Fractional photothermolysis. Features of the procedure using the Fraxel laser device

From this article you will learn:

• types of fractional lasers and the principle of their operation,
• Fraxel laser: reviews, rehabilitation, before and after photos.

The Fraxel laser device can reduce the severity of wrinkles, reduce the depth of acne scars, eliminate age spots, and also treat many other skin problems. The Fraxel cosmetology laser is a fractional type laser and is available in three modifications: “Fraxel re'fine”, “Fraxel re'store” and “Fraxel re'pair”.

The peculiarity of fractional lasers is that they divide the laser beam into thousands of microscopic fractions (small rays, each of which is one tenth the diameter of a hair) and direct these fractions simultaneously to a specific area of ​​the skin. As you will see below, this leather processing technology has global benefits.

Fractional laser can be ablative or non-ablative. Fraxel restore and Fraxel refine are non-ablative. Such lasers work deep in the skin without disturbing the integrity of the stratum corneum of the epidermis. But “Fraxel repair” is ablative, and its effect occurs with a violation of the integrity of the stratum corneum of the epidermis. The latter seems less safe, however, the effectiveness of Fraxel repair is much higher than other Fraxel devices.

Fraxel: indications for the use of fractional laser

Fraxel, like many other fractional lasers (manufactured under other brand names), is commonly used to treat the following problems:

• to reduce wrinkles and deep lines on the face and neck (Fig. 4-5),
• for general skin rejuvenation and increasing its elasticity,
• stretch marks (striae) after pregnancy (Fig. 6),
• scars and scars after operations (Fig. 7),
• acne scars (Fig. 8),
• enlarged pores,
• age spots, melasma (Fig. 9),
• spider veins,
• treatment of skin keratosis.

Fraxel: before and after photos

Indications

Fraxel treatments are usually prescribed for people over 30 years of age. This is an ideal remedy for those with damaged, sunburned or simply aging skin.

Using the device, you can eliminate:

• visibility of crow's feet near the eyes;
• severe signs of sunburn;
• senile pigmentation;
• enlarged pores;
• consequences of acne;
• actinic keratosis.

In addition, you will definitely notice an improvement in your complexion. If there were postoperative scars or stretch marks, they will become smaller. Laser also works well against the effects of acne and other skin diseases. The number of sessions is determined after a 3D skin diagnosis and conversation with the patient.

Three modifications of the Fraxel laser –

There are three main original Fraxel devices, which are used in different clinical situations, and depending on the severity of the problem.

Fraxel Re'fine –

This is a fractional non-ablative erbium laser, with a wavelength of 1410 nm and a single pulse energy of 5 to 20 mJ (Fig. 10). This laser works to a depth of 0.7 mm, and the stratum corneum of the epidermis remains intact. This is the softest type of Fraxel laser, after which healing occurs as quickly as possible, and the procedure itself is as painless as possible and lasts only 20 minutes.

Fraxel refine is used to smooth out fine wrinkles around the eyes, tighten the skin of the eyelids, remove age spots and other pigmentation on the skin, and treat melasma. Also, this type of laser generally improves the condition of the skin and can be used primarily to prevent aging.

Thus, the indications for using Fraxel refine are exactly the same as for photorejuvenation techniques using IPL devices. The latter, as a rule, are much cheaper than Fraxel laser treatment. However, Fraxel can be used on people of any skin color, and IPL devices are not recommended for people with dark skin.

Fraxel Restore –

This is a fractional non-ablative erbium laser, with a wavelength of 1550 nm and a single pulse energy of 4 to 70 mJ (Fig. 11). The depth of exposure, depending on the settings, ranges from 0.4 to 1.4 mm. This type of laser is used to treat similar problems that Fraxel refine can eliminate, but only more severe. For example, to smooth out more pronounced wrinkles.

Fraxel restore reviews also claim that it does an excellent job of removing small atrophic acne scars, hypertrophic scars, and is also used to treat stretch marks after pregnancy, pigmentation and skin keratosis.

