Fraxel Laser For Melasma

Fractional laser resurfacing is best used for sun damaged pigmentation & age spots. Well known brands include Fraxel, LaseMD Ultra, Fraxel & Moxi. These lasers gently exfoliate the upper layers of skin, in turn reducing pigmentation & dullness. Fractional lasers are inefficient ways of treating melasma pigmentation as new pico lasers offer better results, with less costs & side effects


3-7 days


40+ days

Treatment Time

30 minutes


SPF + pigment correctors

Treatment science score

The Science of Fraxel Laser for Melasma

  • Fraxel is a fractional laser
  • It is best used to treat non-melasma pigmentation such as sun damage & age spots
  • Fractional lasers are third choice laser for melasma as they generate too much heat
  • Heating of the skin can lead to rebound & worsening of pigmentation
  • Picosecond lasers have largely replaced fractional lasers for melasma treatment
  • Pico lasers have no recovery, unlike fractional laser which take up to 7 days

The Fraxel laser markedly improves sun damage, age spots & improves the luminosity of skin, providing a radiant glow. They are best employed in lighter skin types for the treatment of non-melasma pigmentation.

What is Fraxel laser?

Fraxel laser improves skin quality including sun damage, age spots, & non-melasma pigmentation. This gentle laser resurfaces the upper layers of skin to reveal new, rejuvenated & blemish free youthful skin.

Is it any good for melasma?

No, Fraxel is a dismal laser for melasma, but an awesome laser for other forms of pigmentation. The ideal melasma laser targets pigment & produces very little heat. Fraxel targets water & produces too much heat. Pico lasers like Picosure Pro or Picoway are better for melasma pigmentation.

What is it really good for?

Fraxel laser’s optimal application window is for sun damage, age spots, & freckles in lighter skin types. It can treat pigmentation in darker skin patients, however pico lasers are much better at this role.

What results can I expect from the Fraxel laser?

Though marketed as a melasma treatment, this laser produces disappointing results in comparison to new pico lasers. Clear & Brilliant can give moderate results in some patients after a series of 5 sessions, spaced 3-6 weeks apart.

We use Fraxel to treat non-melasma pigmentation. In this context, results are awesome.

How does it work?

Fractional laser can treat melasma via three mechanisms-

  • Exfoliation of the skin: this is the main mode of action as fractional lasers provide a transit of pigment. This improves the appearance of dull skin & melasma.
  • Increased absorption of skin care actives: by breaching the skin’s surface, it allows for more efficient passage of vitamin C, retinol & other pigment correctors.
  • Repair of sun damaged skin: aids in skin rejuvenation with a reduction of sun induced pigment.

How many sessions are required?

Results can be seen after just one session, however in the context of melasma pigmentation, the settings of Fraxel have to be low. On this basis a series of 5 sessions will be required.

*Higher density Fraxel or LaseMD Ultra can be performed on non-melasma pigmentation. 1-3 sessions required for optimal results.

What is the recovery following Fraxel?

Recovery takes 3-8 days, depending on the settings. The time is –

Day 0-1: Redness & swelling
Day 2-4: Flaking & mild crusting
Day 4-7: Healing starts & ends

What is the difference between Clear & Brilliant & Fraxel laser?

Clear & Brilliant is a mini-Fraxel. It is about 20% the power of the big brother. Fraxel laser is used to treat non-melasma pigmentation including sun damage, age spots, freckles & liver spots.

In summary, Fraxel laser:

  • Great for non-melasma skin rejuvenation & pigmentation treatment
  • Recovery of 4-6 days
  • Requires 3-4 sessions for best results

What are other effective lasers for melasma?

In order of merit, more effective lasers include-

  • Picosure Pro: the one we use most often, gives results in over 85% of cases.
  • Picoway: second best
  • CuRas laser: excellent laser for melasma
  • C6, RevLite: time tested lasers but slower results
  • LaseMD Ultra: like a Clear & Brilliant laser, only better
  • Vascular lasers: for redness associated with melasma

What are the side effects of Fraxel?

In the context of melasma there are two big side effects when employing higher power fractional lasers-

  • Melasma rebound after Fraxel. This can be seen in up to 50% or more of cases.
  • Worsening of melasma due to excessive heating. This is why we use picosecond lasers as heat generation is negligible. Post inflammatory hyperpigmentation can be seen in up to 20% of Fraxel cases (for melasma). In contrast the PIH rate following Picosure Pro is less than 4%.

Other rare side effects include infection & prolonged redness.

Can Fraxel be used on all skin types?

Yes, but it is not the best laser for darker skin as the risks of skin darkening is high. Picosecond lasers are infinitely better & safer than fractional lasers when treating skin of color.

What about AHA chemical peels vs Fraxel for melasma?

