What is Fraxel laser? Fractional photothermolysis for skin rejuvenation

The Fraxel laser is one of the pioneers of fractional photothermolysis, a revolutionary approach to skin resurfacing introduced in the early 2000s. Unlike traditional ablative lasers that treat the entire skin surface, Fraxel creates thousands of microscopic treatment zones (MTZs — Microscopic Treatment Zones) surrounded by healthy, untreated tissue.

This fractional technique strikes a balance between efficacy and safety: it stimulates deep skin remodelling while preserving enough intact tissue to allow rapid healing, typically within 24 hours. The principle is simple yet ingenious — only a “fraction” of the skin is treated during each session, enabling the surrounding healthy areas to accelerate recovery.

Fraxel systems mainly use two wavelengths: 1550 nm (targeting the deeper dermis for collagen remodelling) and 1927 nm (targeting the epidermis to address pigmentation concerns). Some devices combine both wavelengths in a single platform (Fraxel DUAL).

With over 7.7 million treatments performed worldwide and more than 120 published clinical studies, Fraxel benefits from strong scientific validation and extensive clinical experience.

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How the Fraxel laser works

The Fraxel laser uses a fibre-optic erbium laser emitting at 1550 nm, a wavelength that is strongly absorbed by tissue water. As the beam penetrates the skin, it creates microscopic columns of thermal coagulation — controlled zones of injury measuring approximately 100 to 400 microns in diameter and extending from 400 microns up to 1.4 mm in depth, depending on the settings used.

Formation of microscopic thermal zones
Each laser pulse vaporises and photocoagulates a narrow vertical column of tissue. These MTZs typically represent around 5–29% of the total treated surface during a session, leaving 71–95% of the skin intact between zones.

Healing response
The surrounding healthy tissue responds immediately. Re-epithelialisation begins within hours and is usually complete within 24 hours, thanks to the migration of keratinocytes from untreated areas into the MTZs. This rapid healing explains why Fraxel involves far less downtime than fully ablative lasers.

Progressive dermal remodelling
Within the dermis, controlled heating triggers a cascade of biological responses. Fibroblasts are activated and begin producing new type I and III collagen. Histological studies show a significant increase in collagen and elastin density in the papillary dermis as early as eight weeks post-treatment, with continued remodelling over several months.

Skin temperature and efficacy
Research indicates that skin temperature at the time of treatment directly influences the size of the MTZs. Simultaneous skin cooling improves patient comfort but slightly reduces MTZ size and may therefore marginally affect efficacy.

Ideal candidates for Fraxel laser

Fraxel is suitable for a wide range of patients thanks to its favourable safety profile and versatility. Clinical studies confirm safe use across all Fitzpatrick skin types (I–VI), although additional precautions are required for darker skin tones.

You are likely a good candidate if:

• You wish to improve skin texture, fine lines, acne scars or sun damage
• You are looking for gradual results without prolonged social downtime
• You can commit to a course of treatments (usually 3–6 sessions)
• You have realistic expectations — Fraxel delivers significant improvement, but results are generally less dramatic than with ablative CO₂ lasers
• You can tolerate a few days of redness and mild peeling

You are unlikely to be a suitable candidate if:

• You are pregnant or breastfeeding
• You have an active skin infection, active herpes, or severe uncontrolled acne
• You are prone to keloids or excessive scarring
• You are taking isotretinoin (Roaccutane) or have taken it within the past six months
• You are taking systemic corticosteroids
• You are seeking immediate results or have a major event within the next 1–2 weeks

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Treatment areas with Fraxel laser

Clinical studies support the effectiveness of Fraxel for multiple facial and non-facial indications.

Face

• Photoageing (wrinkles, fine lines, uneven texture, enlarged pores)
• Atrophic acne scars — studies show results comparable to traditional ablative resurfacing after a treatment series
• Hyperpigmentation and dyschromia (age spots, melasma, pigmentary sun damage)
• Hypopigmented scars
• Mild skin laxity (results are generally less impressive than CO₂ lasers for severe perioral laxity)

Other areas

• Neck and décolletage
• Back of the hands (photoageing)
• Forearms
• Post-surgical or traumatic scars

The Fraxel 1927 nm wavelength is particularly effective for epidermal pigmentation concerns and shows the greatest pigment improvement in comparative studies.

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What happens during a Fraxel laser session

Before treatment
A topical anaesthetic cream is applied 45–60 minutes prior to the procedure. Sun exposure, retinoids and exfoliants should be avoided for at least one week beforehand. If you have a history of cold sores, prophylactic antiviral treatment is recommended.

