and noted you had said it should not be done on the neck. Could you specify why since mine was done on the neck as well as the face.

    Comment by Gail — March 14, 2007 @ 1:11 pm

  6. Gail,
    Thanks for your question. Generally, ablative procedures such as deep laser or chemical peels should not be done on the neck because of the higher risk of scarring. Most CO2 laser procedures fall into this category.
    However, at very low power settings, or with a ‘fractionated’ beam, CO2 laser treatment can be done with less risk on areas such as the neck. (The reason for this is the limited regenerative capacity of non-facial skin, compared to facial skin).
    Similarly, ‘light’ chemical peels can be done safely in these areas. Note that non-ablative lasers can be used safely on most non-facial skin. I hope this clarifies things….

    Comment by drmost — March 14, 2007 @ 1:27 pm

  7. i am interested in the active fx procedure for wrinkle tightening. in your experience do you think it is better to get
    a couple of fraxels or one active fx?

    Comment by rosa — March 18, 2007 @ 4:52 pm

  8. What company is releasing the fractionated CO2 laser and when do they plan to make it available?

    Comment by Van S. — March 25, 2007 @ 6:20 am

  9. Van,
    Thanks for the inquiry. The fractionated CO2 is out now (Lumenis makes it), and I hear other companies are developing it as well. (I have no financial interest in any of these companies, by the way).

    Comment by drmost — March 26, 2007 @ 7:27 am

  10. Hello Dr. Most: Thanks for allowing me to contact you so easily. I came back from a consult in BH with an MD. — I have some fine - moderate wrinkles around the chin area.. I had previously had erbium laser treatment and was told initially that it would take care of it. However, once I was prepped for laser, I was informed that “my chin problems were the result of bone loss and that the laser treatments would not completely take care of it. He made 2-3 passes over a period of time and still they were there. He suggested restylene and I refused. Today, 8 months later, I saw another physician and he said restylene was not the solution ( I did not have deep marionette lines) just wrinkles and suggested fraxel laser (or chemical peel). The chemical peel was not really discussed. I felt quite hurried - doctor was extremely distracted. The price for the chin treament alone was extremely high x 4 or 5 treatments. So… is the the fractionalized CO2 laser you are speaking of better for removing wrinkles than the fraxel laser. Fraxel lasers seems, from photos, to be effective with acne scarring. Or is a chemical peel (just to the chin area) a more effective way to do this? Thank you!

    Comment by Patricia A. — April 6, 2007 @ 5:36 pm

  11. Thanks for the question.
    I cannot give medical advice over the web. However, it sounds to me like you’ve already had an ablative laser procedure with the erbium laser, but it would depend on the depth of the peel. Generally speaking, the fraxel or fractionated CO2 would not give much more benefit than an ablative laser, nor would a chemical peel. I would be glad to examine you if you are in the San Francisco Bay Area, or are willing to travel here.
    Dr. Most

    Comment by drmost — April 10, 2007 @ 3:44 pm

  12. As a nurse practitioner, I am interested in getting into the business. I have two questions. First, what unbiased excellent training is available? Secondly, what laser equipment should I invest? I want to be knowledgable and able to perform procedures with the best possible outcomes. I am interested in starting out doing hair removal, vascular and pigented lesion reduction and acne treatment with the ability to grow. I recently went to the ASLMS trade show in Dallas and of course, everyone told me their laser was the best. I am starting out at ground zero. Can you offer me any advice? HELP!!!

    Comment by Tammy — April 15, 2007 @ 6:25 pm


    Comment by SHARON L. — April 24, 2007 @ 11:20 pm

  14. Dr. My dermatogist suggested I do some investigating into CO2 Fractionalized Laser treatment. I have early signs of rhynophyma and have a couple of mounds starting to protude on each side of my nose. Is this a treatment that could have some positive effect in helping to mitigate the physical changes that are occurring? I would appreciate any information or direction I could follow.

    Comment by rod l. — May 1, 2007 @ 2:42 pm

  15. Thanks for the question.
    Rhinophyma has been treated with such CO2 laser for many years. I have not seen any published reports on use of fractionated CO2 on this entity. However, I can imagine that it may have a beneficial effect on early rhinophyma, given that standard CO2 works on more advanced rhinophyma cases. Hope this helps.

