This document has been prepared to help provide you with information about Fraxel™ laser treatment, its risks, and alternative treatments. It is important that you read this information carefully and completely.
Lasers have been used by plastic surgeons and other physicians as a surgical instrument for many years. Laser energy can be used to cut, vaporize or selectively remove skin and deeper tissues. There are many different methods for the surgical use of lasers.
Traditional laser skin resurfacing procedures (using CO² and Erbium lasers) involve ablative techniques, resurfacing broad areas of skin. These carry a high-risk profile, procedure problematic side-effects and entail prolonged post-operative healing and recovery times. Non-ablative techniques (using various other lasers or Intense Pulsed Light) carry fewer risks but generally produce only limited improvement.
Fraxel™ laser treatment is a new approach, using fractional photothermolysis, providing many of the benefits of invasive skin resurfacing performed with traditional devices, but with fewer side-effects and less recovery time.
Fraxel™ laser treatment is used to treat conditions such as fine wrinkles, fine lines, surface roughness, acne scars, enlarged pores, brown spots and pigmented lesions.
The Fraxel™ laser procedure requires multiple treatments over a period of several months. Photographs may be taken to document the changes that take place. With your consent, these photos may be used for publication or presentation in a scientific journal or lecture; however, your name will remain confidential.
You will be interviewed to obtain information regarding your medical history, and a clinical examination will be conducted to assess your skin type and to determine if you are a good candidate for this treatment.
- Prior to treatment, you will be asked to remove any make-up you are wearing.
- The area to be treated will be anesthetized with topical numbing cream.
- Following your treatment, you will experience swelling, redness and flaking similar to moderate sunburn for 3 to 14 days.
- The use of a sun screen is a must after any laser treatment.
- Light flaking or peeling of the skin may also occur.
- The use of moisturizers and make-up can help mask the appearance of flakiness and redness, however, please inform the physician what products you are using or intend on using. Some products contain ingredients that are too active or harsh on the skin and are not recommended. If in doubt, NoviSkin has put together a package of basic products safe to use with your Fraxel™ laser procedure.
Skin treatment programs may be recommended both before and after the Fraxel™ laser treatment in order to enhance the results.
Mechanism of action
Fraxel™ laser treatment produces thousands of tiny treatment zones on the skin, known as microthermal treatment zones. The target chromophore for the Fraxel™ laser is water; however, only a small fraction of the skin is treated at one sitting.
Each wound field is composed of thousands of microthermal zones and surrounding spared tissue units that comprise “nodes” of cutaneous repair.
The wound healing response differs from that in previous techniques because viable cells exist between treatment zones, including epidermal stem cells and transient amplifying cell populations. Each laser hit produces a 30- to 70- μ m plug of microscopic epidermal necrotic debris that naturally exfoliates in approximately 14 days.
During this time, the skin takes on a bronzed appearance. The top layer of the skin (stratum corneum) contains relatively little water; therefore, it remains intact after treatment with the Fraxel™ laser, preventing water loss and reducing the risk of infection. The Fraxel™ laser energy passes through the stratum corneum, thermally denatures the epidermis, and penetrates into the dermis.
The results are both immediate and progressive. Soon after the treatment, the surface of your skin will feel softer and smoother, look brighter and show a more even tone. The next 3 to 6 months will bring more improvement as the deeper layers of the skin continue to create new collagen. Results are long lasting depending on your lifestyle, age, skin condition and skin care regimen.
There are 2 different approaches in treating one’s skin with the Fraxel™ laser:
the gentle approach (performed by one of NoviSkin’s qualified therapists) means less downtime/recovery time 6 to 72 hours) , however, more treatments are needed (generally 8 to 12). We refer to this treatment as Fraxel™ 2+ (for texture and rejuvenation) or Fraxel™ 4+ (for texture, rejuvenation and pigmentation).
the stronger, slightly more aggressive approach (performed by one of NoviSkin’s medical aesthetic physicians) means longer downtime/recovery time (5 to 7 days), however, fewer treatments are needed (generally 4 to 6). We refer to this treatment as Fraxel™ 8+ (for texture, rejuvenation, pore size, scarring and pigmentation).
Given that Fraxel™ laser treatments can treat many indications, please discuss alternative options specific to your aesthetic needs with your physician. Some alternative treatments can include:
- Surgical procedures such as Dermabrasion
- Chemical peels
- Excisional surgery
- Other types of laser treatment such as CO², Erbium and Intense Light may be substituted.