During treatment
The practitioner adjusts the laser parameters according to your skin type, the area treated and treatment goals. Key settings include energy per pulse (typically 6–40 mJ per MTZ) and treatment density (2,000–3,500 MTZ/cm²).

The laser is passed systematically over the treatment area, usually in 8–10 passes. You will feel heat and tingling during the procedure. Treatment time ranges from 20 to 45 minutes depending on the area.

Sensation
With topical anaesthesia, discomfort is manageable for most patients. Many describe the sensation as similar to small elastic bands snapping against the skin. Cooling improves comfort but may slightly reduce MTZ size.

How many Fraxel sessions are needed?

The standard protocol involves 3 to 6 sessions, spaced 2 to 4 weeks apart, to achieve optimal results. This is necessary because only a fraction of the skin is treated during each session.

By indication:

• Photoageing / fine lines: 3–5 sessions
• Acne scars: 4–6 sessions
• Melasma: 4–6 sessions (with appropriate pigment preparation)
• General dyschromia: 3–4 sessions
• Hypopigmented scars: 5–6 sessions or more

Studies show that a course of Fraxel treatments can achieve clinical results comparable to traditional ablative resurfacing for atrophic scars, with significantly less downtime.

Fraxel laser results: a realistic timeline

Immediately after
Marked redness (erythema) and a heat sensation similar to moderate sunburn. Mild swelling, particularly around the eyes if treated.

Days 1–3
Redness peaks within 24 hours, then begins to subside. The skin may appear tanned or slightly darkened. Mild swelling persists. No obvious peeling as seen with ablative lasers, but the skin may feel rough.

Days 4–7
Redness decreases significantly. Fine, light flaking may occur (no crusting as with CO₂). Most patients can resume makeup and normal activities.

Weeks 2–4
Skin appears smoother and more radiant. Early improvements become visible, particularly in texture and glow.

Months 2–3
Continued improvement as new collagen forms. Visible reduction in fine lines, improved texture, softening of scars and pigmentation.

Months 4–6
Optimal results. Collagen remodelling continues, with improvements that may last 6–12 months or longer after the final session.

Long-term studies show durable results, with no delayed adverse events reported in patients followed for up to three years.

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Patient satisfaction with Fraxel laser

Clinical studies consistently report high satisfaction rates:

• 75% of patients report being very satisfied (4 or 5 out of 5)
• Average satisfaction score: 4.16/5 at 3–6 months, maintained at 4.15/5 at 12 months
• Patients report particularly strong improvements in texture (87%), dyschromia (85%) and scarring (80%)

Patients especially value the minimal downtime relative to results, the gradual and natural improvement, and the ability to address multiple concerns simultaneously.

Side effects and complications of Fraxel laser

Fraxel is associated with a relatively low complication rate. In a large retrospective study of 961 treatments, only 7.6% resulted in complications — all temporary and without long-term sequelae.

Common and expected

• Redness (100% of patients) — lasting hours to 7 days
• Mild swelling — resolves within 2–5 days
• Sunburn-like sensation
• Fine peeling (less pronounced than with ablative lasers)
• Temporary dryness and rough texture

Less common

• Acne-like eruptions (1.87%) — usually resolve with appropriate treatment
• Herpes reactivation (1.77%) — highlighting the importance of antiviral prophylaxis in at-risk patients
• Contact dermatitis
• Prolonged redness (over 7 days)

Rare

• Post-inflammatory hyperpigmentation (PIH) — higher risk in Fitzpatrick IV–VI, but incidence remains low with appropriate settings
• Hypopigmentation (very rare with non-ablative Fraxel)
• Bacterial infection
• Drug eruption
• Telangiectasia
• Scarring (extremely rare)

Complications are evenly distributed across age, skin type, body area and laser settings, with the exception of PIH, which occurs more frequently in darker skin tones.

Fraxel compared with other technologies

Versus ablative CO₂ laser

• CO₂: more dramatic results, especially for severe laxity and deep wrinkles, but 7–14 days of downtime and higher risks
• Fraxel: noticeable, measurable and consistent results with minimal downtime (3–7 days)

Versus ablative Er:YAG laser

• Er:YAG: more superficial ablation, faster recovery, less tightening effect
• Fraxel: non-ablative, deeper penetration, excellent for scars and texture

Versus IPL

• IPL: excellent for pigmentation and vessels, no downtime
• Fraxel: superior for texture, scarring and collagen remodelling, with short downtime

