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Fraxel vs Scar Revision

Fraxel: A laser that heats thousands of microscopic columns in the skin and leaves the skin between them untouched. Used for sun damage, acne scars, and rough texture. It takes a course of treatments and a few days of looking sunburned each time.

Scar Revision: The whole set of procedures used to make an existing scar less noticeable — cutting it out and closing it more neatly, flattening it, releasing it, or resurfacing it. No procedure erases a scar. Revision trades the scar you have for one you would rather live with.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Fraxel, based on the entry’s treatment or equipment reference.Editorial illustration for Scar Revision, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Fraxel if…

Choose for acne scars or sun damage with a few days of downtime per session instead of the week-plus of ablative lasers.

  • Rolling or boxcar scars
  • Sun spots and rough texture
  • You can plan 3–5 sessions

Choose Scar Revision if…

Choose to trade a scar you dislike for a neater one — no procedure erases a scar.

  • A wide, raised or puckered scar
  • The scar is at least a year old
  • You accept a new, better-placed scar
Often combined

Can you have both?

Fraxel is often used 6 to 8 weeks after scar revision surgery to blend the new scar.

Key differences

● Fraxel
● Scar Revision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Moderate
Moderate
Results showImmediately → 3+ months
1–3 months
3+ months
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
A longer series (4–6+)
A short series (2–3)
Cost per visit$ → $$$$$
$$$
$$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

Fraxel

Scar Revision

What is it?

It is a nonablative fractional laser.

Fraxel heats microscopic zones while sparing skin in between.

Platforms differ.

Wavelength and device determine the treatment.

It is not CO2 resurfacing.

It is less intensive than ablative lasers.

It is not risk-free.

Burns, redness and pigment changes can occur.

It improves scars.

It aims to improve appearance, comfort or movement.

It uses several methods.

Surgery, injections and resurfacing may be combined.

It does not erase scars.

It modifies scar tissue rather than restoring unscarred skin.

Keloids need special care.

Excision alone can cause a larger recurrence.

What it treats

Evidence level
Fraxel
Scar Revision
Strong evidenceMost established uses
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Improves rolling and boxcar scars.

AI-generated educational illustration of Sun Spots: 1. Sun Spots Header — Light Skin; Lighter skin. Not a clinical photograph.

Sun Spots

Clears sun damage.

Scars on light skin.

Scars

Improves width, texture and color.

Moderate evidenceSome supportive research
A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Smooths texture.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Combined with injections to prevent return.

Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Punch excision for deep scars.

Limited evidenceEarly or small studies
Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Low settings may help some.

—
Little evidence
Ice Pick Scars on light skin.

Ice Pick Scars

Too deep for most sessions.

Two areas of fair skin side by side on a hip. New pink-red bands sit above, and older flat silvery-white bands below, with only a small difference in color between the pale marks and the skin around them.

Stretch Marks

Usually treated with lasers or needling.

Can make it worse
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Can worsen redness.

—

Treatment areas

Treatment areas

Face and hands.

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone
● Fraxel
● Scar Revision
Lighter skin
Low risk
Redness and swelling for days.
Low risk
Scar fades over a year.
Medium skin
Some risk
Dark marks possible; lower settings help.
Some risk
Dark marks possible.
Deeper skin
Some risk
Safer than ablative lasers at lower density with an experienced provider.
Higher risk
Keloids can return larger; injections or radiation are often combined.

How it works

Fraxel

Scar Revision

How it works
Fraxel DUAL diagram: 1927 nm reaches up to 0.3 mm and 1550 nm up to 1.6 mm, depending on settings.
Scar Revision mechanism diagram. The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.
Diagram explanation

Fractional heat zones leave surrounding tissue untreated. Superficial 1927 nm treatment helps fade uneven pigmentation; deeper 1550 nm treatment triggers repair and collagen remodeling.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Fraxel
Scar Revision
Earlier planning
Not specified

6 to 12 months: Waiting: Surgeons want 6 to 12 months of natural settling first.

2–4 weeks before

4 weeks before: Sun: Avoid tanning, self-tanner and sunburn.

Pigment preparation: For deeper skin tones, providers may prescribe a pigment-lowering cream for 2–4 weeks and test near the ear.

Sun: Keep the scar out of the sun and use SPF 30 or higher.

2 weeks before: Smoking and vaping: Stop both at least two weeks before and after surgery.

The week before

Cold sores: Tell your provider; preventive antiviral medicine often starts the day before.

Hair removal: Stop waxing, threading and hair-removal creams.

Actives: Stop retinoids, retinol and acids 3–7 days before.

Not specified

Day of treatment

Fraxel
Scar Revision
Before you arrive

Arrive with clean skin and no makeup.

Arrange a ride if you will have strong settings or oral pain medicine.

What to bring: Old photos: Photographs from before the injury, if you have them.

Arrival & prep

Skin is cleaned and photographed. Numbing cream stays on for 45–60 minutes.

