Fractional laser resurfacing At A Glance
- Best Results1-3+ treatments
- Treatment Recovery1- 5+ days
- Procedure Time10 -40 min
- Skin SpecialistDermal therapists / nurses
- Duration of ResultsVariable to 5 years
- AnaestheticNumbing, gas
- Back to Work1-6 days
Clinic Cutis has over a dozen fractional lasers & devices, ranging from gentle treatments such as Clear & Brilliant, Fraxel, Pico Fractional, through to powerful devices such as the Ultrapulse CO2 laser & Sciton Erbium laser. We often combine several lasers in the one treatment to provide better results, whilst reducing the number of sessions.
FactsFacts on fractional laser resurfacing
- Fractional lasers can improve pigmentation, wrinkles, scars & textural skin issues
- The ideal laser depends on your skin type, downtime, concerns & expectations
- Gentle fractional lasers include pico lasers, ideal for darker skin types
- Next levels up include Clear & Brilliant, Fraxel & LaseMD
- Erbium & CO2 lasers are used for heavy pigmentation, sun damage & deep wrinkles
- In most cases I combine two to three lasers in the same session
- The majority of skin rejuvenation patients require only one session
- Lasers can be combined with injectables to give the best possible results
What is fractional laser resurfacing?
Fractional, as the name suggests, treats ‘fractions’ of skin, measured as a percentage of the surface area. For example, 5% density means only 5% of the entire surface area is treated. Typical densities range from 5% to 70+%. The higher the density, the more involved the treatment. As a guide-
Low densities ranging from 5% to 15% are used to treat melasma, deep keloid scars, burns, & most conditions in darker/ethnic skin.
Medium densities ranging from 15-50% are used to treat sun damage, fine lines, wrinkles & acne scars.
Heavy densities ranging from 50-80% are employed to treat wide spread pigmentation, sun spots & marked skin laxity/wrinkles.
Why are we different compared to others?
We have developed a treatment called Hybrid laser resurfacing, namely combining two laser wavelengths in the one session. This means most patients require only one session of laser to achieve the desired results.
Hybrid resurfacing saves money, as well as procedure & recovery time. The combination of lasers depends on your concerns, skin type & downtime.
What conditions can fractional lasers treat?
The most important concept to grasp is that laser resurfacing is not the answer to skin rejuvenation. Balanced rejuvenation addresses skin texture, tone & volume. Lasers address skin texture, thus improving skin quality.
As a guide, fractional lasers can treat the following skin conditions-
Pigmentation: this includes freckles, lentigos (age spots), sunspots, deep melasma
Lines & wrinkles: from mild to very deep wrinkles.
Dull skin: lasers resurface the skin, improving optical properties & radiance.
Enlarged pores: fractional thulium lasers are best for light skin types, fractional pico lasers for darker skin.
Acne, surgical & traumatic scars: we use over 8 types of fractional lasers to address scars including Ultrapulse CO2, Mixto, eCO2, CORE, Fraxel, ProFractional, Juliette Erbium fractional & many more.
Laxity: Lasers can provide skin tightening via collagen contraction. Hybrid resurfacing including Fraxel HD/ LaseMD/ CO2 can make a huge impact on the quality of collagen.
How many sessions will I require?
1-3 sessions. It really depends on the job & your downtime.
For sun damage & wrinkles, most patients only require one session of resurfacing using both Fraxel/LaseMD & CO2 fractional lasers.
Acne scars required 2-4 sessions, spaced 4-8 weeks apart.
View our Treatment Gallery
What is the best fractional laser for rejuvenation?
Matching a laser to your expectations will give the best results. The ideal laser depends on your skin type (colour), your clinical findings & your downtime.
As a guide-
Level 1 / 2 concerns include mild sun damage, pigmentation, fine lines/wrinkles, mild scars & enlarged pores.
Lasers include: Clear & Brilliant, Fraxel, LaseMD, Fractional Pico, CORE CO2, HALO, IPL, Tixel (non laser).
Level 2 / 3 concerns include precancerous sun spots, deeper lines, heavy pigmentation, scars & textural changes.
Lasers include: Fraxel Dual, CO2 fractional CORE, Mixto, eCO2, erbium ProFractional, combination BBL/lasers.
Level 4 / 5 concerns include heavy sun damage, deep wrinkles, age spots & warts, deep scars.
Lasers include: Hybrid CO2 & erbium fully ablative / fractional laser resurfacing.
What is the best fractional laser for acne scars?
If I had to pick only ONE device, it would be a CO2 fractional laser. It is important to understand that not all scars require a laser (see the section on acne scarring to understand). When we use a fraction laser for acne scar treatments, we use one of the following devices;
Ultrapulse CO2: reserved for super deep & complex acne scars including keloid scarring.
eCO2 Fractional: best for most scar types in all skin types. Probably the best CO2 laser for scar work.
Mixto CO2: Good for scars in darker skin types, this laser is used a lot in Asia. I have replaced it with eCO2.
