Fraxel restore Dual Laser treatments have been generating very happy and excited patients around our office lately. This newest laser system is very specific for removing unwanted brown spots, pigment, and fine to moderate wrinkles quickly, safely, and effectively. We have just added a You Tube video to help educate patients about Fraxel Dual laser. To see Dr. Persky performing and discussing a Fraxel restore Dual laser treatment go to http://www.youtube.com/watch?v=4FjGCW3dEPU. If you have any questions regarding Fraxel Dual, or for that matter any other questions that may arise regarding facial cosmetic surgery, please feel free to call or email our office. Dr. Persky will be happy to answer your all of your questions. Be well.

Fraxel laser has become the leader in fractionated non-invasive skin rejuvenation laser technologies. As predicted, "Fraxel" as become a verb in the English language as in, "I am Fraxeling my face". What began in early 2001 as a challenge from the brilliant and forward thinking Rox Anderson, MD (Boston, MA) to Reliant Inc. has evolved into 4 distinct Fraxel laser treatment platforms; restore, refine, repair, repair Lite, and Dual. Solta Inc. now manufactures Fraxel.

Michael A. Persky, MD has embraced Fraxel technology from its original Fraxel restore release in early 2004 to the current recent release (1/10) of Fraxel Dual. Dr. Persky would like to share his thoughts about Fraxel.

Fraxel Dual combines two lasers in one system, the restore and the Thulium 1927. The restore is an amped up version of the originally released Fraxel restore (SR750, now 1550) that works by heating the skin with an Erbium laser that stimulates collagen production without damage to the superficial skin, thus with very little downtime. Patients are red and slightly swollen for about 2 days followed by 3 to 4 days of "bronzing", and then return to their normal state with a few less fine to moderate wrinkles and brown spots. This newer version of restore is 25% faster, and more effective, requiring on average 25% fewer treatments.

The latest addition to the Fraxel menu is theThulium 1927 portion of Fraxel Dual which addresses brown spots and melasma on the face and body. It is very effective at treating age spots, freckles, and other brown pigment skin problems, in many cases with a single quick, painless treatment. It has been referred to by one of Dr. Persky's patients as "IPL on steroids!" With Thulium 1927 downtime is related to superficial skin peeling which takes from 5 to 10 days depending on the individual.

With Fraxel Dual, the restore and Thulium lasers may be combined for both superficial and deep non-ablative skin resurfacing with minimal downtime.

The most dramatically rejuvenating of the Fraxel lasers is Fraxel repair. Fraxel repair is an ablative fractionated carbon dioxide (CO2) laser that is capable of helping patients look years younger, retaining their natural appearance with a non-surgical treatment. Our experience with treating patients with Fraxel repair over the past two years has been excellent. The laser actually removes a volume of skin causing tightening immediately followed by 4 to 6 months of collagen production. It is particularly effective around the eye lids, cheeks, and neck. Skin tone, texture, and color improve. Some patients have opted for second treatments with repair, and benefit from results that are greater than single treatments added together. Surgical and acne scars respond dramatically to the treatment, but for scars usually 2 to 3 treatments are required for optimal results. The downtime for repair is 7 to 10 days for return to work, but it may take 4 to 8 weeks for skin color to return to normal. Most patients enjoy the " sun-vacation color" from about the second week on.

Fraxel repair Lite is a popular treatment among patients who want to keep a fresh rosy glow to their face. It involves using Fraxel repair at very low settings; therefore there is minimal downtime, maybe two days of moderate swelling and redness. Patients love the way their skin looks and feels after Lite treatments, but a recent repeat Lite patient commented, "Dr. Persky, you need to warn your patients that this Lite is addictive because my skin looks so good." Lite is also effective at boosting the effects of full Fraxel repair treatments in patients who desire a little more kick to their skin rejuvenation.

Fraxel refine is a controlled version of Fraxel restore, with limited power and treatment settings to allow the placement of the laser into medispas and cosmetology salons.

