Fraxel Laser For Melasma

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

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.