Prior to the invention of lasers, AHA peels such as glycolic & lactic acids were the standard of treatment, however these peels were hampered with rebound pigmentation & melasma recurrences. Taking this into consideration, conducted with skill & precision, AHA peels are better than Fraxel lasers, however not as effective as Picosure Pro lasers.

*Refers to treatment of melasma only. For other forms of pigmentation, lasers are better than peels.

How does Fraxel laser compare to Cosmelan peels or Dermamelan peels?

Dermamelan or Cosmelan peels are more effective than Fraxel lasers but less effective than picosecond lasers with more side effects & recovery. We do employ these peels for interstate & overseas patients who require only one session.

What about the Fraxel melasma studies? What do they show?

Fraxel got FDA approval for melasma in 2005, nearly 20 years ago. Since then technology has moved on, & hence it’s use for melasma is largely outdated

FDA’s approval of Fraxel for melasma involved a study showing that use of the device resulted in significant improvement of melasma in seven of 10 female patients. In a second 10-patient study, facial areas treated with the device showed statistically significant improvements in the appearance of melasma and quality of skin texture, as compared with use of topical therapy alone. No serious adverse events were observed in any of the studies.

Though these studies were significant in value, it has never been replicated.

What is the difference between Fraxel, Moxi, LaseMD Ultra & Fraxel 1940 laser?

These are great laser systems however the standout lasers are the Fraxel & LaseMD as they are true 20 mj lasers that are thulium not diode driven. The beam profile of these two lasers are better than the competitors.

How then, does Fraxel improve some cases of melasma?

Here is how-

  • Increased absorption of skin care actives / laser assisted drug delivery
  • Epidermal exfoliation
  • The melanin shuttle theory; best for deep dermal melasma.
  • Rejuvenation of sun damaged skin; the best indication for Fraxel laser.
  • Modulation of inflammation & cell function; modulated via non-specific targeting of chromophores, apart from water.

When does the clinic use Fraxel for melasma?

We use Fraxel for select cases of melasma that are resistant to other lasers, or in patients who have a very short remission rate following other lasers or peels.

In this context the settings matter. Your dermatologist will discuss if this is the correct avenue for your type of melasma. Treatments are typically spaced between 4 to 5 weeks apart, with maximal results at 6 months. It is worth noting that not everyone responds to this treatment.

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What about microneedling for melasma?

Just about everything is better than microneedling for melasma. The aim of microneedling is to increase the permeation of skin care actives & pigment correctors. If you stick to 0.1 to 0.2 mm, microneedling can be marginally effective.

If you would like to try microneedling, you can try this at home using a 0.2 mm stamping device.

The Melasma Clinic difference

Our specialist clinic can effectively treat pigmentation in all skin types, employing bespoke treatment protocols that consist of skin care actives, picosecond lasers, clinical peels & in some cases prescriptive medication. With 20 years of dermatology behind us, we can manage all forms of pigmentation, from melasma, through to post inflammatory pigment.

Dr Davin Lim

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If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination…

More of our mostFrequently asked questions

What is the Dual wavelength of Fraxel & what does it do?

How to treat Fraxel induced - flare ups of melasma?

What is Fraxel CO2 & is it any good for melasma?

Will lasers be effective for all cases of melasma?

What types of fractional lasers do we use?

A SummaryMelasma treatments with Fraxel; summary

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

In the context of treating melasma, Fraxel it ranks as a mediocre laser at best, as pico lasers, in particular Picosure Pro, give far better results with no downtime & less costs. Not to mention the added safety of picosecond laser technology. 



Where this laser excels (though less than fractional CO2 lasers) is with laser assisted drug delivery using the 1927 Permea wavelength. SkinCeuticals has demonstrated the finesse of novel delivery of CE Ferulic acid using non-ablative 1927 wavelengths. Sure, topical drug delivery is attractive for a condition like melasma, however the feasibility of long term use (costs to the patient) is the rate limiting factor.

Want to know more about the science of 1927 thulium & diode lasers & how we use them for melasma? Here is the science. The 1927 wavelength of Fraxel penetrates to only 200 to 240 microns, meaning it is superficial. The target is water, but it remodels fibroblasts & other cells via thermal injury but also cytokine or growth factor release. This can-

  • Repair the compromised basement membrane via up regulation of collagen 4. This can reduce dermal drop out of melanocytes & reduce dermal melasma.
  • Modulate blood vessels (non-selective photothermolysis).
  • Repair senescent fibroblasts to up regulate collagen & alter crosstalking via cytokine release
  • Aid in transepidermal exfoliation of superficial pigment
  • Release cytokines high up in the skin (epidermal apoptosis) that alter the signalling of other cells implicated in melasma.

In the clinic we primarily employ Fraxel, LaseMD Ultra & Clear & Brilliant to increase remission rates (percentage as well as time) for melasma in select patents. Treatment progress is slow, but in some patients it can be useful.