As with all facial cosmetic procedures, patient expectations are paramount. Dr. Persky's vast experience with Fraxel since 2004, particularly with Fraxel repair has resulted in an emphasis on patient expectations at the original consultation. The vast majority of patients respond extremely well to the treatment, looking years younger. There have been a handful of patients who have not responded to the treatment as well as others. Many of these patients respond well to a second repair treatment or Lite treatment. These secondary treatments are provided at reduced charge, the cost of operating the disposable components of the laser.

Lastly, we recommend that our patients protect their investment in their skin rejuvenation by using excellent skin care products following Fraxel treatments. A commitment to using sun protection and avoiding excessive sun exposure is most helpful.

The Fraxel Dual Laser is the latest and most effective improvement in laser therapy for the treatment of bothersome brown spots. Certainly, Fraxel Dual is not as exciting, romantic, or dangerous as the "duals" created by Alexandre Dumas in his classics, "The Three Musketeers" and "The Count of Monte Cristo", but when treating brown spots on the skin, worthy of Athos, Porthos, and Aramis' motto, "One for all, and all for one!"

Fraxel Dual is a quick, easy, and painless laser skin rejuvenation safely performed in the office. Downtime is minimal involving 2 to 3 days of redness and swelling followed by another 4 to 7 days of peeling (like after one of those early summer sun burns when we were sun worshipping teens). The face, neck, chest, hands, and any other area of the body can be treated. The laser is 25% faster than previous technologies.

Patients comment that their skin looks and feels rosy and fresh, and that even fine wrinkles are improved. One of our most recent patients who had previous experience with multiple series of IPL (Intense Pulsed Light) laser treatments remarked, "The Dual is great, it is like IPL on Steroids!"

I am sure that you will be seeing and hearing a great deal of positive press in the near future regarding Fraxel Dual skin rejuvenation. In the meantime, if you have not yet read "The Count of Monte Cristo" I recommend it highly. Enjoy!

Be well.

Fraxel restore is the original Fraxel laser product, a fractionated Erbium laser that works at 1550 nanometer wavelength. It is non-ablative, heats the skin in pixilated columns that results in collagen stimulation over time, resulting in improvement of fine to moderate lines and wrinkles, and improvement in skin pigmentation (as well as tone and texture). The older Fraxel restore required a series of treatments (4-6) separated by about 2 to 3 weeks. The Dual's 1550 has been modified to be faster, more effective, and more comfortable than the prior Fraxel re:store laser. Usually patients will require 3 instead of 4 treatments with this laser as compared to the previous version. It is also effective for the treatment of acne, traumatic, and surgical scars.

Fraxel Dual laser adds another laser to the restore laser. The new wavelength is 1927 nanometers; it is a Thulium laser (say that a few times in a row). 1927nm is very specific and effective at treating brown pigment including sun damage lentigines (sun spots), aging spots, and studies are being conducted for the treatment of melasma. In a single treatment, remarkable clearance of pigment occurs within 7 to 10 days. The treatment is very tolerable, either with or without numbing cream. The face as well as the entire body can be treated. Unlike IPL treatments, usually 1 to 2 treatments are all that are necessary for fresh rosy skin.

Patients also like the comfort, quickness, and uniform application of the laser. Solta, the company that makes Fraxel, will not be offering stand alone Fraxel restore units. They will only be selling the "Fraxel restore Dual". Another advantage of the Dual is that the two laser treatments can be combined at the same treatment session for those patients who desire a deeper treatment for collagen stimulation along with eradication of brown spots.

We believe that Fraxel restore Dual will be a very popular treatment, especially here in California. Many of the first patients treated have been actresses, treating their face, chest, and hands. Patients are extremely happy and excited with their fresh new skin. The big question is how long will the results last? That will depend on the individual patient, their sun protection habits (including clothing, hats, physical sun block, etc.), and in melasma patients their hormone levels (which should be normal at the time of treatment).

Dr. Persky is proud to be the first facial plastic surgeon in Southern California to offer his patients all of the available Fraxel laser platforms including Fraxel restore Dual and Fraxel repair.

Good luck, be well, and wear your sun screen.

Dr. P

Here is a list of frequently asked questions about the new Fraxel Dual Laser by Solta:

What is different between the new Fraxel re:store Dual and the older Fraxel re:store?

