On the last week of a long vacation from her job, a close friend asked me to witness her first Fraxel laser treatment, an in-office procedure that flash-fries skin in the name of stimulating collagen, giving it the reputation as the best laser for fine lines and wrinkles. She warned me that her face would undergo a metamorphosis in the days that followed, proceeding to “fall off” and eventually giving way to a newer, better complexion. While the aftermath was less dramatic than she anticipated — her skin turned slightly like sandpaper rather than full-reptilian before going waxy and then arriving at its final creaseless destination with noticeably faded sun spots.
While I’ve tried various lasers sporadically to zap broken blood vessels and defuzz my body (it was the earlier aughts), I haven’t done Fraxel before, and I realized that I knew very little about how lasers work in general beyond that when wielded correctly, lasers have the power to regenerate damaged skin. Since the world of lasers can be overwhelming slash intimidating, I looked to dermatologists for basic guidelines on where to begin.
First-timers should start during the fall.
If you’ve never experimented with lasers, and you’re somewhat of a sun-worshipper, experts agree cooler darker months — i.e. fall and winter — are the ideal time to start treatments because you’re able to repair any damage that occurred over the summer without further aggravating post-laser skin. “Sun exposure activates the melanocytes and other skin cells, to protect from UV rays, which can backfire and make the skin more sensitive and prone to side effects from some lasers,” explains dermatologist Dr. Ellen Marmur. Before getting a laser treatment, “make sure to discontinue your hydroxy acid or retinols at least a week in advance, as they make the skin extra sensitive,” adds Dr. Joshua Zeichner, Director of Cosmetic and Clinical Research at Mount Sinai Hospital's Department of Dermatology.
All lasers are not created equal.
Fine lines, brown spots, acne scars, and unwanted hair all call for different degrees of laser treatments. Brown spots, for example, respond best to Fraxel and Clear and Brilliant, which is essentially Diet Fraxel, both of which can help you start all over, explains Dr. Mona Gohara, Associate Clinical Professor of Dermatology at Yale. “Fraxel takes off the top layer of skin you’re going to get rid of brown spots, acne scars, and fine lines,” she explains. “It creates heat damage into the skin and the skin responds by creating collagen.”
Clear and Brilliant uses exactly the same technology, but at a lower energy level, Dr. Zeichner explains. “This means less discomfort and less downtime. In fact, you can get it as a lunchtime procedure and go right back to work right afterwards without anyone knowing you had anything done.” Price varies depending on where you live and how many treatments you need, though it usually costs close to $500 per treatment.
But it’s best to start before real degeneration sets in. “The ideal candidate has sun spots and underlying sun damage which you can see as ruddiness or fine lines that are beginning to form,” says dermatologist Dr. Shereene Idriss. Though most younger patients would benefit from a single session, “If you’re 60 years old, one Fraxel won’t give you the results you’re looking for," adds Dr. Idriss. "You’ll need between two to four treatments.” One treatment usually costs about $1000.
For those looking to reduce redness or broken capillaries and blood vessels, V Beam laser is a workhorse that mitigates all of the above. “This laser works by emitting a beam of light that is absorbed by your red blood cells,” Dr. Zeichner explains. “You have more red blood cells in the broken capillaries, allowing the laser to target them specifically.”
Lasers are not for everyone.
Dr. Zeichner cautions those who are pregnant or breast-feeding from getting any laser treatments — and patients with more melanin in the skin should also proceed with caution, says Dr. Gohara, but contrary to popular belief, people of color can safely undergo laser treatments. “It’s not about the laser; it’s the person who is operating the laser,” she says. And though there are some at-home lasers on the market (Tria Beauty makes one for $250, and Iluminage has one that retails for nearly $600), it's best to look to a board certified dermatologist to lower the risk of scarring or hyperpigmentation.
Manage your expectations.
While a single treatment is often times enough, some people may wish to get a series of treatments for optimal results. “I tell my patients that the Fraxel can give up to 50 percent improvement in pigmentation, while the Clear and Brilliant can give up to 25 percent improvement per treatment,” says Zeichner. “In some cases, when treating broken capillaries, we can completely eliminate them after a single treatment. When treating background facial redness, we often need several treatments space every four to six weeks to effectively treat it.” And though, yes, you can expect to pay more than you would a peel or any topical cream, remember: Lasers