By Michael A. Persky, M.D., F.A.C.S.
Fraxel re:pair is the newest and most innovative laser skin rejuvenative system to hit the market in the history of lasers. What is Fraxel re:pair? It is a fractionated carbon dioxide (CO2) laser developed by Reliant Technologies, Inc. in Mountain View, CA. Reliant is the pioneer laser company in “fractionated” laser technology. Three years ago they introduced the first fractionated laser, Fraxel 750, followed by Fraxel SR1500, Fraxel re:store, Fraxel re:fine, and now Fraxel re:pair. Fraxel re:pair treatment is able to correct sagging and loose skin of the face, jowls, and especially the neck in a single quick office treatment. It smoothes wrinkles, even the difficult “bar code lines” of the upper lip. Eyelids become more youthful, “crow feet” fade. As a stand alone treatment around the eyes, it many times yields results comparable to eyelid surgery. It treats bothersome brown “sun damage” spots and freckles, as well as the brown pigment of melasma (light brown facial discoloration associated with pregnancy and birth control pills). Reddish “vascular” blemishes improve. It is especially effective in the treatment of scarring, including acne scarring. Stubborn acne scarred skin smoothes and has improvement in color.
Fraxel re:pair has been tested over the past 2 ½ years on over 500 patients nationwide without significant complications seen with older traditional CO2 lasers. The gold standard for laser skin rejuvenation in the past has been these CO2 lasers. CO2 laser treatments were very popular 10-15 years ago, and are still available today. The problem with the “old” CO2 laser is that it removes 100% of the top 3 millimeters of facial skin. This results in a long period of recovery that includes 7-10 days of open, weeping wounds, and then months of fading from red to pink skin. The complications of the total CO2 treatment included hypopigmentation (the skin was lighter in the treated area than the surrounding area), scarring, and persistent erythema (redness). Plus, only the facial skin could be treated because neck skin was too thin to take 100% CO2. Some of the worst scarring resulted from ill-advised neck treatments. Therefore even in treatments where the face had an excellent result, the neck still looked darker, wrinkled, and older in appearance.
The engineers, scientists, and physicians at Reliant Technologies, Inc. have taken the powerful effects of the CO2 laser, and enabled us to be able to treat skin in a fractionated fashion. This means that instead of treating 100% of the skin and removing the entire surface, we can now treat anywhere from 5% to 70% of the skin, leaving normal skin in between the laser hits to facilitate the healing process. The laser beam width is one tenth the diameter of a hair follicle, yet capable of penetrating through and vaporizing to a depth of 17 millimeters of skin. Patients are seeing even greater tightening of the skin than with the old traditional CO2 lasers. This effect is thought to be due to the five to six times deeper skin penetration with Fraxel re:pair (compared to the 3 millimeter depth of the old CO2 laser).
Fraxel re:pair is capable of treating off face as well without the complications of hypopigmentation and scarring that were seen with traditional CO2 lasers. The areas of skin that are not hit by the laser rapidly fill in the areas of laser vaporization. When magnified, the skin is seen to shrink during the treatment. The skin is completely re-epithelialized within 36 to 48 hours depending upon the aggressiveness of the treatment (i.e. depth and percentage of skin treated). The upper eyelids, neck, and chest have been safely treated with Fraxel re:pair. Patients commonly return to our office saying that friends and relatives are telling them that they look healthy and rested. Studies are currently being conducted on the safety and efficacy of treating hands, arms, and stretch marks. Early results are very positive and promising.
(Left: Before, Right: After)
(Left: Before, Right: After)
How long do the results last? That is always a funny question in facial plastic surgery because as time goes by, the aging process continues. Unless you are Dorian Gray, you will continue to age. It is thought that similar to our experience with the standard CO2 laser, re:pair results will be long term. It may be that a maintenance treatment will be helpful 5, or 10, or even 15 years after the initial treatment. What is known for sure is that the patient’s skin will continually look more youthful than if they had not been treated. I currently tell my patients that they may need to have another treatment in 5 to 10 years. Fraxel re:pair is thought to be a “pre-emptive strike” against aging, and against a face lift. Theoretically, in some patients, the tightening and contracting of excess skin may be enough to avoid surgery entirely. Studies have shown that up to 8 grams of skin are removed in a single treatment. Re:pair is great for those patients showing the early signs of aging who want to improve their appearance, yet who are not candidates for face or neck lifts. It is also great in older patients with loose, sagging skin. Skin color and texture improve as well.
What is involved in the treatment? Every patient is shown photographs of previously treated patients to give them a most accurate expectation of what they will look like and go through from the day of through the weeks after the treatment. An anesthetic gel is placed on the areas to be treated for about 1 hour. Most patients are given Xanax for relaxation and Vicodin for analgesia. The procedure is performed in the treatment room (for patients who do not want to feel a thing, the treatment can be performed under IV sedation with Diprovan in a surgery center). The numbing gel is removed. Some patients get an injection of Demerol immediately prior to treatment. A local anesthetic “nerve block” may or may not be given. If the upper eyelids are included in the treatment, corneal protectors are placed. The Fraxel re: pair treatment on the face takes about 20-30 minutes, the neck takes about 15 minutes. At the completion of the treatment, Aquaphor ointment is applied to the treated areas. The face appears red, swollen, and there are pin point areas of blood for a few hours. Amazingly, there is no pain during the recovery period. Patients are directed to go home, close their blinds and curtains, avoid sunlight, and follow their post-treatment instructions.