Key advantages of Fraxel

• Optimal balance between efficacy and safety
• Suitable for all Fitzpatrick skin types
• Minimal downtime for meaningful results
• Versatility (pigmentation, texture, scarring, photoageing)
• Re-epithelialisation within 24 hours

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How to optimise your Fraxel results

• Strict sun protection: SPF 50 daily; avoid sun exposure for at least four weeks before and after each session
• Skin preparation: For Fitzpatrick IV–VI or melasma, pigment preparation with hydroquinone or azelaic acid for 2–4 weeks reduces PIH risk
• Intensive hydration: Use non-comedogenic moisturisers post-treatment to support healing
• Avoid certain products: No retinoids, acids or exfoliants for at least one week before and after treatment
• Patience and commitment: Optimal results require completion of the full treatment series
• Post-treatment care: Gentle cleansing, moisturising and sun protection; avoid makeup for 24 hours or as advised

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Combining Fraxel with other treatments

Fraxel can be integrated into a multimodal rejuvenation plan:

• With botulinum toxin: Fraxel for texture and quality + neuromodulators for dynamic wrinkles
• With dermal fillers: Fraxel for global remodelling + injectables for targeted volume restoration
• With topical antioxidants: Immediate post-Fraxel application of vitamin C, E and ferulic acid serums improves redness, melanin index, hydration and reduces post-procedure pain
• With RF microneedling: Synergistic effect for deep acne scars

Clinical studies suggest these combinations are generally safe when performed by experienced practitioners.

Choosing a qualified practitioner for Fraxel laser

Although Fraxel is among the safest laser technologies, outcomes and safety depend directly on practitioner expertise. Incorrect settings or poor technique can lead to avoidable complications.

Choose a practitioner who:

• Has appropriate medical training and extensive experience with fractional lasers
• Carefully assesses your skin type and tailors settings accordingly
• Uses genuine, well-maintained Fraxel devices
• Discusses realistic expectations openly — Fraxel improves, it does not transform
• Offers pigment preparation for darker skin or melasma
• Provides proper follow-up and is available to manage complications

Experience is particularly crucial for Fitzpatrick IV–VI skin types, where PIH risk, although low, requires a cautious approach.

Fraxel laser prices in Belgium

Costs vary depending on the practitioner, treated area, Fraxel device used and number of sessions.

• Per area, per session: approximately €500

Typical prices

• Full face: €450–700 per session
• Eye area: €350–500 per session
• Décolletage: €400–600 per session
• Backs of both hands: €400–600 per session
• Localised area (scars, pigmentation): €300–500 per session

Packages
Many practitioners offer packages of 3–6 sessions at a reduced rate, usually 10–20% off the total cost.

These are cosmetic treatments and are not reimbursed. As multiple sessions are required, total costs may range from €1,500 to €4,000 depending on area and number of treatments. Always request a personalised treatment plan and quotation during consultation.

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Key takeaways on Fraxel laser

Fraxel represents a significant advance in skin rejuvenation technology, offering a remarkable balance between clinical efficacy and safety. By treating only a “fraction” of the skin at each session while preserving healthy tissue, it allows rapid recovery without compromising results.

The clinical data are compelling: over 7.7 million treatments performed, more than 120 published studies, and consistently high satisfaction rates confirm that Fraxel, when used correctly, delivers measurable and lasting improvements for a wide range of concerns — from photoageing and acne scars to pigmentation and uneven texture.

What truly sets Fraxel apart is its versatility. Unlike many technologies that excel in a single area, Fraxel can simultaneously improve texture, soften scars, lighten pigmentation, stimulate collagen and rejuvenate the skin overall. Its safety across all Fitzpatrick skin types makes it accessible to a diverse patient population, although darker skin requires a cautious, tailored approach.

There are limitations. Fraxel is not as dramatic as ablative CO₂ lasers for severe laxity or deep perioral wrinkles. It requires commitment to a treatment course rather than a single session. Results are progressive, not instant. For many patients, however, these “limitations” are advantages — subtle, natural improvements that evolve over months, without prolonged downtime or higher risks.

Fraxel’s favourable safety profile is one of its greatest strengths. With complication rates of around 4–8% in large studies — all temporary and without long-term consequences — it demonstrates that efficacy and safety are not mutually exclusive.

As with any laser treatment, success rests on three pillars: choosing an experienced practitioner who understands skin anatomy and laser parameters, maintaining realistic expectations, and adhering to appropriate pre- and post-treatment care, particularly sun protection.

If you are seeking meaningful skin improvement without committing to fully ablative resurfacing, Fraxel is well worth considering.

Frequently asked questions about Fraxel laser

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