This Article Has Been Medically Approved By

Dr. George H. Sanders

What is a “fractional laser”? On the surface of things it sounds like something that doesn’t do the whole job, just a “fraction” of it. You want it all done right, so why should you think about only a part of it?

The reality is that many times a part is better than a whole. Skin resurfacing lasers have been around for over 40 years. They remove the outer layer of the skin, resulting in an immediate smoothing out of the skin, much as a piece of sandpaper evens out a rough piece of wood. The original lasers gave you the “whole” result. It was like you were “painting” the skin surface with a laser paintbrush, covering every square millimeter. Healing took about 9 days and there was redness that would take several months to resolve. The results were often very impressive.

About 10 years ago “fractional lasers appeared. The first was the Fraxel Laser. It was an Erbium laser and was followed shortly by a CO2 Fraxel laser. A fractional laser does not paint the entire skin surface – it treats only a “fraction” – usually 20% to 30% of the skin surface at one treatment session.

It’s like splattering a small amount of paint on a surface as you shake your paintbrush at the surface – it paints only a fraction of the surface.

The process is repeated every 2 weeks, so that after 4 or 5 treatments, you have treated the entire surface. The advantages to a fractional laser are that it only requires local anesthetic cream and the patient has no crusting, oozing, or dressings afterwards. You look as though you have a mild sunburn for a few days and there is some flaking of the skin the following week. The areas that are treated are treated quite deeply, but heal rapidly because non-treated points surround them.

So which is best? The answer: It depends!

• If you have 8 days to heal, go with a traditional Erbium laser. You’ll probably get a better result with it, particularly in difficult-to-treat regions like the lips. Keep in mind, though, that you’ll also need to deal with the pinkness of the skin that may last for several months afterwards, but that can be covered with makeup.

• If you don’t want to come back 4 or 5 times for treatments, go with a traditional Erbium laser. One treatment and that’s it! If you’re having only a small area(s) treated like the lips and lower eyelids, these can even be treated under local anesthesia.

• If you don’t mind multiple treatments and like the idea of no bandages, no crusting/oozing, and no significant redness afterwards, go for Fraxel treatments. As long as you’re content with a lesser result, you may be very happy. Should you go for an Erbium or a CO2 Fraxel? If you don’t mind a longer recovery with some crusting, the CO2 Fraxel may be the one. I personally prefer the gentler Erbium Fraxel, but the more side effects like crusting that you endure, the better the result, in general.

For an excellent review article on this topic, please go to:

Your thoughts?

George Sanders, M.D.