CORE CO2: OK for most scar types (superficial), I still use it for very mild scarring. This laser is good for darker skin types.
Erbium Profractional laser: This is much more powerful than the HALO laser by Scition (same company). Still a good fractional laser for darker skin types. Just for reference, this laser is 15 times more powerful than HALO (1500 microns erbium compared to 100 microns on the HALO).
YouLaser MT: Good laser for lighter skin types. I used from 2016-2018, I prefer the eCO2 for acne scars.
Fraxel Repair: I stopped using this CO2 laser 2 years ago. It is good for mild resurfacing, other CO2 lasers are better.
Fraxel Dual 1550; we have two of these devices. I do think the 1927 handpiece is great for improving skin quality, the 1550 (scar wavelength) is not great for acne scars. We hardly use it. CO2 is better & more cost effective.
Fractional Pico: best for darker skin patients, post inflammatory hyperpigmentation. Pico does not work well for atrophic scars (this includes Picoway, Picosure) .
Tixel: is not a laser. It is good for atrophic (mild) and early scars in all skin types.
eMatrix: I still have the device but it has been replaced by Tixel (more effective, more cost effective, lower downtime). This is not a laser, but a nano RF device.
What is the best fractional laser for melasma?
I do not like fractional lasers for melasma. There are many better, safer & more cost-effective solutions including Spectra lasers, Pico lasers & novel peels.
I use fractional lasers such as Fraxel 1927, Clear & Brilliant & LaseMD for cases of resistant melasma/ dermal melasma & or to aid tranexamic acid penetration into the dermal layers of melasma. See the section on melasma for more.
Can fractional lasers be combined with other treatments?
Yes. Remember that lasers address skin texture or skin quality, however you may benefit from improving skin tone & volume. In some cases, I combine fractional laser resurfacing with treatments that provide deep collagen remodelling & contraction. These
- RFM or radiofrequency microneedling. Using Genius /Infini RF.
- Tempsure or Pelleve skin tightening with RF
- HIFU with Ultherapy
- Deep focal RF using FaceTite RF, often combined with liposuction.
- Thread lifting with monofilament PDO Mint threads.
How long does it take to recover from fractional laser resurfacing?
Recovery following laser resurfacing depends on the settings. We will give you an accurate idea of healing times, depending on your procedure.
- Level 1 Resurfacing – light. Less than 24 hours – 36 hours
- Level 2 Resurfacing – light to medium 2-3.5+ days
- Level 3 Resurfacing -medium 3-5+ days
- Level 4 Resurfacing – heavy 4-6+ days
- Level 5 Resurfacing – very deep & heavy 6.5 – 12 days
*Healing time is defined as when your skin’s barrier function is completed. In some cases you may be red for a few days to weeks. We will give you an accurate indication of how long it will take for your skin to completely heal up.
What are other less invasive treatments?
If you are apprehensive about even the lightest forms of fractional laser resurfacing, consider other options as listed below.
Tixel: is a fractional device that uses thermomechanical & not light based energy. This procedure can reduce fine lines, wrinkles, as well as textural changes including mild scarring. Downtime ranges from 0-2 days.
Microneedling: can improve skin texture, reduce pores & mild acne scars. We use Dermapen, SkinPen as well as rollers & stampers.
Laser Genesis: Is a very gentle treatment designed to stimulate collagen & reduce redness. It uses a special wavelength of light that penetrates into the dermal layer of skin. Treatment takes 10 minutes, with no downtime.
Pico Genesis: is best for darker skin types. Downtime ranges from 0 to 3 days. Pico lasers can be used in normal mode (faster recovery) compared to fractional high powered mode (2+ days to recover).
Chemical Peels: are great to maintain skin health. We use AHA, BHA, Dermamelan, Cosmelan, TCA, Jessner & retinoic acid peels. A peel program can be tailored for your skin concerns.
LED light therapy: Include blue, red & orange light. Light emitting diode (LED) is also known as low level laser emission devices. These can speed up wound healing, as well as provide rejuvenation by stimulation of collagen, elastin, hyaluronic acid and cellular function. LED therapy has zero downtime.
HIFU, RF: these devices treat the deeper layers of skin, namely the dermis & fat layers. This tightens & rejuvenates skin, improving skin tone. Recovery is typically immediate, with no downtime.
Injectables: include dermal fillers (collagen stimulating as well as hyaluronic acid), muscle relaxants, & fat dissolving injections. These can be incorporated with threads, low level lasers, RF, HIFU, & chemical peels.
How much does fractions laser resurfacing cost?