Fraxel Re'pair –

This is a fractional laser of the ablative type, belongs to the group of CO2 (carbon dioxide) lasers with a wavelength of 10600 nm and a single pulse energy of up to 225 mJ (Fig. 12). Unlike classic ablative lasers, which work only deep into the epidermis, Fraxel Repair works in both the epidermis and dermis. The depth of exposure ranges from 0.4 to 1.6 mm, and it can be adjusted by the settings of the device, on which modes can be selected: “medium ablation” or “deep ablation”.

Medium ablation mode primarily targets the lower layers of the epidermis and upper layers of the dermis, which is suitable for smoothing shallow wrinkles (such as around the eyes), reducing pore size and improving skin texture.

Fraxel repair in the “deep ablation” mode acts primarily on the middle layers of the dermis, which is excellent for smoothing out deep wrinkles. When using this mode, there is also a pronounced skin lifting effect, which you will notice immediately after the procedure. The device is also successfully used to remove age spots and spider veins, as well as to remove hypertrophic scars and scars.

Analogues of the Fraxel Repair laser produced by other manufacturers -

• Active and Deep FX (Lumenis),
• Quadralase (Candela),
• Pearl Fractional (Cutera), etc...

Comparison of Fraxel refine and Fraxel restore – with Fraxel repair…

Fraxel repair fractional ablative CO2 laser is more aggressive than erbium non-ablative lasers Fraxel refine and Fraxel restore, which leads to greater synthesis in tissues of inflammatory mediators, proteins and factors that stimulate stem cells and fibroblast function. Accordingly, the effectiveness of the procedure with the Fraxel ablative CO2 laser will be 2 times higher, although healing will take 2-3 times longer. In addition, it is “Fraxel repair” that gives the best skin lifting effect.

Operation process of fractional CO2 laser: video

NON-ABLATIVE FRACTIONAL PHOTOTHERMOLYSIS

Rice. 1. Diagram of temperature distribution in the upper layers of the skin. Heating zones in the area of ​​microbeam penetration (future MLZ) are surrounded by areas of normal temperature. As the beam penetrates deeper into the tissue, the amount of transmitted energy and temperature decrease

During the exposure of the skin to the Fraxel re:store laser, so-called micro-treatment zones (MTZs) are formed. MLZ are zones of photothermolysis (photocoagulative necrosis) 70–350 microns wide and up to 1.4 mm deep. MLZ have the shape of cones, perpendicular to the surface of the skin, their density can reach 11,000 MLZ/cm2. The chromophore for Fraxel re:store radiation (wavelength 1550 nm) is mainly water, so coagulation occurs in both the epidermis and dermis; The stratum corneum of the epidermis, which contains little water, is minimally damaged, which allows the barrier functions of the skin to be preserved [2]. At the level of the epidermis, the laser heats the skin to a temperature of approximately 90°C; as it penetrates deep into the skin, the laser radiation loses energy, so in the lower part of the MLZ relative to the skin surface, heating occurs to 45–50°C (Fig. 1).

Since heat from the region of laser-induced heating spreads into the surrounding space, the formed MLZs find themselves surrounded by heat shock zones. In these zones, within 1–3 hours after laser exposure, heat shock proteins (HSP47, HSP70, HSP90), growth factors, interleukins and other signaling molecules are released, which trigger proliferation processes in the epidermis and dermis, activate intra- and extracellular proteolysis and attract immune cells, primarily macrophages, to the damaged area. Necrotic debris in the coagulation zone is partially absorbed by macrophages, partially evacuated to the surface of the epidermis and forms the so-called microepidermal necrotic debris (MEND) [2, 3]. MEND contains destroyed collagen and elastin, as well as a large amount of melanin [4, 5]. Due to the migration and proliferation of epidermal stem cells, the basal layer in the affected area is completely restored after 24 hours. After 7 days, at the site of the MLZ in the epidermis, a normally formed area of ​​tissue without elements of dyskeratosis and spongiosis is found [2].

Proteolysis and phagocytosis of necrotic debris in the damaged area is largely stimulated by mediator signals from the proliferating epidermal cells. Migrating fibroblasts in the initial stage of reorganization of the coagulation focus synthesize collagenase and other proteolytic enzymes. 7 days after the procedure, expression of type III collagen is detected in the dermis; foci of neocollagenesis surround the MLZ and are most pronounced in the areas subject to MLZ [2]. Thus, the process of collagen remodeling involves a microsection of the dermis, which is significantly larger in size than the MLZ. The restructuring of the collagen framework occurs within 2–3 months, which is confirmed by smoothing the skin, reducing the depth of wrinkles and pore size.