    Comment by drmost — May 1, 2007 @ 2:56 pm

  16. Hello Dr.

    I was wondering if you have any experience in using Fraxel. I do realize that there is no laser yet to get rid of stretch marks. However will a laser such as fraxel be effective in treating the texture of the skin and making it more smoother. I realize that the discoloration may remain, but i was wondering if fraxel a sufficient laser to treat depressed scars and texture of the skin. Thank you.

    Comment by Becky — June 2, 2007 @ 12:38 pm

  17. My doctor has suggested fractional laser resurfacing as a treatment for the mild ‘crepe paper” wrinkles I am noticing. He will be using a new laser from a European company “Mixto”–are you familiar with it, and if so, how effective do you think this treatment will be? Also, what kind of recovery time have you found with this procedure–can you cover the redness with makeup and resume normal activities immediately? Thank you for your input–it is much appreciated.

    Comment by Mary — June 3, 2007 @ 4:50 pm

  18. I have had a consultation about the pixel laser. I am primarily interested in reducing some crepiness under my eyes. I also have some fat pockets under each eye which I don’t think can be addressed by any menthod other than surgery. The cost for the pixel is close to $2000. Do you think I would be pleased enough with the results of the pixel as a temporary measure or should I save the money towards actual plastic surgery on my eyes?

    Comment by Carole W. — June 6, 2007 @ 9:54 am

  19. Hi, I would like to get a facial treatment on my neck area, I currently from shaving scars. I have tried laser surgical to remove the hair. But it has not proven to benefit me yet. Currently I have small pits in my face from shaving. What would you recommend for me to do about smooth out my face to not show the pits?


    Thanks for the post. It is not possible to give you specific medical advice here. However, there are several treatments that can be effective (to a varying degree). These include Fraxel-type fractionated erbium lasers, fractionated CO2 lasers, traditional CO2 lasers, and dermabrasion or chemical peels. You should see a competent facial plastic surgeon or dermatologist to help you with this. Hope this helps.

    Comment by Leo J.B. — June 18, 2007 @ 9:56 am

  20. Hi

    I had the Fraxel on my neck and my neck looks worse then when I started.
    I would rather have what I had then what I got.
    Will this be different in a couple of days.


    Comment from Dr. Most:


    I would recommend you speak to your physician regarding this. Having not examined you or treated you, I cannot give you medical advice.
    -Dr. Most

    Comment by Brenda W. — June 23, 2007 @ 10:12 am

  21. My wife (40 years old) has some pigmentation irregularities on her left cheek. She has consulted with a dermatologist who specializes in Fraxel laser treatments. This person has recommended a 5 session treatment from just below her eyes to her jaw line. My concern is this. My wife is Asian and has extremely delicate skin. Even the slightest trauma (mosquito bites or scratches) may take 2 or more weeks to heal and often leave discoloration that may last several months. Is there some danger that Fraxel treatment will cause permanent discoloration or other damage?

    Comment from Dr. Most:
    The risk of pigmentation abnormalities after laser treatment is much lower with Fraxel, but it still exists.  Perhaps ask about your physician’s experience in patients with similar skin types…
    -Dr. Most

    Comment by Ron — June 23, 2007 @ 8:40 pm

  22. How long do the effects of fractional laser last?


    This is quite variable, and depends on the patient, the type of fractional laser used, the number of treatments and settings at each treatment….

    Comment by Linda — July 13, 2007 @ 2:42 pm

  23. I am having a full facial using the co2 laser, for ance scarring Can you tell me how long the recovery time for this procedure is? I only have ten days after this surgery before I have to return to work.


    The recovery period depends on the density and power of CO2 laser used…it is best to ask your physician.

    Comment by Jeanna B. — July 13, 2007 @ 9:01 pm

  24. Any suggestions for lightening (eliminating?) freckles caused by sun damage during my teen years (I am in my 50’s now) - all over my upper back and shoulders?

    I cannot give you medical advice over the internet…However, there are a number of modalities available.  Most notably, various types of lasers are available…I recommend you see a local dermatologist…Good luck to you.

    Comment by Mary — July 21, 2007 @ 9:00 am

  25. There’s very little literature on how well Fraxel improves line scars (as opposed to acne scars). How well can it help miminze the appearance of a facial straight line scar caused from an accident? Also I’m told fraxel can cause very small hyperpigmented spots on all skin types, not just asian. Is that true? Do those fade away like a tan or are they permanant?