In certain situations, Fraxel™ laser may offer a specific therapeutic advantage over other forms of treatment. Alternatively, Fraxel™ laser treatment may not always represent a better alternative to other forms of skin treatment, surgery or laser. Risks and potential complications are associated with alternative forms of treatment.
It is advised that you do not undergo Fraxel should you be affected by any of these contra-indications:
- Skin infection – at the treatment site.
- Skin Cancer / Skin Disorders – laser skin treatments may not offer protection against developing skin cancer or skin disorders in the future. Laser energy directed at skin lesions may potentially vaporize the lesion. Laboratory examination of the tissue specimen may not be possible.
- Damaged Skin – skin that has been previously treated with deep chemical peels, dermal abrasion, or radiation therapy may heal slower than normal skin following treatment by lasers. The occurrence of this is not predictable. Additional treatments may be necessary.
- Roaccutane® (isoretinoin) – Roaccutane (or any of its generic forms) is a prescription medication used to treat acne and other skin diseases. This drug may impair the ability of skin to heal following laser treatments or surgery for a variable amount of time, even after the patient has stopped taking it. Individuals who have taken this drug should advise Dr Duvenage, Dr Nadesan and staff and allow their skin adequate time to recover from Roaccutane (or any of its generic forms) before undergoing laser skin treatment.
Be aware that Fraxel™ Laser Treatments may influence
Dermal fillers – A variety of injectable products are used to plump up deep wrinkles and facial lines. These products are injected into the dermis or inner skin and are known as “dermal fillers”. The most commonly used fillers are Hyaluronic Acid-based fillers and Collagen-based fillers. Fraxel™ laser treatment performed over these products is usually safe, but the treatment is likely to cause these dermal fillers to disappear.
Other wrinkle fillers, including liquid silicone, are longer lasting and more likely to cause prolonged skin irritation with Fraxel™ laser treatment.
The occurrence of problems with laser treatment over dermal fillers is unpredictable. It is essential that you inform your NoviSkin physician if you have ever been injected with dermal fillers.
Distortion of Anatomic Features – Laser skin treatments can produce distortion of the appearance of tattoos and permanent make-up such as liners used on lips, eyelids and eyebrows. Please inform Dr Duvenage, Dr Nadesan and staff of such at each treatment session
Although the majority of patients do not experience these complications, you should discuss each of them with your NoviSkin physician to make sure you understand the risk, potential complications and consequences of laser skin treatment.
Pain – Patients usually experience a hot prickling sensation of the skin with Fraxel™ laser treatment. Topical anaesthetic ointment and a cooling device are used to help control the discomfort during treatment. Depending on patient feedback during the procedure, the energy settings of the laser can be adjusted to minimize any painful sensation. For several hours after the procedure, the patient may feel a stinging sensation similar to mild sunburn.
Swelling – Fraxel™ laser treatment usually causes moderate swelling which may last from 2 to 7 days. Laser treatment sessions can be performed at lower or higher energy settings, depending on patient’s individual responses and preferences.
Redness – Fraxel™ laser treatment will cause redness, pinkness or bronzing of the area (similar to a mild to moderate sunburn), which usually resolves in 3 to 14 days.
Flaking – The skin will flake for up to 2 weeks after treatment. This exfoliation takes place as the reorganized epidermal skin replaces aged or photo-damaged skin. Moisturizers and make-up can help control or conceal the flaking, however, please inform the physician what products you are using or intend on using. Some products contain ingredients that are too active or harsh on the skin and are not recommended. If in doubt, NoviSkin has put together a package of basic products safe to use with your Fraxel™ laser procedure. It is important not to pull or pick at flakes or scabs, as this will tear the newly resurfaced skin and may cause scars.
Bruises – Rarely, the laser treatment may cause some pinpoint bleeding in the skin which will stop without any lasting effect, usually disappears in 1 to 2 weeks.
Herpes Simplex Virus – Patients with a history of fever blisters or Herpes Simplex Virus infections should take Zelitrex or similar medication both before and after each laser treatment in order to suppress an infection from the virus.
Blistering – The laser procedure may produce heat in the upper layers of the skin, resulting in blister formation(s). The blisters usually resolve within a week. If you develop any blisters, please inform NoviSkin immediately on 012 460 4646/50, so that we may prescribe an appropriate ointment.