CLINICAL APPLICATION OF NON-ABLATIVE FRACTIONAL PHOTOTHERMOLYSIS METHOD USING THE EXAMPLE OF THE FRAXEL RE:STORE PROCEDURE

The process of fractional remodeling, which the Fraxel re:store laser fractional photothermolysis apparatus initiates in the skin, takes place in the epidermis and dermis at a depth of 0.3–1.5 mm, therefore this laser is used to correct a number of aesthetic defects expressed in changes in relief and skin texture.

The main indications for the Fraxel re:store procedure can be divided into three groups:

a) involutional changes in the skin; b) dyspigmentation; c) cicatricial deformations of the skin.

In addition to solving specific problems, such as removing age spots and reducing the size of wrinkles, the Fraxel procedure improves the mechanical properties of the skin, reduces the size of pores and evens out the texture. Selective heating of water and the principle of fractional exposure make it possible to carry out the procedure on almost any area of ​​the face and body, as well as with any phototype on the Fitzpatrick scale, which seriously expands the capabilities of Fraxel in comparison with methods of traditional (non-fractional) laser skin remodeling.

The mechanism for smoothing skin texture under the influence of Fraxel is that all structures in the area of ​​the MLZ are coagulated, including those containing melanin. Newly formed in the process of subsequent remodeling, epidermal cells synthesize and accumulate an adequate amount of melanin, which is clinically expressed in the lightening of age spots and smoothing of skin texture.

The large depth of the formed MLZ allows the destruction of pigment localized on the basement membrane of the epidermis and in the dermis, therefore Fraxel is used in the correction of deep forms of hyperpigmentation, such as melasma [6, 7]. On average, one procedure involves 20–30% of the skin in the treatment area, so significant lightening or complete evening out of skin color in the area of ​​hyperpigmentation should be expected after 3–4 procedures [8].

Coagulation of the dermis to the reticular layer stimulates the renewal of the collagen-elastin framework of the skin, making Fraxel effective in correcting fine wrinkles and enlarged pores [7]. The non-invasiveness of the method, rapid recovery in the affected area and the absence of heating of the underlying tissues make it possible to treat almost any area of ​​the skin [9, 10]. Positive results are achieved using the method of laser fractional photothermolysis in the treatment of scars of various etiologies and localizations [11–15]. Observations show that the surface of the scar is significantly smoothed out after 4–5 procedures, and in 75% of patients positive dynamics are observed after the first treatment session.

PARAMETERS OF NON-ABLATIVE FRACTIONAL PHOTOTHERMOLYSIS PROCEDURE

Based on the description of the processes occurring in the skin during fractional remodeling, a number of parameters of the Fraxel re:store procedure can be identified that can affect its effectiveness and safety. It seems convenient to us to divide these parameters into two groups: the parameters of each MLZ and the parameters of the MLZ distribution over the treated surface.

A. MLZ parameters

Rice. 2. Histological picture of the epidermis and dermis in microtherapeutic zones (MTZ) on the 2nd day after the procedure with exposure to radiation of different energies. It can be seen that with increasing energy, the depth and diameter of the area of ​​coagulation necrosis increase. Staining of sections with hematoxylin-eosin

MLZ depth. The depth of the Fraxel re:store micro-treatment zone ranges from 370 to 1400 microns and directly depends on the energy of the micro-beam (Energy), which in turn is adjustable within the range of 4–70 mJ (Fig. 2). The device screen displays the beam energy and the depth of the MLZ; the doctor selects the energy in accordance with the indications for the procedure (Table 1), the treatment area and the structural features of the patient’s skin. Hyperpigmentation, skin texture disorders and melasma are associated with disruption of the formation and distribution of melanin in the epidermis, therefore, for their effective correction, it is enough to form MLZ at the epidermal level.

Correction of age-related and UV-induced changes in dermal collagen can only be effective when creating MLZ at the level of the reticular layer of the dermis. Correction of hypertrophic scars requires the use of maximum energy.