    You are correct.  Generally, dermabrasion, scar excision, or CO2 laser work best, depending on the scar.  The hyperpigmentation can occur, and may or may not fade away (best to ask your physician).

    Comment by Terry — July 29, 2007 @ 5:59 am

  26. How well does fraxel work on facial line scars, as opposed to acne scars?

    Comment by terry — July 31, 2007 @ 4:26 pm

  27. Hi could you please tell me what works with instant effect for pigmentation please?
    I have it really bad on my cheeks which gets me really down.
    I have tried IPL and also i have been using a cream called Meladerm for the last 4 weeks had a slight change but nothing to get excited about.
    Would really appreciate your help
    Many thanks

    Comment by Liz — August 13, 2007 @ 5:25 pm

  28. hi doctor please i realy need help as soon as aposible to find me a good treatment. i do have a scar on my forhead and i did the first treatment was by co2 laser this is was on 3-23-2007 but still my sacr there and the eara look more light then before?i went to another doctor also he said he can help me with the another laser called pixel2940 and he said this is make my scar mor smooth but till now i dont know what to do which one better to me the co2 laser or the pixel laser??? and i wanna get heal fast i can i live in bad time by hiding my forhead always and i dont now what to do please i need your help …..
    thank u


    It is really not possible for me to give medical advice on the internet.  I would recommend seeking more than one opinion with doctors in your area.

    -Dr. Most

    Comment by janet — September 5, 2007 @ 3:59 pm

  29. hi dr. most

    my question now is which one the best laser for the scars ? could u please to tell me ?

    thnx alot for ur help

    Comment by janet — September 6, 2007 @ 12:01 pm

  30. hi dr. most please i need ur help iam realy going to scheduled appointment to do the second treatment for my scar .the first one was co2 laser and the second will be pixel laser ?so i need ur opinion which one its good and more get to heal more fast the co2 laser?or pixel laser? please i need ur answer becasue i have to call and schedul the second treatmnet i wanna get better and stop hiding all the time ???

    thank you for ur time

    Comment by janet — September 9, 2007 @ 12:44 pm

  31. Hi,

    What are the approx. costs for Active FX for the full face? I live in Florida.



    COMMENT: The cost would depend on the total area treated, the depth energy/used, etc…..

    Comment by Lin P. — September 19, 2007 @ 10:56 pm

  32. Hi, I’m considering the Active FX laser treatment primarily for wrinkles and I’m just wondering about the risks involved. Is there any chance of permanent scarring. I’m scared to death I’m going to wind up looking like a burn victim! Thanks for your help.

    Thanks for your post.  There is always a risk of scarring with ANY facial procedure.  Some procedures just have lower risks than others.  Variables include the energy used, type of device, and the patient’s skin types….you should discuss this carefully with your physician.

    (NOTE:  We cannot give medical advice on this forum)

    Comment by Shelly — October 8, 2007 @ 4:03 am

  33. would fraxel be helpful for rosacea and overlapping melasma? i have large pores and sensitive skin, have had a severe reaction to hydroquinone. have tried photofacial and microdermabrasion with no luck. i understand this i just general advice, and i would have to consult w/my physician. thanks.


    Thanks for understanding we cannot give medical advice.  It may help for pigmentation abnormalities like the ones you mention.

    Comment by donna g. — October 10, 2007 @ 2:10 pm

  34. I would like to mention that I have used botox for the chin wrinkle/distortions with what I consider dramatic results. Misshapen orange peel look disappeared!

    REPLY:  Yes, Botox can be effective in this area.  It should be applied by someone who is experienced in Botox to the chin.

    Comment by kimmie — October 13, 2007 @ 9:58 am

  35. I developed a large keloid behind one of my ears after receiving a face lift 5 years ago. It was excised by my plastic surgeon, only to form again. I am now thinking of receiving ActiveFx as a means of tightening my facial skin, which has lost a great deal of elasticity, since the face lift. I am willing to try ActiveFX to avoid another surgery. Should I be worried about keloid formation on the face with this procedure. Is hyperpigmentation a concern? Other than laxity, I I have beautiful skin, so ruining something good would be a real shame.