As a guide-
- Level 1 Resurfacing – $420 to $590 eg. Clear & Brilliant
- Level 2 Resurfacing $990 eg. Fraxel
- Level 3 Resurfacing $1,290 eg. Fraxel High Density
- Level 4 Resurfacing $1,990 eg. Fraxel + CO2 Fractional
- Level 5 Resurfacing $3,990 – $6990 eg. CO2 +/- Erbium fully ablative laser resurfacing
Davin Lim does level 4+ resurfacing. Milder forms of fractional laser resurfacing are conducted by nurses @cliniccutis
* Some cases of fully ablative laser resurfacing are partially covered by Medicare. Examples include scar revision (acne, traumatic or surgical scars).
What are the potential side effects of laser resurfacing?
Side effects are very rare following fractional laser resurfacing. This is because only a ‘fraction’ or percentage of skin is treated. This allows for much faster healing times compared to fully ablative CO2 or erbium lasers. Possible side effects include-
Infection: rare. For bigger jobs we cover all patients with anti-inflammatory antibiotics. All patients with a cold sore history are required to take antivirals.
Hyperpigmentation (darker skin): PIH or darker skin can occur in some patients, mainly ethnic skin types (or if you have sun exposure). This is rare following fractional laser resurfacing, but maybe seen with fully ablative lasers in darker skin types.
Persistent redness: common 10%, this may last 1-4 weeks depending on the settings of the laser. Easily treated with vascular healing lasers or LED light therapy.
Scarring: extremely rare, less than 0.3%
Can fractional lasers be used on areas that have fillers?
Yes, fractional lasers are safe. This is because dermal fillers are usually placed deep under the skin’s surface. Additionally, fillers are heat stable. *
I often perform dermal fillers on the same day as fractional laser resurfacing** (in the context of conservative fractional delivery).
References: *Lim DS, Shao E, Derm. Surg 2018, **Geronimus R, 2020
What is a HALO fractional laser & is it any good?
HALO laser resurfacing is one of the first hybrid lasers to offer a low downtime, low level gentle treatment.
In my practice, I believe there are many better laser combinations compared to HALO resurfacing. In fact I do use one of the wavelengths (erbium fractional) of HALO. The problem with HALO is that the depth of penetration is over 15 times less than the fractional laser wavelength of the ProFractional (made by the same company as HALO).
I do believe that thulium combined with sensible low density CO2 gives far better results, with similar downtime compared to erbium paired with a non-ablative wavelength. Nevertheless HALO is a good laser for beginners as hybrid lasers are integrated within the software to allow for sequential delivery of wavelengths.
What is Fraxel laser?
Fraxel is almost a household name in the aesthetic world. This laser was first introduced in 2006, with an updated version in 2010. Since then it has not had any major updates. Regardless it is a good laser (especially the 1927 wavelength), & Clinic Cutis has 2 Fraxel Duals.
Fraxel can be used in many ways including multiple treatment sessions, a high density session or one part of hybrid laser resurfacing (the other part is CO2). This fractional laser is best for lighter skin types (1-3), darker skin types do better with pico laser resurfacing.
How would I know if laser resurfacing is the correct treatment for me?
It can be very confusing trying to understand what is the best treatment for your skin concerns. In most cases a simple solution is the answer. In other cases laser may not be the best option.
For an obligation FREE assessment & consultation, book an appointment with my clinical team @cliniccutis. Level 1 to 3+/4 procedures are conducted by my nurses.
Alternative book an appointment with myself (consultation fee applies). Just a heads up- my work focuses on deep resurfacing, surgical procedures, deep peels, & complex cases of scarring (acne, trauma, surgical, burns). I only perform level 4 to 5 laser resurfacing.
Davin’s viewpoint on fractional laser resurfacing
Fractional lasers are most customizable treatments in dermatology. There is a specific laser wavelength for every condition & skin colour. Within the same wavelength, there are many different ways to deliver the energy. Variables such as spot size, pulse width, pulse distance, pulse duration, power & technique can deliver vast outcomes.
The two most common fractional lasers used by myself & my nursing team are the 1927 thulium lasers (Fraxel, LaseMD) & CO2 lasers. These lasers can address skin concerns ranging from pigmentation, sun damage, wrinkles, scars, enlarged pores, through to burns & even stretch marks.
In the context of fractional CO2 lasers, there are many different types. They each have their own function. For example, I use the CORE CO2 for very fine work, whilst if I require power, the Ultrapulse is my preferred laser. For ethnic skin, I may choose the Mixto CO2 or better still the eCO2.
We use many other wavelengths of fractional lasers including erbium fractional, as well as erbium glass 1550, non-ablative 1440, & pico fractional at 532,1064 & 755. In some cases we combine different wavelengths in the same treatment. This is called hybrid fractional resurfacing. The ideal laser is dependent on your skin concerns, skin colour & downtime. For skin rejuvenation in lighter skin types, the most common combination is with 1927 & CO2 fractional. For rejuvenation in darker skin types, the go to is the pico laser.
At the end of the day, lasers are merely tools of the trade. They can be likened to a power tool for a carpenter. It is important to start with good equipment, however it is how we employ these instruments that gives the finished product/result.
Join the conversation
Join Dr Davin Lim on Instagram to stay up to date