In some areas of the skin, the anatomical thickness of the epidermis and dermis of which differs sharply from the average values, the energy should be set taking into account the structural features of the skin in these areas. For example, in the area of ​​the mobile eyelid, the energy should not exceed 10 mJ, even if the indication for the procedure is a hypertrophic scar.

Diameter of MLZ. The diameter of the Fraxel re:store micro-treatment zone ranges from 70 to 350 microns. This parameter, like the depth of the MLZ, depends on the energy of the microbeam and can affect the healing process [16]. It is believed that as the diameter of the microdamage increases, the rate of restoration of the basal layer of the epidermis decreases, and when the diameter of the microdamage exceeds 500 μm, this rate drops catastrophically quickly. In addition, observations show that normal neocollagenogenesis during fractional coagulation at the level of the reticular layer of the dermis occurs with MLZ with a diameter not exceeding this value. In addition to the energy of the microbeam, the diameter of the MLZ depends on the temperature of the skin at the site of its formation [17] and on the geometric parameters of the microbeam [3].

The Fraxel re:store fractional laser photothermolysis device uses a system for automatically optimizing the microbeam diameter to achieve maximum coagulation depth with minimal energy. The ratio of MLZ diameter/MLZ depth does not exceed 1/5.

MLZ distribution. The Fraxel laser distributes MLZ over the skin as the working handle moves across the skin, while the tip of the handle must always be in contact with the surface of the skin, and the handle itself must maintain a perpendicular position relative to the plane of the surface being treated to achieve maximum coagulation depth. The act of moving the handle from one boundary of the sector being processed to another is called a pass. During such a pass, Fraxel forms a strip 15 mm wide of the required length, on each square centimeter of which the MLZ are distributed with the same density. The Optical Tracking System (IOTS) ensures uniform distribution regardless of handle speed. Typically, the procedure consists of carrying out several passes over the same place, during which the total density of the MLZ (Total Density) is formed.

The total MLZ density (or MLZ density) is the number of MLZs on each square centimeter of the treated surface, formed during the entire procedure. The percentage of coverage—the percentage of coagulated tissue in the treatment area—directly depends on the density of the MLZ.

The percentage of coverage is the most important parameter of the procedure, on which its effectiveness and safety depend. In fact, percentage coverage is the area of ​​coagulated areas on the surface of the skin divided by the area over which they are distributed. For an average aggressive procedure, the coverage percentage is 20%. This parameter is nonlinearly related to the density of the MLZ and the diameter of the MLZ. The more MLZs are formed and the larger the diameter of each MLZ, the larger the coverage percentage will obviously be.

The effectiveness of the procedure and the rehabilitation period depend on the percentage of coverage. The doctor selects this parameter based on medical history, assessing mainly the ability of the patient’s skin to regenerate, and also based on the patient’s wishes, what should be taken as a priority: the effect of treatment or rapid rehabilitation. It is recommended to use a coverage percentage below 20% when treating melasma, as well as for patients with Fitzpatrick phototypes IV–VI.

Rice. 3. Fraxel re:store treatment levels and corresponding percentage coverage values

Treatment Level . The coverage percentage is adjusted by changing the so-called Treatment Level. There are 15 treatment levels in total, each of which has its own coverage percentage. The first level of treatment is the most gentle, it corresponds to 5% coverage, the 15th is the most aggressive, it corresponds to 48% coverage (Fig. 3).

All adjustable parameters of the procedure are interconnected. This means that changing one parameter automatically changes a number of others. For example, to provide 20% coverage at an energy of 10 mJ, it is necessary to achieve a density of 2000 MLZ/cm2. The MLZ density is calculated automatically (Fig. 4). But with increasing energy, the diameter of the MLZ inevitably increases, so the system automatically reduces the total density of the MLZ, keeping the coverage percentage unchanged.

So, to achieve the same 20% coverage, but with an energy of 20 mJ, the density will be 780 MLZ/cm2. Simultaneously with the change in the total density of the MLZ, the density of the MLZ per pass also changes. It can be concluded that the density of the MLZ is a parameter clinically less important than the percentage of coverage. When changing the energy and level of treatment, the total density of the MLZ can theoretically change from 100 to 11000 MLZ/cm2, while the key for the doctor will remain the percentage of coverage (level of treatment), and the density of the MLZ will be more informative.

