Procedure

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Fraxel (Nonablative Fractional Laser). Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

Fraxel is the treatment I spend the most time setting expectations around: good at sun damage and rough texture, reasonably good at acne scars over a course, and not a face lift.

What I find myself repeating: plan for three to five sessions, and pick a stretch of calendar with nothing social in it, because each one costs a few days of looking flushed and feeling like sandpaper.

The change keeps arriving for months after the last visit, because the collagen part is slow, so judging at week two is judging too early. The honest risk is pigment, and on deeper skin tones, or in anyone with melasma or a recent tan, this laser can leave brown patches that take months to clear, so see someone who treats skin like yours often, start conservatively, and be strict about sunscreen.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledNonablative fractional resurfacing, fractional 1550 nm laser, Fraxel Restore, Fraxel Dual
TreatsSun damage and brown spots, acne and surgical scars, fine lines, rough texture, pores that look enlarged
DowntimeAbout 3 to 7 days. Redness and swelling for the first two days, then a rough, bronzed look that flakes off
SessionsUsually 3 to 5, spaced 2 to 4 weeks apart
Typical costRoughly $900 to $1,500 per full-face session in the US, less for a small area. Varies widely by city and provider
Results timelinePigment looks better in 1 to 2 weeks. Texture, lines and scars keep improving for 3 to 6 months
PainNumbing cream for 45 to 60 minutes, then a hot prickling during the 20 to 30 minutes of treatment
Skin tone safetyCan be done on deeper skin tones with lower settings and an experienced provider. Temporary dark patches are the main risk

What It Is

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Fraxel is a brand of fractional laser. Fractional means it does not treat the whole surface at once: it puts down a grid of tiny treated columns and leaves untreated skin between them, so healing is faster. The Fraxel devices most people mean are nonablative, meaning the laser heats the layer underneath without removing the outer layer. The skin stays intact, so there is no open wound and no dressing. Two wavelengths are used. The 1550 nm setting reaches deeper and works on scars, texture and fine lines. The 1927 nm setting stays shallow and works on brown pigment and sun damage. Many visits use both. Worth clearing up, Fraxel Repair is an ablative carbon dioxide laser sold under the same brand. It is much stronger, with weeks of downtime, and not the treatment on this page.

How It Works

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The laser fires rapid tiny pulses as it moves across the skin, each heating a narrow column of tissue from the surface down into the dermis, the living layer below. These columns are called microthermal treatment zones, and a pass treats only a small percentage of the surface.

The untreated skin between them supplies the cells that repair each column, so healing takes days rather than weeks.

Then two things happen. In the outer layer, the heated cells and the pigment they carried are pushed up and out over the next few days, which is the bronzed, gritty texture around day three and the reason brown spots fade. In the deeper layer, the heat injures collagen and the repair response lays down new collagen over months, changing texture, fine lines and the depth of a scar.

Because the outer layer is never removed, the barrier stays closed throughout. That is the nonablative trade: less downtime and less risk than an ablative laser, and less change per session.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNEEDLINGABLATIVE LASERREACHES THE MID DERMIS

This works around one to one and a half millimetres down, in the middle of the dermis where collagen is made. That is the depth that changes scarring and firmness, and it is also why the downtime is longer and the result takes months to appear. The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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No strong evidence for any condition.

Pros and Cons

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Pros
  • Several problems at once Sun spots, texture, fine lines, acne scars.
  • Downtime measured in days Normal-looking skin within a week.
  • Good evidence behind it Studied for scars, photoaging and pigment for years.
  • The result keeps building Better at three months than three weeks.
Cons
  • It is a course, not a treatment Three to five sessions is normal.
  • It costs a lot A full-face course runs into thousands, and is not covered.
  • It does not tighten Loose skin, jowls and deep icepick scars do not respond.
  • Pigment risk is real Brown patches are the commonest complication.
  • Each session has downtime Two days of swelling, then days of bronzed skin.

How to Prepare

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4 weeks before1 week beforeOn the day
Tanning and pigment cream
4 weeks before
No tanning, self-tanner or sunburn for at least 4 weeks. On deeper skin tones, many providers prescribe a pigment-lowering cream for 2 to 4 weeks and test a spot near the ear.
Actives, hair, cold sores
1 week before
Stop waxing, threading and hair removal creams for a week, and retinoids, retinol and acids 3 to 7 days before. Say if you get cold sores; most providers prescribe an antiviral the day before.
Numbing and a ride
On the day
Clean face, no makeup, and about an hour of numbing cream. Arrange a ride for a strong setting or oral pain medicine.

What Happens

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ArrivingThe treatmentLeaving
Arriving
Skin is cleaned and photographed, and the provider checks what you stopped using and whether you have been in the sun. Settings come from your skin tone, what is being treated, and how much downtime you can take. Numbing cream sits for 45 to 60 minutes. Your provider will ask about these things.
The treatment
The cream is wiped off and a blue tint may go on. The handpiece passes over each area several times in different directions while cold air blows, and heat builds with each pass. A full face takes 20 to 30 minutes. With numbing, most people call it strongly uncomfortable rather than unbearable, worst on the forehead and around the mouth.
Leaving
Skin is red, hot and swollen, like a real sunburn. Ice packs and a bland ointment usually go on before you leave.

