When someone says “fractional therapy”, most people who are in-the-know about plastic surgery will say, “Oh, that means Fraxel laser therapy.” That’s because the first fractional laser that was ever marketed went by the name of Fraxel. That was in 2004. Now there are others on the market that use the same type of technology.

Fractional therapy means that a laser is used on the skin and treats a small fraction of the skin at a time. This could be compared to road workers coning off a portion of the road and only working on that portion for an hour or longer. Then they move onto the next portion of the road and keep working.

Or another way to think of it would be that you have a tile kitchen floor. You have to clean it and the only way it ever gets truly clean is when you’re on your hands and knees, cleaning it one tile at a time. You would be giving your kitchen floor fractional therapy!

Since a fractional laser treatment uses a laser, it’s the laser that is targeting very small sections of your skin. An ablative laser will target the epidermis; a non-ablative laser will target the dermis. However, a fractional laser targets both the epidermis and the dermis – and this is why your results from fractional therapy will always be better. Stem cells will be activated to produce more collagen from the deep layers while surface irregularities of the skin are removed.

What Fractional Therapy is Used For

Fractional therapy is often a choice of many plastic surgeons for sun damage, skin pigmentation issues because of sun damage, wrinkles and deep wrinkles called rhytids. If there’s been scarring in the past from trauma or acne, or even stretch marks, fractional therapy will be one of the best treatments as it'll stimulate dermal rejuvenation to its fullest.

Some lasers are only used for the face but fractional lasers can address the neck, hands and chest as well. This makes it a very useful strategy in your anti-aging toolbox.

How Fractional Therapy Has Progressed Over Time

The first fractional therapy device was a non-ablative laser called Fraxel, manufactured by Solta Medical, Inc. It used a blue optical guide – a blue dye – that was smart enough to determine when the machine was in the exact place it had to be. Only then would the laser fire.

The laser was approved for the treatment of deep wrinkles around the eyes, skin resurfacing, acne scars, melisma, pigmented lesions and scars from surgery. This laser produced minimal patient discomfort, and the changes in the skin according to the earlier discussion.

A later version of this Fraxel laser eliminated the blue dye and is called the Fraxel Re:Store. Clinical studies showed a 54 percent improvement in wrinkles around the eyes and mouth, as well as skin texture within a month (one treatment).

At three months, there was a 34 percent improvement in wrinkles and 47 percent improvement in skin texture. Improvements in pigmentation of the hands were seen between 50-75 percent of all patients in three months with a 25-50 percent improvement rate in skin roughness and skin wrinkling.The face improves in 2-3 months while the hands need just over a month for maximal improvement.

Combining the Fraxel non-ablative laser with intense pulsed light has been found to give better results than Fraxel alone. It gave better dermal collagen remodeling, skin tone evening out, and good results with scars, surgical scars after Mohs surgery, and stretch marks.

How Does Fractional Therapy Specifically Work in the Skin?

The fractional laser will deliver a cone of light energy to the small area of the skin. Since the laser is energy that could be measured in heat units, the area of the skin that receives the laser energy will heat up. Within the area, pigmented cells of the epidermis are expelled and the collagen fibers of the dermis absorb the light that stimulates them to remodel. New collagen strands form, which becomes one reason why the skin takes on a rejuvenated and more youthful look.

The tissue around the coned area isn't affected by the light energy. This aids in healing because the damage isn't extensive but rather pinpointed. The body then sees the area as something to heal.

What Happens During Fractional Therapy?

There’s a specific process that all doctors follow for fractional therapy:

  1. Decide on the areas that will be targeted. It might not be the entire face but instead the area that has been scarred by acne.
  2. Take photos before treatment.
  3. Decide on a plan of treatment.
  4. If the patient has dark skin or highly pigmented areas, these areas will be lightened with hydroquinone, a lightening agent. Sometimes a chemical peel will be chosen. (Read Your Ultimate Guide to Chemical Peels.)
  5. Ask the patient if he/she has a history of cold sores. Herpes infections may be activated with the fractional laser treatment. If the answer is yes, then a prophylactic agent may be used.
  6. Prior to the treatment, remove all makeup. Jewelry should also be removed.
  7. Apply an anesthetic cream to the area that will be treated. Allow it to work for up to an hour.
  8. Remove any excess anesthetic cream from the face.
  9. Apply the gliding gel to the area of the face that will be treated. This is so the tool being used will glide over the skin surface easily.
  10. Begin the laser treatments. Glide the hand tool over the skin slowly. Follow the gliding motion with the cooling device, which quickly cools the heat delivered to the skin in the cone region. The entire process takes about 30 minutes.