During the first 2 to 3 days, patients wash their face with a soft wash cloth with a very mild cleanser every few hours. They then briefly soak in a dilute Acetic Acid solution (8 oz. of water with a teaspoon of vinegar). Aquaphor gel is then reapplied. This continues until the skin is re-epithelialized. Usually by the third day, the skin is dry, tight, and can feel mildly itchy. At this point, generous application of gentle moisturizer and when out sun block is essential. Likewise, avoiding the sun as much as possible helps to decrease the chances of post inflammatory hyperpigmentation. The skin is dry, flaky, and red to pinkish for the next 3 days. At one week after the treatment patients appear pink. We recommend Jane Iredale mineral make-up specifically matched to the patient’s skin color. At this time patients may return to their normal activities. Depending upon the strength of the treatment and the individual healing tendencies of the patient, it may take another 1 to 3 weeks until the skin returns to its’ normal color. Patients are encouraged to protect the investment that they have made in their treatment by using effective skin care products afterwards. We recommend SkinMedica, Nia-24, and ReVale skin lines.
Many patients ask whether they should have a face/neck lift or Fraxel re:pair. If there is excessive skin then surgery is indicated. In the majority of patients, the ultimate appearance is better with Fraxel re:pair, as there is not only tightening of the facial and neck skin, but the overall healthy result on the skin cannot be obtained with surgery. Some patients have upper and/or lower eyelid surgery under local anesthesia in the office concurrent with their Fraxel re:pair treatment. Fraxel re:pair is limited in the treatment of very deep lines at the lower corners of the mouth, and in eliminating “marionette” lines of the lower mouth. It helps minimally with “jowling”, but will not get rid of jowls.
Patients must take their treatment seriously and follow their treatment instructions both pre- and post-procedure. Some patients receive hyperbaric oxygen therapy, while others have Gentle Waves LED light therapy to speed the healing process.
Fractional CO2 laser skin rejuvenation is where facial cosmetic surgery is heading for at least the next ten years. There were 2 or 3 laser companies with fractional CO2 at the beginning of 2008. By 2009 there will be over 12 companies launching their version of Fraxel. The advantage of Fraxel re:pair over the current similar lasers and the many to soon be released is Fraxel’s research over the past 4 years. As of June 2008, Fraxel re:pair had 27 published research articles in peer reviewed scientific journals while the next closest competitor had only 1 article. Fraxel is the only laser that is applied to the skin in a continuous roller fashion while all other laser use a “stamping” application that is less consistent, only more time consuming. Fraxel is the technology that other laser companies are racing to match.
The cost of the procedure varies depending upon the areas treated, the geographic location, and the experience/qualifications of the treating physician. The cost ranges from $2500 to $7500. The cost is a fraction of the cost of similar surgical procedures.
I am fortunate to be the only facial plastic surgeon in Southern California to offer all three of the currently available Fraxel laser treatments. Fraxel re:fine provides safe, gentle resurfacing for patients in their 20′s and 30′s. You can prevent or address the first signs of aging, such as fine lines and mild pigment problems without downtime. Fraxel re:store treatment offers patients in their 30′s, 40′s and 50′s a noninvasive solution to wrinkles around the eyes, acne scars and brown spots, helping the skin to regain its youthful glow. Fraxel re:pair treatment is designed for patients in their late 30′s to 70′s looking for a preemptive strike to treat deeper wrinkles and skin laxity without a surgical facelift.
Your physician should be expert in CO2 laser technology, and the more experience, the better. It is very important that patients choose their treating physician very carefully to avoid potential problems. Fraxel re:pair is an extremely powerful laser. When used properly it has been shown to be extremely effective and safe in creating a rested, naturally healthy, more beautiful you.
About Dr. Persky:
Dr. Michael Persky considers his work to be as much an art form as a medical procedure and has practiced facial plastic and reconstructive surgery in Encino, California since 1985. He graduated with honors from Emory University School of Medicine in Atlanta, Georgia. His residency was completed at Los Angeles County, University of Southern California Medical Center in Otolaryngology and Head and Neck Surgery, specializing in Facial Plastic Surgery. As a Clinical Instructor for the Department of Otolaryngology-Head and Neck Surgery at the University of Southern California Medical Center, Dr. Persky continues to educate and support upcoming physicians in their residency. He is a Board Certified Fellow by the American Academy of Facial Plastic and Reconstructive Surgery, as well as, Board Certified by the American Academy of Otolaryngology-Head and Neck Surgery.
As a medical expert and consultant, Dr. Persky has appeared on numerous television news segments discussing a variety of medical topics. He has also been featured in the Los Angeles Times, the Daily News, and Los Angeles Magazine. He travels throughout the United States lecturing and instructing workshops.