The Fraxel re:store Dual is a combination of the 1550nm laser which the older re:store had, and the 1927nm laser, which is the only laser with this wavelegth. With the older Fraxel re:store, 4 treatments were recommended, now the same correction with the Dual can usually be done in only 3 treatments. The improvements in the 1550nm are:

Faster Treatment Times - With upgrades in the software, you can cut treatment times by about 25% and have no degredation in effectiveness More Comfort - The new handpiece has an integrated Zimmer Cooling Device (cold air) which allows for the skin to be chilled directly where the treatment is occuring.

The 1927nm wavelength allows for:

Groundbreaking pigment eradication - The 1927 allows for a very superficial resurfacing which can eliminate pigmentation from melasma, hyperpigmentation, sun damage, actinic keratosis safely in all skin types, on all parts of the body. It is thought that it will be more effective in treating melasma as it produces minimal heat compared to other laser systems.

Extremely comfortable - very little, if any topical anesthesia is needed for using just the 1927nm laser. This allows for large surface areas to be treated in a single session.

Superfical resufacing similar to a superficial CO2 laser resurfacing - without the downtime or wound care. It is partially ablative, partial nonablative.
When used simultaneously with the 1550nm laser, you get more effective resurfacing - a superficial and deep resurfacing - leading to less treatments for the same results.

Safe for all skin types and all body surfaces.

Please explain further the Fraxel Dual 1550nm nonablative fractional resurfacing?
Fractional laser resurfacing is treating a fraction of the skin with the laser and leaving the majority of the skin uneffected. Typically about 20-35% of the skin is treated with microthermal zones (MTZ's). These MTZ's are columns of tissue heated by the laser that are about 1/10'th the diameter of a hair. By only treating a portion of the skin, the downtime and risks are minimized but the treatment depths can actually be higher - leading to more effective treatments. The 1550nm laser is an Erbium laser which is a rather "cold" laser. It causes very little "peripheral" damage when creating MTZ's, and just heats the tissue. This is nonablative resurfacing. In contrast, the CO2 laser vaporizes tissue (removes tissue) which is ablative resurfacing. Typically, nonablative resurfacing will require multiple treatments, and will have minimal or no downtime.

What can this laser do?

FDA indications include treatment of pigmented lesions, acne scars, melasma, mild to moderate periorbital rhytids (wrinkles), surgical scars and actinic keratosis. Physicians have been using the 1550 nm restore for stretch marks, burns, improvement in pore size with great results. The addition of both wavelenths in a single treatment makes the improvements faster and increases its effectiveness.

For pigmentation, should I do IPL or Fraxel Dual?

An IPL is limited by the natural pigmentation in the skin. If there is a large difference between the area of pigmentation which one wants to remove and the natural skin color, IPL is effective. However, if the pigmentation is light, or very close to the skin color, an IPL has trouble safely removing the pigment. The Fraxel Dual does not care what skin color you are or what color the pigment is. It works by going down to the layer of skin where the abnormal pigment is, and renews/resurfaces it. An IPL can take up to 4 treatments to remove pigment and the Dual should take 1 or 2.

What can I expect after the procedure?

You will have pinkness and mild swelling for about 3 days. There is no wound care, and no dressing changes. Your skin will feel dry and we recommend a moisturizer such as SkinCeuticals Hydra-Balm or Epidermal Repair, Cetaphil, or Aquaphor. After a few days your skin will bronze and feel rough. It is about to peel at this time, and the peeling will take about 3 days to complete. Your skin will then look very refreshed and pink and will return to its natural color in about 5-10 days. By 10 days, my patients look like they have make up or powder on because of the uniform color of their skin.

What are other physicians saying about the Dual?