    Comment:  We cannot give medical advice on this forum.  The risks with ActiveFX are much lower than standard CO2, but not zero.  Best to consult with your physician or, if you live in the San Francisco Bay Area, visit Dr. Most for his opinion.

    Comment by Julia — October 13, 2007 @ 6:46 pm

  36. i am looking for wrinkle reduction in the eyes and skin tightening.
    which would be most effective the Active FX or the standard Co2 laser. i was told that the active fx was better by the dr.s nurse but i have my doubts. that any thing could achieve better results over the Co2. could you share your opinion


    Standard CO2 is the most effective and is the treatment by which other lasers are judged.  However, it does have it’s downsides and is not right for all patients….consult your doctor.  If you live in the San Francisco/San Jose Bay Area, you can come to visit Dr. Most for his opinion.

    Comment by laura — October 15, 2007 @ 7:56 pm

  37. what is the cost of or range for 1 treatment of fraxel lazer treatment for the entire face?


    This can vary greatly….we suggest you visit more than one doctor in your area for the price range.

    Comment by maxi — October 18, 2007 @ 3:33 am

  38. I have acne scars since late teens and it has been bothering me for more than 20 years.
    I have tried photo laser(IPL),chemical peel,micro dermabration and so on but there was no improvemnet.

    I found Fraxel and it may be good but before I spend money,I ‘d like to know if it improves my acne scar.

    Thanks for your question.  We cannot give medical advice over the internet.  We recommend you see a good facial plastic surgeon or dermatologist for an assessment.

    Comment by k. — October 30, 2007 @ 12:40 pm

  39. Hi,A quick question. If you had to choose the SAFEST procedure to reduce the appearance of depressed acne scarring all over the face (esp. cheeks and area beside the eyes leading to forehead), in someone with browner/tan complextion, would say the Fraxel/Pixel would be the best bet? I am looking for a safer treatment for my skin-type (a mix of East Indian and European). I am not worried about how long it will take or how many treatments are needed to see change.
    I understand that you cannot give specific medical advice, just asking for your informed opinion. Many promoters of fraxel state that it is safe, etc.

    The fractionated lasers have much lower risk of pigmentation issues post-procedure than do the standard lasers.  Of course, risks are never zero and also depend on the energy used with each session, etc.

    Comment by ConcernedPerson — November 4, 2007 @ 9:38 pm

  40. I would like your opinion on the fraxel and pixel 2940. I am having difficulty finding alot of information on the pixel. If a person had sensitive skin, was looking to improve some fine lines in the face/eyes/possible neck and looking to correct/improve just a few acne scars, and looking to tighten up the skin a little, what would be the best of the above mentioned lasers to use? I realize that you cannot give medical advice; however, just looking for an educated, honest opinion if the above symptoms were there. Also, what is the difference in downtime and side effects of those lasers?
    Thank you.


    You are correct in that we cannot give medical advice.  Note that what we’d recommend would depend on your skin tone, etc.  Generally speaking, CO2 laser is still the gold standard, but not for all skin types.  A new fractionated CO2 laser (Active FX) may be useful for you; have you investigated that?

    Comment by Tina — November 11, 2007 @ 1:19 pm

  41. I understand that there is an art to all medicine. How then do the laity make informed decisions about these elective procedures? I have been coping with melasma for 10 years - it’s not a matter of physical health - but it makes me sad. I have seen two plastic surgeons over the years - one said to use a bleaching cream (didn’t work), the other suggested a facial peal and retinol cream. I know there are lasers and peals and dermabrasion and creams etc… What are the best questions to ask to insure that I’m selecting the best treatment and the best physician? I know that everything has risks and there are no guarantees - but I need to spend my money wisely and I don’t want to aggravate the problem. Both practitioners I saw were great “salesmen” - how do I choose amongst the “offers?”

    We understand your frustration.  Melasma is a difficult problem.  Without seeing you in consultation, it is impossible to give you medical advice.  However, you are doing the right thing by investigating with multiple physicians to learn about possibilities. Perhaps asking for actual results from that physician (not given to the physician by a company who makes a particular product or laser) would be useful.  Look for examples of patients of similar age and skin tone.  Good luck to you in your search.