Scabs – A scab may be present after a blister forms. The scabs will disappear during the natural wound-healing process of the skin.
Scars – Although normal healing after the procedure is expected, in some rare cases, keloids or raised scars may result. Scars may be unattractive and of a different colour than the surrounding skin. Addition treatments may be needed to treat scars.
Burns – Burns are rare, yet represent the effect of heat produced by laser energy. However, the eyes should be kept gently shut (not squeezed shut) during the procedure as an added precaution.
Visible Skin Patterns – There is the possibility of irregular colour variations within the skin including areas that are both lighter and darker. Such visible skin patterns can usually be corrected with further sessions of Fraxel™ laser treatment.
Pigment Changes – Although rare, the treated area may heal with increased pigmentation (increased skin colouring). This occurs most often with darker coloured skin and after exposure of the area to the sun. The treated area must be protected from exposure to the sun by using sunscreen for 4 weeks after treatment to minimize the chances of too much pigmentation. These spots usually fade within 3 to 6 months. In some cases, the pigment change is permanent.
In some subjects, the treated area loses pigmentation and becomes lighter than the surrounding skin. Normal colour tends to return gradually over a period of 2 to 4 months.
Infection – Usually a concern when a blister has formed. If you develop any blisters, please inform NoviSkin immediately on 012 460 4646/50. The blister should be covered with ointment until it has been seen by one of NoviSkin’s physicians.
Dry Eyes – Patients who have had laser vision correction or those who already have dry eyes may experience a temporary aggravation of the symptoms of dry eyes when the treatment is performed on the skin of the lower eyelids. This resolves as swelling and puffiness disappear after treatment.
Rosacea – Patients with diagnosed Rosacea often benefit from Fraxel™ laser treatment. However, some patients with Rosacea have experienced a temporary aggravation of redness of their skin lasting several months. The occurrence of this is not predictable.
Allergic reactions – local allergies to ointments or topical preparations have been reported seldom where from the laser itself. Allergic reactions may require additional treatment.
Please take special note of the following:
Lack of Permanent Results – Fraxel™ laser or other treatments may not completely improve or prevent future skin disorders, lesions, or wrinkles. No technique can reverse the signs of skin ageing.
Unsatisfactory Result – There is the possibility of an unsatisfactory result from these procedures. Laser treatment procedures may result in unacceptable visible deformities, skin slough, loss of function, and permanent colour changes in the skin. You may be disappointed with the final result from Fraxel™ laser treatments.
Medical Aid / Insurance – Fees for cosmetic procedures are not covered by Medical Aids / Insurances. Any expenses incurred following a cosmetic procedure, such as hospitalization or treatment of complications, are not usually covered by their policies.
Additional Treatment or Surgery Necessary – There are many variable conditions, which influence the long-term result of laser skin treatments. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with these procedures. Other complications and risks can occur but are even more uncommon. Should complications occur, additional surgery or other treatments may be necessary. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied as to the results that may be obtained.
Any additional treatment or surgery done in the event of complications, or revisionary procedures are done subsequent to the above-listed procedures, will entail additional expenses for which you are responsible. These expenses can include, without limitation, the cost of an operating room, anaesthesia, hospitalization, investigations, medications, medical supplies, surgeon’s fee, and/or other professional services.
Post Care Instructions
- Use plenty of SPF 50 several times a day and avoid large amounts of sun exposure if at all possible. If sun exposure is necessary, wear clothing that covers the treated area.
- Apply a light cream moisturizer whenever feeling dry. Heavy ointments such as Vaseline may clog your pores and cause mild breakouts, so just remember to keep your skin moisturized.
- Do not use abrasive scrubs or toners for 10 days or so after the last treatment. Allow skin to fully heal before returning to normal skin care routine.
- READ YOUR LABELS! If your products have glycolyic acids or Retin A in them, discontinue use for two weeks before your procedure and two weeks post treatment.
- Cleanse and moisturize daily with light, plain products such as Bioderma Sensibio products or Cetaphil and Nutraderm products. If in doubt, NoviSkin has put together a package of basic products safe to use with your Fraxel™ laser procedure.
- If you have a history of cold sores, ask your doctor about care!!
If you have any queries or questions regarding the Fraxel™ laser treatments, please contact NoviSkin on 012 460 4646/50 and one of our staff members will gladly assist you. For appointments, please contact our reception on 012 460 4646/50.