Everything You Need to Know About Fractional Lasers

Are your skincare products just not cutting it in terms of the complexion goals you hope to achieve? While there are ingredients on the market that are capable of benefitting your skin's appearance, sometimes getting to the root of your complexion concerns comes down to being open to in-office treatments. That’s where fractional lasers come in. To find out what fractional lasers are and how they might just be the answer to your skincare prayers, scroll down.

What Are Fractional Lasers?

According to board-certified cosmetic dermatologist at Union Square Laser Dermatology in Manhattan, Y. Claire Chang, MD, fractional lasers are resurfacing lasers that benefit the skin by creating columns of thermal damage in the skin. By creating columns—as opposed to allover damage—the skin is able to heal itself and regenerate itself, leading to the appearance of a revitalized complexion. “Fractional lasers target both the epidermis [the outermost layer of skin] and dermis [beneath the epidermis] to reduce pigment and stimulate collagen formation, respectively,” she explains. “The columns of injury are interspersed with areas of normal skin, which helps speed up wound healing, decrease side effects, and reduce downtime.”

Fractional lasers fall into two categories: ablative and nonablative. Where they fall depends on whether or not they affect the stratum corneum (the topmost layer of the epidermis). “Ablative fractional lasers create full-thickness injury in the skin, whereas nonablative fractional lasers leave the stratum corneum intact,” Chang shares.

Benefits of Fractional Lasers

• Promote collagen production
• Speed up wound healing
• Minimize the appearance of fine lines and wrinkles
• Blur the appearance of scars
• Lighten dark spots and melasma
• Reduce the appearance of photodamage
• Shrink the appearance of pores

All in all, Chang says that fractional lasers are able to improve the skin’s complexion from all angles, addressing everything from pigmentation and texture to signs of aging.

The number-one benefit of fractional lasers, however, is that they’re a worthy option for all skin types—something that can’t be said about many other treatments. The trick is to go to a board-certified physician for treatment. “Darker skin types are at higher risk for side effects, including hyperpigmentation and scarring,” Chang admits, noting why it’s important to go to a physician trained in lasers to minimize any risks. 

How to Prepare for a Fractional Laser Treatment

To make the most of your fractional laser treatment, it’s important to know how to prepare. Jennifer MacGregor, MD, a board-certified dermatologist at Union Square Laser Dermatology in Manhattan, recommends consulting with your physician prior to booking to ensure that it’s the right treatment for you. She suggests running through the skincare you use and the medications you’re on, as well as the products and supplies you’ll need post-treatment to make sure that you’re as prepared as possible. “Skincare products are not tested on lasered skin,” she says. “[So] it’s essential for the doctor to direct what will be applied to the skin while you are recovering. This maintains safety and has the potential to enhance your results (laser-assisted delivery of topicals to the skin is a whole field).”

After consulting with your physician, you’ll know exactly which products need to be removed from your routine ahead of treatment. As a general rule of thumb, Chang says that patients should discontinue the use of retinoids at least a week before fractional laser treatment. Additionally, she says that some physicians prescribe lightening creams, like hydroquinone, to use prior to treatment to reduce the risk of post-inflammatory hyperpigmentation. “For ablative fractional laser treatments, like CO₂ laser, your physician may have you take antivirals and antibiotics to prevent against viral and bacterial infections,” she adds. 

What to Expect During a Fractional Laser Treatment

To kick things off, Chang says that, regardless of the type of fractional laser used, an anesthetic cream is typically applied to the treatment area 45 minutes to an hour before treatment. 

While the discomfort during treatment depends on the type of fractional laser being used, board-certified dermatologist Joel L. Cohen, MD, of AboutSkin Dermatology, says that nonablative fractional lasers typically have mild two to three out of 10 discomfort and heat levels, while ablative fractional lasers are known to be more uncomfortable. “Patients feel the vibration and heat of the treatment—plus smell the laser-tissue interaction (though an air evacuator is used to vacuum some of the smoke plume),” he explains of ablative lasers. 

Due to the higher levels of discomfort associated with ablative lasers, Chang says that physicians often use local injections on top of the topical cream to ensure that it’s as painless as possible. “A cold air may also be applied during treatment to help with pain,” she adds. Still, it’s important to understand that unpleasant sensations can be part of the process.

That said, Chang says the treatment itself is rather quick, ranging anywhere from a few minutes to 30 minutes depending on the size of the treatment area.

Fractional Lasers vs. Other Facial Lasers

There are so many different cosmetic lasers on the market, which makes them feel difficult to differentiate. According to Cohen, however, it’s quite simple. “Fractional lasers target facial wrinkles and textural irregularities, where there are other lasers that specifically target blood vessels and rosacea (like Sciton ProV),” he explains.

All in all, cosmetic dermatologist, chief medical officer, and founder of PFRANKMD, Paul Jarrod Frank, MD, says that fractional lasers stand apart thanks to the manner in which they deliver energy to create maximum results with minimal downtime. “The device offers a lot of versatility and is very customizable with the ability to go through every layer of skin,” he explains. “The advantage of Fraxel (fractional lasers) over other laser skin procedures/treatments is that you are not breaking the skin—the healing is rather open.”