Rice. 4. Fraxel re:store laser treated thermal paper. Areas of penetration of the laser beam are visible in the form of white dots, which are distributed over the entire width of the pass made. With increasing energy, the diameter of the points increases and their density decreases, while the total area of ​​all points on each square centimeter in the pass area in sectors 1, 2, 3 and 4 of thermal paper remains the same

Fraxel allows you to accurately control the percentage of destroyed tissue in the area of ​​the procedure, which makes it possible to achieve predictable and reproducible results. At the same time, the risk of possible complications associated with exceeding the coverage percentage is reduced to a minimum. The last parameter that the doctor can change is the number of passes. The number of passes made in the same area can vary from 4 to 16, the average and most often used number of passes is 8. The percentage of coverage does not depend on this parameter, since the system automatically recalculates the density of the multi-layered zone per pass, dividing the total density of the multi-layered zone by the number of passes. So, with a total density of 2000 MLZ/cm2 and the planned 8 passes, passes with a density of 250 MLZ/pass will be formed. If the doctor considers it necessary to plan 16 passes, then the density per pass will already be 125 MLZ/cm2.

Usually the number of passes is adjusted to achieve maximum patient comfort. As the number of planned passes increases, the duration of the procedure increases, but at the same time it is more comfortable for the patient. This parameter is set in advance, but can change, as well as the energy and level of treatment, directly during the procedure.

FRAXEL RE:STORE METHODOLOGY

A. Indications

• age-related skin changes: structural changes in the epidermis and dermis, elastosis, wrinkles, including oral and periorbital, changes in the structure of collagen and connective tissue, enlarged pores (medical technology No. FS 2007/172 dated August 9, 2007); • pigmentation: pigment disorders, lentigo, actinic (solar) keratosis, chloasma; • scars: atrophic and hypertrophic, acne scars, skin stretch marks.

B. Contraindications

• absolute: epilepsy, pregnancy, lactation, psoriasis, cancer, tendency to form keloid scars; • relative: inflammatory processes in the area of ​​intended treatment, chemical peeling and other similar procedures performed less than 2 weeks before treatment, atopic dermatitis in the acute stage.

B. Preparation for the procedure

Preparation for the Fraxel re:store procedure must necessarily include: removing makeup, photographing the patient, applying surface anesthesia 40–60 minutes before the procedure and measuring the area of ​​the treated surface using IOTS and the built-in calculation program. An assessment of the area of ​​the treated surface is necessary to determine the total energy that will be transmitted by the laser during the entire procedure, and can indicate to the doctor possible errors at the time of its implementation.

D. Carrying out the procedure

The Fraxel re:store procedure in the facial area lasts 15–20 minutes, while treating a scar 10 cm long – 5 minutes. During the procedure, the doctor distributes the planned number of passes over the treated area. To control the distribution of passes over the surface of the skin, the so-called Trecking Gel is used - a waterless gel based on mineral oils and polyethylene. The gel leaves a shiny film on the surface of the skin, on which traces of the rollers of the tip of the working handle are imprinted. This allows the doctor to accurately determine the boundaries of each pass and carry out the next pass strictly in accordance with the previous or adjacent pass. There are many different techniques for distributing passes, the description of which is beyond the scope of this article, however, any technique should ensure uniform distribution of MLZ of a given density with maximum comfort for the patient and with precise control of the percentage of coverage.

D. Completion of the procedure

Upon completion of the procedure, the gel and remaining anesthetic cream are removed from the skin, after which Panthenol or Regenerative cream from the SYSTEM nanogreen PROFI cosmetics line is applied. Most patients use this cream during the first three days after the procedure (Fig. 7). Undesirable side effects that can be expected after the Fraxel re:store procedure are less common than after other aggressive procedures (for example, after CO2 laser ablation), and are presented in Table 2.