The scar is photographed and examined relaxed and stretched.

Treatment

The laser passes over the skin while cold air cools it.

Expect prickly heat that builds with each pass, often strongly uncomfortable—especially on the forehead and around the mouth.

A steroid injection takes minutes and meets real resistance.

Surgical revision cuts the scar out as a narrow ellipse and closes it in layers, usually 30 to 90 minutes. A Z-plasty swaps small flaps to change direction. Punch excision removes a small round scar. Laser or microneedling takes 20 to 45 minutes. Expect pressure, not sharpness.

Before you leave

Skin feels hot, red and swollen. Ice packs and a bland ointment are usually applied.

Tape over the line, wound care instructions, and a date for stitch removal — 5 to 7 days on the face, 10 to 14 days on the body.

After your treatment

Fraxel
Scar Revision
First 24 hours

Days 1–2: Redness and swelling, especially around the eyes.

First 2 weeks: Swollen, bruised and tender.

Days 2–7

Days 3–7: Rough, bronzed skin flakes away. Do not scrub or pick.

Not specified
Weeks 2–4
Not specified

Weeks 2 to 8: The new line turns pink, firm and slightly raised — normal healing, not failure.

Beyond 1 month

1–3 months: Time to results.

Scar improvement can last years; sun damage can return with sun exposure.

Months 3 to 18: Redness fades and the ridge softens from month 3 to 6, with massage and silicone doing the work.

Time to results
Not specified

Over 6–12 months

How long results last
Not specified

Permanent

Risks

Risks
  • Dark patches
  • Worsening redness
  • Cold sores
  • Acne or white bumps
  • Lighter patches
  • A scar thickening or spreading again
  • Itching, burning or tenderness in the scar
  • A dent or pale patch after an injection
  • A new dark patch
  • Numbness or odd sensation

Cost

Per session

About $900–1,500 for a full face in the US. Smaller areas cost less.

In the US this varies more than almost any other dermatology procedure, because "scar revision" covers a five-minute injection and a ninety-minute operation.

Full course

Several thousand dollars. Packages may reduce the per-session price.

Not specified
Insurance

Cosmetic treatment is not covered. Coverage for surgical or injury scars is uncommon.

Insurance often pays when a scar limits movement or vision, interferes with function, or follows cancer surgery or an injury.

Questions

Fraxel

Scar Revision

Individual Questions
How many Fraxel sessions will I need?

Three to five, two to four weeks apart. Sun damage sometimes needs fewer, acne scars usually need the full course, and deeper skin tones are treated at lower settings, which means more sessions.

Does Fraxel get rid of acne scars?

It improves them rather than removing them. Studies of nonablative fractional lasers show partial improvement in scar depth and appearance over a course. Deep icepick scars respond least and are often better treated by combining the laser with subcision or filler.

How much downtime is there really?

Plan for a week. Two days of redness and swelling, then a few days of rough, bronzed skin that flakes off. Most people cover it with makeup from day three and look normal by day seven.

Does it hurt?

With an hour of numbing cream and cold air, most people call it hot and strongly uncomfortable rather than unbearable, and it stops as soon as the laser does. The forehead and around the mouth are the worst.

Is it safe for deeper skin tones?

It can be done, but differently. The main risk is temporary dark patches. Lower settings, more sessions, pre-treatment creams and strict sun protection all lower that risk, and the provider experience with your skin tone matters more than the device.

Is Fraxel the same as CO2 laser?

No, though one device sold under the Fraxel brand is a carbon dioxide laser. The Fraxel most people mean is nonablative, heating the skin without removing the surface. A carbon dioxide laser removes tissue, does more per session, and brings one to two weeks of downtime and more pigment risk.

Can a scar be removed completely?

No. Every treatment replaces the scar with a different one — flatter, narrower, paler, or running in a less obvious direction. Often a large improvement, not removal.

How long should I wait before revising a scar?

Usually 6 to 12 months, because most scars keep improving on their own in that time. Scars that limit movement and raised scars still growing are treated sooner.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound borders and often flattens over a year or two. A keloid grows beyond them, keeps going, and does not settle by itself. Keloids come back after surgery much more often, so they are usually injected rather than cut.

Will scar revision help my acne scars?

Some of them. Rolling scars respond to subcision, needling and laser; deep icepick scars often need punch excision or a targeted acid technique; boxcar scars sit in between. Expect a course and partial improvement, not one operation.

Does insurance cover it?

Sometimes — when the scar restricts movement or vision, causes symptoms, or follows cancer surgery or trauma. Revision for appearance is cosmetic. Ask the office to check with your insurer before you book.

I have deeper skin tone, and I keloid. Is anything safe?

Yes, but the order changes. Injections, silicone and pressure come first, elective surgery on high-risk sites is approached carefully, and if a keloid is removed, something is always done alongside to control the healing. Tell the provider at the first visit.

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