Potential Side Effects

To kick things off, let’s be clear: Even with potential side effects, fractional lasers are much less risky than other lasers thanks to their ability to target sections of skin rather than the entire surface of a treatment area. That said, Chang admits that, even still, fractional lasers may cause treatment-related pain, redness, swelling, peeling or flaking, crusting, and hyperpigmentation, even though these side effects are short-lived during the healing process and often dissipate over the days and week following treatment. “Less commonly, treatment may also cause acne-like eruptions, HSV flares, bacterial skin infections, erosions, prolonged redness, and post-inflammatory hyperpigmentation,” she adds.

The Cost

“Treatments can range from $400 to $7,500,” says Frank, who is the author of “The Pro-Aging Playbook,” noting that it depends on the type of fractional treatment, the area being treated, and where the treatment is taking place. Typically, treatments in metropolitan areas cost more than treatments in suburban zones.

Aftercare

Following fractional laser treatment, Cohen says that it’s extremely important that you keep the skin clean during the healing process. “Wash your face with a gentle, non-abrasive cleanser several times a day,” he says. “In addition, after ablative lasers, we have patients spray hypochlorous acid (like Lasercyn) throughout the first couple of days after the procedure.” The antimicrobial spray helps relieve any irritation while preventing infections and further discomfort during the healing process. 

As far as how long aftercare takes, Chang says to expect anywhere from a few hours to several weeks. It all comes down to the specific treatment and how sensitive your skin is. To play it safe, she says to use very gentle skincare, avoiding retinoids, chemical peels, harsh soaps, and any other irritating products while your skin is healing. Additionally, she emphasizes the importance of sun protection during the healing process. Since your skin is already in a sensitive state, it’s important to protect it at all costs. 

The Most Common Type of Fractional Lasers

As you now know, fractional lasers are divided into two main categories: ablative (open) and nonablative (non-open). MacGregor shares that “ablative fractional laser wavelengths vaporize skin either across the surface in higher densities or deeper into the skin at lower densities. Nonablative wavelengths generally heat and remodel the skin, but don’t vaporize the skin.” 

Due to the less-invasive nature of nonablative fractional lasers, Frank says that they’re the most common type on the market. “They're not ablative because patients can use makeup during the recovery,” he says. “There is no open skin. The healing is quick and they're fractional, meaning that the heat and light is delivered in a pixelated fashion.”

With that in mind, the most common nonablative fractional lasers are as follows:

• Clear and Brilliant. “The Clear and Brilliant laser is a low-energy resurfacing laser that can help stimulate collagen to help with fine lines/wrinkles and pores,” Chang says. “The Permea handpiece has a more superficial target, helping to reduce brown spots, improve hyperpigmentation (including melasma, post-acne blemishes), brighten the skin, and even skin tone. Because this laser is low energy, it is relatively well-tolerated with minimal downtime. It is a great introductory laser for laser-naïve patients.”
• Fraxel Dual. “Fraxel Dual has two wavelengths (1550nm and 1927nm), allowing it to target pigment as well as stimulate collagen,” Chang explains. “Fraxel Dual is one of our most popular resurfacing lasers and can be used to treat numerous conditions, including photoaging, brown spots, wrinkles, uneven texture, large pores, scars, stretch marks and skin pre-cancers.”
• Sciton Moxi. This nonablative laser touts itself as the perfect option for those just starting their skincare journey. It can be used on every skin type, all year-round, to deliver clearer, smoother skin. “There is no wound, as the laser isn't vaporizing the tissue,” Cohen says.

Even though ablative fractional lasers are less popular nowadays, there are still common offerings on the market. They are as follows.

• Fraxel Repair. “Fraxel Repair is an ablative fractional laser (fractionated CO2 laser) that can be used for skin rejuvenation and to promote new collagen formation,” Chang says. “It is most useful for improving scarring, deep wrinkles, severe sun damage, and skin laxity. Recovery time is longer than nonablative Fraxel Dual treatments.”
• Sciton ProFractional. This ablative fractional laser creates deep channels in the skin to effectively revitalize its appearance. Despite being ablative, ProFractional uses ultra-narrow channels that are less likely to create negative side effects or call for longer healing times. Instead, people undergoing this treatment can expect healing to take just a few days. 

But that’s not all. Hybrids also exist. “The Sciton Halo laser is a hybrid fractional laser that combines both nonablative laser and ablative laser,” Chang adds.

The Final Takeaway

Fractional lasers offer a method for revitalizing the appearance of skin with little downtime or risk of negative side effects. As a general rule of thumb, nonablative fractional lasers are the safer bet for the vast majority of people thanks to their shallower reach. That said, there are so many different lasers out there that it’s worthwhile to find a dermatologist skilled in multiple kinds. “Many practitioners choose lasers based on their own experience and what lasers are available in their office,” Chang says. “I recommend finding a dermatologist who has access to and experience with multiple lasers in order to really get the best laser treatment for your skin type and condition.”