What Happens After Fractional Therapy?

There are expected changes in the skin after the fractional therapy. Here’s a list of them:

  • It feels like a mild sunburn after the procedure. This only lasts about an hour.
  • Swelling occurs after the procedure. This is the body’s inflammatory response, which is necessary for healing to occur in the skin. Swelling may be decreased with the aid of ice packs.
  • The skin will start to look bronze or pink.
  • The skin gets flaky and starts to peel. This is a good sign because it means that the old dead skin is being replaced by new skin.
  • Your skin will need additional moisture and you’ll have to use a doctor-recommended moisturizing cream.
  • Your skin will be sensitive to sun damage so you’ll need to wear sunscreen of at least SPF 50.
  • The treatment will be repeated about a month later, and in some cases, continued at the rate of once a month for six months.

Side Effects of Fractional Therapy

Almost every cosmetic procedure has potential side effects. With Fractional Therapy, you may experience any of the following:

  • Crusting of the skin
  • Excessive peeling and scaliness of the skin
  • Outbreak of acne, herpes or Candida infections
  • Dermatitis

Not All Fractional Lasers are the Same

A short history of how different cosmetic lasers progressed is the best way to understand them.

Carbon Dioxide (CO2) Laser System

This laser was the first type used by most practitioners in a continuous beam mode, which removed all of the epidermis and a portion of the dermis. Downtime was about a week or more depending on the aggressiveness of the clinician. It caused pain, swelling, persistent redness, infections, darkened areas after the procedure and after healing was complete, and even blanched areas in some patients (up to 20 percent of patients) a few years later.

Erbium Yttrium Aluminum Garnet (Er:Yag) Laser

This laser was created to offset the hypopigmentation that resulted from the CO2 lasers but it ended up causing similar issues. Downtime was still up to seven days, depending on the aggressiveness of the practitioner.

Near-Infrared Non-Ablative Lasers

These lasers were the next generation of lasers but the effects on the skin were minimal and thus not worth it to the patient. The wavelength range was 1319-1320nm and 1450-1540nm. Their effects on collagen and elastin were minimal. Non-ablative lasers don’t give you the same results as ablative laser resurfacing – when it comes to skin rejuvenation. These set the stage for fractional lasers.

Fractional Lasers

Fractional lasers brought a renaissance of laser resurfacing solutions that actually worked but had fewer overall adverse effects as other lasers. They are different from each other based on the diameter of the ‘cone’ and in the degree of depth they penetrate.

The mechanisms used in fractional therapy occur through the transepidermal delivery of treated dead skin into the outside layer of the skin, which is exfoliated away. (Read 5 Effective Exfoliating Techniques for Healthy Skin.)

It’s the surrounding normal skin that assists in this process.

Fractional lasers can be non-ablative and ablative. Ablative lasers emit light that is superficial or deep to a depth of the skin less than 750 microns for the superficial ones and greater than 740 microns for the deep ones.

Different Fractional Lasers Based on nm Classification

Device nm

  • Reliant Fraxel re:stor 1550, 1440 nm
  • Cynosure Affirm 1440 nm
  • Palomar StarLux:Lux 1540 1540 nm
  • Quanta System Matisse 1540 nm
  • Asclepion Dermablate 1540 nm
  • Lutronic USA Mosaic 1550 nm
  • Sellas 1550 nm

Different Ablative Resurfacing Erbium YAG Lasers and CO2 Lasers

Laser Type

  • Alma Lasers Pixel Erbium YAG
  • Sciton ProFractional Erbium YAG
  • Palomar StarLux 2940 Erbium YAG
  • Asclepion Dermablate Erbium YAG
  • Hoya ConBio DermaSCULPT Erbium YAG
  • Lumenis Active FX Deep FX CO2
  • Lasering USA Slim MiX/SX CO2
  • Quantel Exelo 2 CO2
  • Reliant Fraxel re:pair CO2
  • Ellpse Juvia CO2
  • DEKA SmartXide CO2
  • Dosis M&M Q-Ray CO2
  • Alma Lasers Pixel CO2
  • Latronic eCO2 CO2
  • Candela QuadraLase CO2

Fraxel laser treatment or fractional therapy is here to stay for awhile! The best way to determine whether or not it's something for you is to have an evaluation of your skin by your plastic surgeon. They will tell you the options for you, why they are your best choices, and what types of results can be expected from them on your skin.