    Comment by Katherine — November 12, 2007 @ 8:13 pm

  42. I am asian and was recommended fraxel by two different dermatologists. Unfortunately, the treatments have left me with a tan, darker shade. Is this permanent? Can it be treated? My dermatologist has prescribed a kojic acid and hydroquinone bleaching cream and also a peel. But I am really concerned about whether this poses more riskes. How can I find someone who specializes in Indian skin? I am devastated by this.

    I am sorry you have experienced this.  I would do as you are doing; perhaps someone who reads this blog will post an answer to your question about a doctor who specializes in Indian skin….I do not know of any with that particular specialization, but I do know several very good dermatologists in the San Francisco and Seattle areas.

    Comment by Mariam — December 24, 2007 @ 7:40 pm

  43. which procedure, historiclly, has better results with ice-pick acne scarring? fraxel or punch excision? thank-you.

    My experience has been that typically, ice-pick type scars require excision, which can be followed by dermabrasion or laser treatment. This is a difficult problem without a perfect solution.

    Comment by christine — January 10, 2008 @ 5:10 pm

  44. Is the Pixel laser good for wrinkles on the hands? What laser is the most effective?

    Thanks for the question. Dr. Most limits his practice to the face and neck…you may want to check with a dermatologist. We hear that Pixel does work well on the hands, but we do not perform that procedure.

    Comment by Maria — January 11, 2008 @ 7:15 pm

  45. hi whats the best treatment for shallow pic scars, think thats what they are, 0.5mm*0.5mm
    very shallow, people dont notice them, i notice them when i look in the mirror in the light. several of them that make the skin look rough. They dont show up in normal photos, you would have to look right close into the skin to see them.
    can 70% gyolic peels help over 8 treatments or better of with lasers?
    also have 3 shallow rolling scars on the other cheek which are visable after a shave. over an area of a 20p coin. people e will notice them as soon as i point them out. been told there very minor though.
    current condition of skin acne free for 2 years, have 2-3 spots that come up, had moderate acne for several years during university.
    What can help me, its driving me mad. also still have faint pigment marks, its been over 2 years. why are they not going?

    This type of question is fairly common, but impossible to answer unless examined in person. Some peels may work for you…consult with a local facial plastic surgeon or dermatologist for a definitive answer.
    Thanks for your post.

    Comment by R.C. — January 13, 2008 @ 5:15 am

  46. Please could i know how many years do the the fraxel last..and what the percentage of improving???
    thanking you in advance

    Thanks for your question. Pixel and Fraxel will give different amounts of improvement depending on the patient, the power settings, and how many treatments you receive. The longevity will depend on how you take care of your skin and the amount of damage already there….

    Comment by n. — January 29, 2008 @ 1:11 am

  47. I would like to know the main differences between the Active FX C02 and the Erbium lasers. I have had 5 Fraxel Lasers done on my face (last year) and would like to know this information for a future treatment.
    Thank you.

    Erbium and CO2 are lasers that work at different wavelengths; they are fairly similar in characteristics in terms of skin treatment, in that both are ‘ablative’. Fraxel and Pixel are fractionated erbium lasers, ActiveFX is a fractionated CO2 laser.

    Comment by Armida — February 10, 2008 @ 1:58 am

  48. Hi Dr.,
    I’m just recently had my second fraxel to help with a scar on my nose. I was gone over a few extra times on a high setting and a few days after it was very red and formed red lines and dots that were gone after a day or tw. the redness is still here, but not as bright and it appears as if the treatment damaged my skin, if not cause a few new scars. is this possible? my doctor claims that fraxel can’t and doesn’t do this, but I see a difference. If there is a lighter spot that formed what is the likelyhood that it will become my normal shade again? The texture is also worse, not smotth like it says it should be. any thing you can tell me would be very appreciated

    I think that only time (6-12 months) will determine if any true new scarring occurred…your physician may have photos that you can examine to determine if any changes occurred. No treatment is completely free of issues like scarring–but scars are generally less likely with Fraxel, Pixel, and other new lasers.

    Comment by karen — February 19, 2008 @ 2:27 pm

  49. after have may laser treatments to help smooth out a scar my skin texture is different. It’s almost as if it’s been thinned out. it has fine lines and is creepy. when i smile it looks stretched and creasey. my doctor says that lasers can’t do this that they thicken the skin. Is this true and if so, then why does my skin look and react this way?

    Thanks for the post. Generally, lasers do thicken the skin. It would be hard to determine what happened to you without having examined you before and after the treatments. It would also depend on the type of laser, the power setting and number of passes on the skin.