Recovery

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Day 1 to 2Day 3 to 7Week 2 to 4
Day 1 to 2
Swelling is worst on the first morning, often around the eyes, and settles over a day or two. Sleep propped on an extra pillow. Cool packs and a plain ointment help, and the redness stays. This is the part people are least prepared for.
Day 3 to 7
Skin turns bronzed and feels like fine sandpaper as the treated cells work their way out. Brown spots look darker before they flake away. Do not scrub or pick; the rough layer sheds by about a week, leaving pink, smooth skin.
Week 2 to 4
Some people break out or get small white bumps called milia. Both settle on their own and are worth mentioning at your next visit rather than picking at.

Aftercare

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2 to 3 days48 to 72 hours4 weeks
Makeup
2 to 3 days
Wait 2 to 3 days, until skin is no longer weeping or intensely red. Mineral makeup first.
Exercise
48 to 72 hours
Heat, sweat and flushing all worsen swelling.
Sun
4 weeks
Strict avoidance and SPF 30 or higher daily for at least 4 weeks. Sun on healing skin is the main cause of dark patches.
Actives
No retinoids, vitamin C or acids until flaking has finished, usually about a week. Restart slowly.
Washing
Cool water and a gentle cleanser, no scrubbing or brushes. A plain ointment or thick bland moisturizer several times a day while it is rough.

Risks

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Most people get redness, swelling and several days of rough skin. That is the expected course. The problems worth knowing are pigment changes, infection, and burns from settings that were too aggressive.

Dark patches
New brown or gray patches, usually 2 to 6 weeks afterward. The most common complication, more likely on deeper skin tones and after sun. Usually temporary, but it can take months to clear and clears faster when treated early.
Redness that is getting worse
Redness that increases after the first week instead of settling.
A cold sore outbreak
Tingling, then blisters, usually around the mouth. Antiviral medicine works best started immediately.
Acne or small white bumps
Common in the weeks after and usually temporary, but treatable rather than something to wait out.
Skin that stays lighter
Pigment loss is uncommon here and harder to correct than dark patches, so raise it early.

In Deeper Skin Tones

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Nonablative fractional lasers are used on deeper skin tones, and that is part of why the technology exists. The risk profile is different, and it should change how the treatment is done.

The main risk is post-inflammatory hyperpigmentation, meaning dark patches left after the skin is inflamed. Skin with more pigment answers heat by making more pigment. It is the complication reported most in deeper skin tones, and while it usually fades, it can take months.

Lower energy, lower density, fewer passes and longer gaps between sessions all cut that risk. That means more sessions for the same result, which costs real money and time, and it belongs in the conversation before you start.

Many providers also pre-treat for 2 to 4 weeks with a pigment-lowering cream, do a small test area, and insist on no recent sun and daily sunscreen afterward. Sunscreen matters more here, not less.

Melasma is its own conversation. Heat can worsen melasma at any skin tone, and melasma is more common in deeper skin tones. Fractional laser is sometimes used for it, but the evidence is mixed and relapse is common, so it needs a provider who treats melasma specifically.

The practical advice is simple: ask how often the provider treats skin like yours, ask what settings they use and why, and be wary of anyone who says skin tone makes no difference.

If You Stop

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Nothing to taper and no rebound. Stop at any point and your skin does not end up worse than it was.

What you have is roughly what you keep, plus whatever is still arriving from the collagen response. Scar improvement generally holds. Texture and fine lines fade slowly over years as skin ages, and new sun spots appear if sun exposure continues, which is why the brightening goes first.

A reasonable point to stop and reassess is after three sessions. If photographs in the same lighting show no real change by then, more of the same is unlikely to help, so discuss a different approach rather than finishing out of momentum.

Combining Treatments

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Same day
Home routine
Skin already on a retinoid and daily sunscreen does better.
Same day
Pigment cream
Between sessions it helps sun spots and lowers the risk of dark patches.
Different visit
Subcision and filler
These reach the tethered and deeply indented scars a laser does not.
Wait 2 weeks
Botulinum toxin and filler
A different visit, commonly a couple of weeks before or after.
Different visit
Vascular laser
Redness and broken capillaries need their own treatment.
Wait 2 weeks
Peels, microneedling, waxing
About 2 weeks either side on the same area, energy devices included.
Until healed
Flaking skin
No laser on skin still flaking from something else.
Wait 2 weeks
Another session
At least 2 weeks apart, further on deeper skin tones.
Wait 6 months
Isotretinoin
Traditionally about 6 months, though recent guidance is more permissive.

Insurance Coverage

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Insurance does not cover this for cosmetic purposes. Scars after surgery or injury are sometimes submitted, but coverage is uncommon.