E. Complications

The most extensive study of the incidence of various complications after the Fraxel re:store procedure to date was conducted by Graber EM et al. based on data on 961 procedures [19]. The most common side effects were acne (n=18; 1.87%), herpes virus infection (n=17; 1.77%), erosion (n=13; 1.35%). Post-inflammatory hyperpigmentation (n=7; 0.73%), prolonged erythema (n=8; 0.83%), prolonged swelling (n=6; 0.62%), dermatitis (n=2; 0.21) were observed less frequently. %), impetigo (n=1; 0.10%) and purpura (n=1; 0.10%). The provided statistical data once again confirms that Fraxel fractional photothermolysis is safer than traditional aggressive methods of laser remodeling of the skin surface.

CLINICAL CASES

In conclusion, we present two clinical examples of the use of Fraxel re:store. Since the number of publications and reports on the clinical use of this laser is quite large, we find the most interesting results of Fraxel treatment in situations where the use of traditional treatment methods is ineffective or difficult. Materials kindly provided by Dr. Oleg Sheptii (TelosBeauty High Technology Clinic, Moscow).

1. Treatment of hypertrophic scars

Patient V., 35 years old. Post-traumatic scars in the forearm (inner surface) 19 years ago. Note. Typically, 6–7 procedures are sufficient to correct hypertrophic scars; the patient wished to continue treatment after the 7th procedure, which allowed us to make the last observation (Fig. 6).

Equipment used: Fraxel re:store laser (Solta Medical Inc., USA).

Impact parameters: energy 2–70 mJ (70 mJ directly in the area of ​​scars, 25 mJ in the area around the scars), treatment level 6–7, number of passes – 8.

2. Treatment of skin stretch marks

Patient A. 42 years old. Striae in the abdominal area, formed after prolonged use of hormonal creams.

Equipment used: Fraxel re:store laser (Solta Medical Inc., USA).

Impact parameters: energy 25–40 mJ. Treatment level 6–7. The number of passes is 8. Since the patient had a history of atopic dermatitis, which is a particular contraindication to the procedure, the first procedure was performed at the minimum parameters for correcting stretch marks of 25 mJ.

CONCLUSIONS

Laser non-ablative fractional photothermolysis is successfully used in aesthetic medicine for the treatment of chrono- and photoaging, smoothing skin texture, removing hyperpigmentation, smoothing surgical and traumatic scars, the consequences of acne, as well as skin stretch marks. The Fraxel re:store laser allows you to perform a non-ablative fractional photothermolysis procedure with a high degree of safety, and thanks to clear control over a number of its parameters, it makes it possible to predict the positive and negative effects of the procedure. The effectiveness, safety and recovery time of Fraxel re:store depend mainly on the energy and level of treatment - parameters of the procedure that are directly related to the depth of remodeling and percentage of coverage.

How Fraxel Fractional Laser Works –

To understand how it all works, you need to know the structure of the skin (Fig. 13). The skin consists of 3 layers: → epidermis (surface layer), → dermis (middle layer), → subcutaneous fatty tissue.

The epidermis consists of numerous layers of keratinocytes of varying degrees of differentiation. The epidermis also contains melanocytes (so-called pigment cells), which are responsible for skin color. The dermis consists of collagen and elastin fibers, fibroblasts, which provide the skin with strength, firmness and elasticity (24stoma.ru).

As our body ages, the appearance and general characteristics of the skin change. The epidermis becomes thinner, various spots on the skin become more noticeable, and the collagen content in the dermis by the age of 45 decreases by almost half. Skin moisture is noticeably reduced due to a decrease in hyaluronic acid content. All this leads to the gradual appearance of wrinkles, the formation of deep lines on the face, and the skin becomes flabby.

Principle of operation -

Using special technology, the laser beam is split into thousands of microbeams, each of which is one-tenth the size of a human hair.
That is why such lasers are called fractional. The meaning of such fractionation is that areas of destroyed tissue are subsequently surrounded by areas of undamaged viable tissue, the cells of which will ensure rapid restoration of damaged areas. When using non-ablative Fraxel lasers (Fraxel refine and Fraxel restore), numerous micro-areas of tissue coagulation (MTZ microthermal zones) are formed - in the form of columns perpendicular to the skin surface (Fig. 14). And when using the Fraxel repair ablative laser, not only injury occurs, but also a certain percentage of tissue is removed, which leads to a pronounced skin lifting effect.