    Comment by m. — February 20, 2008 @ 1:18 pm

  50. I have a perhaps common situation, however, it is either that I am searching using the wrong words or there is simply not enough association to facial contouring without injectables… I am a 26 year old female, I have sagging skin on my upper cheek and ranging alittle into the lover eye area. It adds ten years to my age (I don’t mind looking 36 when I’m 36) on my right eye it is due mostly to blunt force trauma (sustained an blow from an abusive x-boyfriend. I’ve consulted with derms and aesthetic surg that have only given me implants and injectables as options. I was wondering if there is any laser (Fraxel;Paxel;Pixel;Photofacial) or otherwise that would help. I am looking for a non-invasive procedure and I not wish to spend 10K. I would do the whole face because my face is starting to look shallow.

    Any suggestions. Even if sugessting searching under a particular word. I would appreciate any help.

    Thanks for the comment. Your situation is somewhat complicated and there are several possible solutions. These would vary from a reparative mid-face lift (often done after trauma) or injections with fat or synthetic materials. You would need to be examined by an experienced facial plastic surgeon to determine which is right for you.

    Comment by Michelle — February 22, 2008 @ 11:41 am

  51. What method is more effective in reducing the fine lines around the mouth and lips, Dermabrasion or Fraxel Laser? Thanks in advance for your opinion.


    Hard to say without examining you in person. Generally speaking, dermabrasion (not microdermabrasion) is more effective, but has higher risks.

    Comment by Judy M — February 24, 2008 @ 8:51 pm

  52. With all the news out there does anyone have any experience between the Lumenis active fx and the new Fraxel re:pair CO2 laser vis-a-vie deep wrinkles, minor discolorations and small veins on the lighter skinned community–and which laser carries the least amount of downtime and which laser carries the least amount of long-term adverse side effects?

    Thanks for the post. I am not aware of any studies comparing them (yet)….

    Comment by chris — February 26, 2008 @ 12:03 pm

  53. I understand that the new fractional CO2 lasers result in less downtime and this fractional option was recommended to me for this reason (although it was mentioned that two sessions might be necessary so that really means double downtime, just spread over two period of time). I am 40 and have very fair skin with sun damage and also worry about malignant melanoma due to a family history.

    If downtime wasn’t a concern and if I really didn’t want to go through this procedure again, would it make sense to consider the older standard CO2 laser?

    The CO2 is the most effective, but it causes lightening of the skin and is associated with more downtime than other lasers. It is meant for fair-skinned patients…if you fit this profile, it may be right for you…..best to be examined by an experienced doctor to help you decide.

    Comment by Susanne — March 4, 2008 @ 12:35 pm

  54. Hello, Dr. Most:
    A plastic surgeon here in Colorado who used to do a lot of CO2 laser resurfacing now swears by Elos Refirme for fine lines and tightening. Have you heard anything good/bad about the Elos system?

    Thanks much.

    Thanks for the post. I do not have experience with this system…nor have I heard much yet…let me know what you think if you have it done….

    Comment by Ellen — March 5, 2008 @ 8:39 am

  55. I cannot find any information about how long the active fx results lasts. Everything says years? 2 years, 5 years?

    It is not really possible to give a number here, for several reasons. First, the effects are variable. Second, we have not way to really study side-by-side the effects of the laser over time, unless we did half of a series of patients’ faces and followed them. I don’t think too many people would sign up for that study! However, I would surmise that the effects are long-lasting, insofar as they do not ‘reverse’ over time. Rather, the aging process continues (at different rates in different people), and at some point you may ‘catch up’ to where you were when you started…..Hope that makes sense.

    Comment by dee dee — March 11, 2008 @ 8:42 am

  56. Understanding that you can not give medical advise over the internet… Do you happen to have any knowledge
    about new MIXTO SX lasers’ effectiveness in diminishing crepey skin undereyes, sleep-lines on the side of eyes My primary concern is the undereye crepeyness, but as you know this skin is so thin, is scarring and discoloration here a common side effect? About my skin: My skin tone is light and even. I have blonde hair. Thank you!

    I do not have an opinion on that one yet….I’ll let you know when I do.