Ask Your Doctor

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If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding first. Most providers postpone elective laser treatment.
If you get cold sores
Say so even if it has been years. An antiviral tablet the day before is standard, and an outbreak on lasered skin can scar.
If you have taken isotretinoin recently
Say when you finished. It changes the timing and possibly the settings.
If you have melasma
Heat can worsen melasma, so treating it with a laser is a specialized decision.
If you have a deeper skin tone
Ask about settings, test spots, pre-treatment creams, and how they handle dark patches.
If you have had a keloid scar
Thickened scars count. It needs a discussion and usually a test area first.
If you have been in the sun recently
Self-tanner too. Treating tanned skin raises the risk of burns and blotchy pigment, so expect to be rescheduled.
If you take a sun-sensitizing medicine
Some antibiotics and diuretics make skin react more. List everything you take.
If you have an autoimmune condition
Immune-suppressing medicines too. Healing and infection risk both change.
If you have taken gold medication
Rare now, but gold deposits in the skin can react badly to laser light.
If your main concern is sagging skin
Wrong procedure, and better to find out before you pay for a course.

At-Home Versions

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A prescription retinoid, or over-the-counter retinol
Good alternative
Improves fine lines, texture, and pigment over months of daily use. It is the closest thing at home to what a laser does, and it is what keeps a laser result. This is the sensible default.
Daily broad-spectrum sunscreen
Good alternative
Not a treatment for texture, but sun is what causes most of the pigment and much of the fine-line change. Without it, a course of laser is being undone as it goes.
Vitamin C serum and pigment-lowering ingredients such as azelaic acid or niacinamide
Okay alternative
Useful for brown spots and general brightness. Slower and milder than a laser, and safe to keep using long term between sessions.
At-home microneedling rollers
Bad alternative
Needles long enough to help are long enough to injure and to introduce infection, and home devices are not sterilized between uses. Not a home version of this treatment.
Home "fractional laser" handsets
Okay alternative
A small number of low-powered devices exist and are cleared for wrinkles around the eyes. They deliver a tiny fraction of the energy of an office device, and results are correspondingly small.

How It Compares

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MicroneedlingDiagram: how Microneedling works in the skin
Microneedling
The same
Aimed at the same acne scar and texture problems, without light or heat, so the pigment risk is lower, which matters on deeper skin tones. Generally cheaper per session and gentler, and generally slower to show the same amount of change.
Radiofrequency microneedling
Different job
Needles deliver heat below the surface while sparing the top layer, so it is often chosen for deeper skin tones and for people who also want some tightening. Costs more and stings more than plain microneedling.
Ablative fractional carbon dioxide laser
The same
Removes tissue rather than heating it, so it does more per session for scars and lines. It also means an open wound, one to two weeks of real downtime, higher cost, and considerably more pigment risk on deeper skin tones.
A small clear glass bowl holding a shallow pool of pale amber liquid on a white background, with a white fan-shaped brush lying beside it, bristles resting against the bowl.Diagram: how Chemical Peel works in the skin
Chemical peel
Different job
For surface pigment and clogged pores. Much cheaper and available almost anywhere. It works on the surface, so it does not reach indented scars and does far less for texture.
Clear + BrilliantDiagram: how Clear + Brilliant works in the skin
Clear + Brilliant
Worse
From the same manufacturer. A far gentler version of the same idea, with about a day of downtime and a much smaller result per session. A reasonable choice for early texture and dullness, not a substitute for a course of Fraxel on scars.
Topical tretinoin
Different job
Works on fine lines, texture, and pigment daily at home over many months, for a small fraction of the cost. Slower and less dramatic, and it is the thing that holds any laser result in place.

Finding a Provider

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Who may operate a laser varies a great deal by state. In some it must be a physician, physician assistant or nurse practitioner; in others a nurse or a supervised esthetician may treat, and the supervision is often loose. This is a medical procedure with medical complications, so ask who is actually in the building.

Useful questions: which device and wavelength, what energy and density they plan and why, how many people with your skin tone they treat in a typical month, whether they will do a test spot, and the plan if you get dark patches or a burn.

Red flags: a consultation that never asks about your skin tone, tanning, cold sores or medicines. Photos taken in different lighting. Pressure to buy a six-session package on the first visit. A promise that scars will be gone. A provider who cannot name the device, or who calls every laser a Fraxel.

Myths

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  • "It is a one-and-done treatment." It is not. Three to five sessions is the normal course, and marketing showing a dramatic single-session change is usually showing the best possible responder, different lighting, or a stronger ablative device.
  • "Fraxel removes acne scars." It improves them. Studies of nonablative fractional lasers report partial reduction in scar depth over a course, and deep icepick scars respond least.
  • "It tightens skin." It does not lift loose skin or change jowls. New collagen improves texture and fine lines; sagging is structural.
  • "If my skin does not peel, it did not work." Flaking varies with the person and the settings. Some people barely shed and still see change over the following months.
  • "You should avoid it if you have deeper skin tone." Too simple. It can be done at adjusted settings by someone experienced. The risk of temporary dark patches is higher, and the plan should look different.
  • "The results are permanent." Scar improvement generally holds. The brightening does not, because skin keeps aging and the sun keeps making new spots.

Questions Patients Ask

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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.

References

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