In response to such damage, the body begins to synthesize more proteins, mediators and signaling molecules, which cause the activation of skin stem cells and increase the rate of their division. A large number of new cells begin to gradually synthesize the structural elements of the skin, such as collagen and elastin. Moreover, after using the Fraxel repair ablative laser, these processes are more pronounced.

When using non-ablative Fraxel lasers (Fraxel refine and Fraxel restore), coagulation areas occur predominantly in the dermis without compromising the integrity of the stratum corneum of the epidermis. And when using the Fraxel repair ablative laser, coagulation occurs with a violation of the integrity of the stratum corneum, which leads to the formation of microholes in it up to 200 microns in size, which are completely restored in about 24-45 hours (Fig. 17). Damage to the dermis is restored in 4-7 days.

Why laser

Fraxel is a new word in hardware cosmetology. Its effectiveness has already been confirmed by millions of patients. The laser is perfect for any skin type, including sensitive ones.

It is possible to use microflows not only on the face, but also on the neck, chest, and arms.

Participation in sessions will not affect your daily life in any way. You do not need to undergo surgery and there is a recovery period.

The Fraxel effect is literally new skin. Smooth relief, fresh complexion and elimination of minor defects in the form of wrinkles or acne marks. Improvement is observed within 2–3 months, and the result lasts up to 1 year.

Stages of the procedure using Fraxel –

Preliminary preparation

The problem area is determined and adapted to the template to determine the target area of ​​correction. Fraxel photos must be taken before the procedure. The patient should remove all jewelry and wash their face thoroughly with soap and water before the procedure.

For patients with skin pigmentation problems, treatment with a whitening cream (eg hydroquinone) or a pre-chemical peel may be required. In patients at high risk of developing herpes, Acyclovir can be used as a prophylaxis against herpes.

Next, an anesthetic is applied to the treated area. You must wait 45-60 minutes before the full anesthetic effect occurs. Then the anesthetic is removed and a special gel is applied to the treatment area, which ensures that the Fraxel laser handle glides easily over the surface of the skin.

Fractional laser treatment procedure

Treatment time depends on the area being treated. For example, a full face usually takes about 30 minutes, a neck about 20 minutes. The degree of pain during the procedure will depend on the energy power of the laser light pulses (from 4 to 70 mJ; set on the equipment). Sometimes a cooling device (such as a Zimmer) is used to reduce discomfort during the procedure.

Typically 4-5 Fraxel treatments are required, depending on the level of energy used and the condition of the skin being treated. These procedures are performed within a month.

Fraxel: reviews and consequences

For about 1 hour after the procedure, patients may experience a sensation similar to that of sunbathing. During healing and for several months after the procedure, it is recommended to apply a moisturizing sunscreen with a protection level of at least 50 SPF. It is necessary to protect the skin from exposure to the sun with clothing and wide-brimmed hats.

Swelling may be present and usually resolves within 2-3 days. Expect your skin to have a pink tint for 3-5 days. In addition, the epidermis is restored within up to 40 hours, which at the beginning may have a tan color (this disappears in 3-14 days). As a rule, peeling of the skin is observed, but this problem is easily solved by using a moisturizer. According to the cosmetologist's indications, after ablative therapy with the Fraxel repair laser, skin peeling can be applied using water, Vaseline and gauze 1-2 times a day.

Fraxel: photo immediately after the procedure, and in dynamics

Unique advantages of laser rejuvenation:

• With each procedure, 15-25% of old tissue can be removed, and healthy young skin is formed in its place.
• Remodeling processes occur in depth, and not just on the surface. The collagen and elastin framework is renewed.
• Solving several cosmetic problems simultaneously in one session.
• There are no restrictions on skin color, thickness or sensitivity. The procedure is suitable for all skin types.
• Laser rejuvenation can be used on any delicate areas, for example, the hands, décolleté, neck, eyelids, etc.
• No special medical care is required other than standard SPF sun protection and moisturizing cosmetics. The convenient fact is that makeup can be applied the next day after the procedure.
• The procedure is performed using only local anesthesia and lasts 30-60 minutes.