    Comment by mb — March 26, 2008 @ 10:28 am

  57. I have a lot of sun damage—red spider veins and blotches from tanning in my younger days, especially on my upper cheeks and around the nose. I spent $2000 for 4 laser treatments. They wouldn’t tell me what kind of laser it was, but it was one spot at a time, and very painful. It didn’t eliminate most of the damage. I’m 48, with fair young-looking skin, and wrinkles are not a problem, but I was wondering what kind of laser would be most effective in removing sun damage?

    Thank you for your post. There are a number of options, including lasers and intense pulsed-light (IPL) treatments. Only a personal examination could determine what is right for you. Some topical treatments may help as well (such as retin-A or similar derivatives).

    Comment by Valerie — April 21, 2008 @ 7:32 am

  58. I had BBL laser treatment on my back for acne scaring which left hyperpigmentation marks exactly where the laser hit. What treatment can I do to get it back to normal as soon as possible.

    Thanks for your post. The answer depends on many things:
    1-Your skin type
    2-How much sun you had prior to and after treatment
    3-What type of laser used
    4-The amount of time that has passed since the treatment.
    Hopefully, the color difference will fade over time. The doctor who treated you should be able to discuss with you.

    Comment by Sharron — April 23, 2008 @ 9:13 pm

  59. Hello, I’ve received CO2 full face surgery approximately 18 months ago. The plastic surgeon wasn’t fully open to explaining the greater chances of hypopigmentating post surgery. I’m no left with a definitive demarcation line along my jaw line. I’m currently undergoing Faxel treatments at another clinic to hopefully defuse this and better blend to the neck area. Question, is there anyhting else out there that would be more beneficial?

    Dr. Most Reply:
    Thanks for your post. I think fractionated erbium (such as Pixel or Fraxel) may work (as you are doing), but there are no guarantees.

    Comment by George S. — May 24, 2008 @ 2:39 pm

  60. Hello, I’m a black man with hyperpigmentation from acne scarring on my left cheek and two small spots on my forehead. From your experience what would be the best procedure (hopefully you have had some patients with black skin)..If not, I live in Seattle can you refer me to someone here. Thank you…Fred

    Recommendation given in private email to Fred.

    Comment by Frederick — June 19, 2008 @ 5:34 am

  61. How are you reachable in San Francisco?
    Please send to my email addresss so Ican come for a consult.

    Our phone number is (650) 736 3223 (FACE)
    Our website is http://www.drmost.com or http://www.sfrhinoplasty.com
    Our email is info@drmost.com

    Comment by Kellee — June 23, 2008 @ 9:08 am

  62. Hi I am an African American female seeking to address hiper pigmentation on my face.
    I have been to several dermatologist who have given me topical treatment that have made a slight effect in the
    appearance of dark spots on my face from acne scars. One mentioned laser surgery, but was unsure of how it would perform on my complexion, (I am light brown). he stated that there has not been enough studies as of yet. Well I am curious to know if there is any hope for me. I would like to know what types of laser surgery should I investigate. I do not desire to be ignorant before seeking to schedule a consultation with some one. Nor do I want to worsen the condition of my skin.

    Thanks for the post, Shalonda. This is a common inquiry (see other posts). It is really not possible to determine what is right for you without a personal exam.

    Comment by Shalonda — June 25, 2008 @ 8:36 pm

  63. Hi, I am a 43 woman who spent an awfully lot of time on sun beds in my 20’s (blissfully unaware of the effects). As a result I have many, many, may ugly sun spots on my hands and forearms, which I desperately want to removed/reduced in appearance. I recently became aware of Fraxel and plan to investigate this procedure further, and I want to ensure I ask the ‘right’ questions at consultations to help me make an informed decision. Apart from ensuring that procedure is carried out by legitimate/authorised party, what are the key questions that should ask e.g. type of laser, risks,. Thanks

    Thanks for the post. You should ask:
    1-The Dr’s experience treating the area you are interested in having treated.
    2-What the are the risks?
    3-What benefit might you achieve (realizing there are no guarantees)

    Comment by Freda — July 21, 2008 @ 8:42 am

  64. I appreciate the work you’ve done on this. Very good job.

    Comment by Anonymous — August 13, 2008 @ 5:09 am

  65. endovenous laser treatment…

    Well what an interesting & helpful site…

    Trackback by endovenous laser treatment — October 30, 2009 @ 6:12 am

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