It is a nonablative fractional laser.
Fraxel heats microscopic zones while sparing skin in between.
Fraxel vs Subcision
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.
Subcision: A needle passed under an indented acne scar to cut the strands holding it down, so the surface can lift. It is aimed at rolling scars specifically, it bruises, and it is almost always combined with something else.
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 Subcision if…
Choose for rolling acne scars that are tethered down, usually combined with needling, laser or filler.
- Soft, wavy rolling scars
- Scars that improve when you stretch the skin
- You can hide a week or two of bruising
Often combined
Can you have both?
A common acne-scar pairing: subcision releases tethered scars and Fraxel smooths the surface. Space them several weeks apart.
Key differences
● Fraxel
● Subcision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Moderate
Moderate
Results showImmediately → 3+ months
1–3 months
1–3 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
Subcision
What is it?
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 releases scar bands.
Fibrous bands tethering depressed scars are cut beneath the skin.
It suits rolling acne scars.
It is not for every pit, mark or raised scar.
It is minor surgery.
It is performed by a clinician with a needle or blade.
History is reviewed.
Bleeding risk, scarring tendency and isotretinoin use are assessed.
What it treats
Evidence level
Fraxel
Subcision
Strong evidenceMost established uses
Acne Scarring
Improves rolling and boxcar scars.
Sun Spots
Clears sun damage.
Rolling Scars
Releases tethered scars.
Moderate evidenceSome supportive research
Wrinkles and Fine Lines
Smooths texture.
Acne Scarring
Best for rolling scars.
Cellulite
Releases dimples.
Limited evidenceEarly or small studies
Melasma
Low settings may help some.
—
Little evidence
Ice Pick Scars
Too deep for most sessions.
Boxcar Scars
Better treated with resurfacing.
Not effective
—
Ice Pick Scars
Too narrow to release.
Can make it worse
Rosacea
Can worsen redness.
—
Treatment areas
Treatment areas
Face and hands.
Selected facial scars; the highlighted cheeks show the general treatment area.
Skin tones
Skin tone
● Fraxel
● Subcision
Lighter skin
Low risk
Redness and swelling for days.
Low risk
Bruising.
Medium skin
Some risk
Dark marks possible; lower settings help.
Low risk
Bruising may leave brief dark marks.
Deeper skin
Some risk
Safer than ablative lasers at lower density with an experienced provider.
Low risk
One of the lower pigment-risk scar treatments.
How it works
Fraxel
Subcision
How it works
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.
A scar is tethered below skin: Fibrous bands can pull a rolling scar downward. The bands are released: A clinician passes an instrument beneath the scar. Repair follows the release: The depression may improve as the tissue heals and remodels.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Before your treatment
Fraxel
Subcision
Earlier planning
Not specified
6 months before: After isotretinoin: Most providers wait about 6 months before subcision, though this is debated and some treat sooner.
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.
2 weeks before: Sun: Keep the area out of the sun and use SPF 30 or higher.
Before you book: Timing: Get active acne under control first, or new scars form beside the treated ones.
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.
Actives and supplements: With your prescriber's agreement, stop blood-thinning supplements such as fish oil, vitamin E and ginkgo.
Day of treatment
Fraxel
Subcision
Before you arrive
Arrive with clean skin and no makeup.
Arrange a ride if you will have strong settings or oral pain medicine.
Not specified
Arrival & prep
Skin is cleaned and photographed. Numbing cream stays on for 45–60 minutes.
Photographs first, then the skin is stretched and lit from the side so tethered scars stand out.
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 tiny entry point is made beside the scar, and the needle or cannula is passed underneath and moved side to side in a fan until the skin releases.
You feel pressure, tugging and a faint crunching as the strands give way. Firm pressure follows to limit bruising, and filler or microneedling may follow. Usually 15 to 45 minutes, and once numb it is pressure, not pain.
Before you leave
Skin feels hot, red and swollen. Ice packs and a bland ointment are usually applied.
Swollen, red and firm, with the treated scars looking temporarily better from the swelling.
After your treatment
Fraxel
Subcision
First 24 hours
Days 1–2: Redness and swelling, especially around the eyes.
Days 1 to 3: Deep purple bruising appears and spreads downward with gravity, worst around day two or three.
Days 2–7
Days 3–7: Rough, bronzed skin flakes away. Do not scrub or pick.
Days 4 to 14: The bruises turn green and yellow, and concealer covers them reasonably well from about day three, once the entry points have sealed.
Weeks 2–4
Not specified
Weeks 2 to 12: Small firm lumps can be felt as the scar tissue remodels, and most soften on their own.
Beyond 1 month
1–3 months: Time to results.
Scar improvement can last years; sun damage can return with sun exposure.
Not specified
Time to results
Not specified
1–3 months
How long results last
Not specified
Long-lasting
Risks
Risks
- Dark patches
- Worsening redness
- Cold sores
- Acne or white bumps
- Lighter patches
- A firm lump that is growing
- Bruising that keeps expanding
- A new brown mark
- A cold sore outbreak
- A scar that looks deeper afterward
Cost
Per session
About $900–1,500 for a full face in the US. Smaller areas cost less.
In the US, subcision commonly runs a few hundred dollars per session, and the price rises when filler, microneedling or radiofrequency needling is added — filler is often the larger part of the bill.
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 almost never covers subcision for acne scars, because scar treatment for appearance is cosmetic.
Questions
Fraxel
Subcision
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.
How do I know if my scars are the right type?
Stretch the skin either side of the scar, or press gently beside it. If the dip flattens out, it is tethered, and that is the scar subcision treats. Scars with sharp punched-out edges that stay put when you stretch are icepick or boxcar scars and need something else.
How long does the bruising last?
Usually 7 to 14 days. It looks worst around day two or three, then turns green and yellow, and concealer works from about day three. Plan for two clear weeks, not one.
Will one session be enough?
Usually not. Most courses are 2 to 4 sessions, 4 to 8 weeks apart. Some of the immediate improvement is lost as cut strands reattach, and the gain builds over the course.
Do I need filler with it?
Not always, but many providers add it. Filler holds the released space open while new collagen forms, which reduces retethering. Ask what would be used, how much, and what it adds to the cost.
Does it hurt?
The numbing injections sting for a few seconds and are the worst part. After that it is pressure and tugging, not sharp pain. The area is sore for a day or two, like a deep bruise.
Is it safe on deeper skin tones?
Yes, and it is often a good choice, because it uses no heat or light. The thing to manage is a temporary brown mark where the bruising was. Sun protection, limiting the bruising and spacing sessions all help.
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