Fractional laser: reviews

Results after Fraxel - reviews confirm that the onset of the effect is progressive. The most visible result appears within 3-4 months after the procedure. During this period, complete healing and replacement of tissue occurs with the formation of new cells with new collagen and elastin. However, after using Fraxel repair, the lifting effect can be noticed immediately after the procedure.

Studies show that a 20-40% overall improvement in fine lines and wrinkles was achieved after a mild rejuvenation procedure. More aggressive procedures (with high light beam energy) performed by fractional laser - reviews have shown from 30 to 70% of visible improvement.

Fractional laser can be combined with surgical rejuvenation methods, as well as non-surgical procedures, such as plasma lifting. In the latter case, the desired result can be achieved faster and with fewer procedures. Laser skin resurfacing is not a cheap pleasure, so the number of procedures can also matter.

How does the technique work?

Fractional CO2 systems generate a laser beam that is divided into many microbeams. When micro-rays hit the skin, they affect it, evaporating thin “columns” to a given depth, stimulating the production of new collagen. The remaining areas not exposed to micro-rays promote rapid tissue restoration and healing.

Over the next 3-6 months, collagen remodeling continues in the skin.

Side effects and complications –

Laser Fraxel reviews confirm that the procedure is usually quite well tolerated by patients. In the near future after the procedure, you can shave and apply makeup. In most cases, patients can return to work immediately after treatment or the next day, which will depend on the power of the laser light pulses chosen by the cosmetologist.

Side effects and consequences after Fraxel –

• excessive peeling of the skin (sometimes the appearance of crusts),
• contact dermatitis,
• exacerbation of herpes, acne,
• infectious skin lesion,
• temporary post-inflammatory skin pigmentation,
• swelling for 1 week after treatment (in such cases, the use of ice and antihistamines helps).

Important: despite the fact that fractional laser is most often used to treat various pigmentation disorders, the treatment itself in some cases can lead to post-inflammatory pigmentation.

Fractional rejuvenation. Contraindications

• Pregnancy or lactation period
• Epilepsy
• Inflammatory processes in the area affected by the laser
• Psoriasis or atrophic dermatitis

At the moment, the most popular procedures are the following:

• laser resurfacing of stretch marks on the skin >>>;
• laser resurfacing of scars on the body >>>;
• laser resurfacing of facial scars >>>;
• fractional laser skin resurfacing >>>;
• laser resurfacing of the lower eyelid >>>;
• laser resurfacing of skin and pores >>>.

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Fractional laser: price

Fraxel prices in Moscow for procedures differ depending on the treatment area and the type of fractional laser itself. Below we have indicated the cost of the procedure using the Fraxel restore device. Depending on the severity of skin changes, 3-5 procedures may be needed to achieve the desired result.

Fractional laser: procedure price

• the entire face, including eyelids, will average 25,000 - 30,000 rubles,
• only crow's feet near the eyes - about 4500-6000 rubles,
• nasolabial triangle - about 6000 - 8000 rubles.

Fraxel procedure cost

Having analyzed the best cosmetology clinics providing laser fraxel services, we have compiled a table with average prices:

Depending on the chosen fraxel repair or fraxel re store dual, the cost may vary. It is most profitable to do this procedure on the outskirts of Moscow - for example, in the regions of the Eastern Administrative District and the North-Eastern Administrative District. We recommend that you immediately check with the clinic staff by phone how much the full course of procedures will cost in order to get a guaranteed effect. In many clinics you can sign up for Fraxel in advance and avoid wasting time in line.

For comparison, prices for fractional laser resurfacing

Doctors performing the Fraxel procedure

It is extremely important to pay attention to the specialization of the doctor performing this procedure. Do not hesitate to ask the clinic staff - after all, your health and appearance depend on their professionalism. We strongly recommend that you do not perform this service in beauty salons or non-specialized clinics. There are many reviews on the Internet from women and men who have suffered from unqualified doctors. Be vigilant and attentive.

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At what age is the procedure indicated?

• Fractional CO2 exposure-resurfacing is done when indicated and is performed on patients over 18 years of age.
• Fractional CO2 exposure-rejuvenation is recommended for patients over 30 years of age.

The presence of indications and the absence of contraindications are the main criteria for choosing a technique.

The patient's main complaint: laxity above the navel and excess skin.