“With the new technology I can offer my patients the safety, comfort and minimal downtime of a non-ablative treatment and achieve results comparable to superficial fractional CO2 treatments. Dr. Vic Narukar, San Francisco, CA

“The expanded versatility of the Fraxel re:store Dual System, with the addition of the new 1927 nm wavelength, increases the number of patients I can treat by providing a safe and very effective treatment for the pigmentation and actinic keratoses associated with photodamage.” Dr. Roy Geroneumus, New York, NY

"I think that Solta Medical (Fraxel) is underestimating the potential for the 1927 laser. I have seen tremendous improvements in my patients in areas other than pigmentation. The beauty of the minimal downtime and minimal discomfort makes this laser very well received with clients, particularly with its effectiveness. This might be the most effective laser vs downtime on the market. I’m very excited about its possibilities." Steve Weiner, MD Santa Rosa Beach, FL

"It is the best Dual since at least Hamilton-Burr" Michael A. Persky, MD Encino, CA
If you should have any further questions or concerns regarding this incredible new technology, please contact me. Be well and wear you sun protection. Dr. P

Seeing is believing. After treating his own patients and closely following the remarkable results of their treatments, Dr. Persky has added the Dual Fraxel Laser System to his Encino practice where many of Beverly Hills and Hollywood's "faces" are treated. Dr. Persky is the first facial plastic surgeon in Southern California to offer his patients all of the available Fraxel platform laser treatments including Fraxel restore, Fraxel repair, and now Fraxel Dual (renew). Dual is the premiere laser treatment for the removal of brown spots, aging spots, and melasma. Dr. Persky has treated patients worldwide with Fraxel lasers, and is very excited about this groundbreaking technology.

The advantages of Dual Fraxel treatment are that up to 50% of the face, and 40% of body surface areas may be treated at one time. In the past, only 20 to 30% of facial and body skin could be treated requiring 3 to 5 treatment sessions. With Dual, most patients require 1 to 2 treatments.

Dual treatments are not only very safe (only the upper 0.2 millimeters of the skin is treated) and effective, but are also quick and relatively painless when compared to the other laser treatments currently available. It can be adjusted to treat all skin types and skin colors.

Fraxel Dual is 2 lasers in one, an improved Fraxel restore for wrinkles, scars, strechmarks, pigment which is faster, involves less treatments, and less discomfort. The second laser system is a unique, new wavelength added - 1927 nm - for rapid resolution of pigment on any skin type, any part of the body with one or two treatments. Superficial resurfacing similar to superficial CO2 without the downtime.

We are most excited about helping our patients get rid of those bothersome age related brown spots on their face and body. So whether it's on the "Red Carpet", or in the grocery store check-out line, we are pleased to have added more one tool to help you achieve your cosmtic goals. Be well and wear your sunblock.

Dr. Persky is the only facial plastic surgeon in Southern California with all of the Fraxel platforms available to his patients.

American Health and Beauty, a cosmetic surgery patient information website has named Fraxel as the top fractional laser treatment in going into 2010.

Fractional resurfacing is the next level of skin treatment. With little downtime and no surgery involved, it is a popular choice for those desiring better skin.

Unlike traditional laser devices, fractional laser systems treat only a fraction of skin at a time, leaving the surrounding area intact for fast healing. Rather than a large beam of energy, there are several smaller energy columns that leave undamaged spaces of skin in between - resulting in greater patient comfort and quicker healing.

1 Fraxel
Fraxel from Solta Medical is one of the most well known of all fractional resurfacing procedures. Fraxel refers to not just one machine but a family of lasers which include the Fraxel re:pair, re:store, and re:fine. This year, they released their latest laser - the Fraxel re:pair Dual that is the first to use the 1927nm Thalium laser, allowing treatment of areas other than the face.

2 ActiveFX
ActiveFX from Lumenis is a fractional CO2 laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities. ActiveFX is the most common of a group of procedures performed by the UltraPulse Encore CO2 laser.

3 Pearl Laser
The Pearl procedure combines the impact of resurfacing lasers with the gentleness and safety of non-invasive procedures to treat aging and sun-damaged skin. Pearl, developed by Cutera, reduces wrinkles, uneven texture and solar damage with fewer treatments and less overall recovery than other technologies to provide a healthy, pearl-like glow.

4 Affirm
Affirm Laser treatments are taken to the next level with the Combined Apex Pulse (CAP) technology in the Affirm system, from Cynosure. The Affirm is a fractional light energy device that allows for a more relaxed and effective treatment with lasting results for patients.

5 eMatrix
eMatrix from Syneron became very popular in September when Sublative Rejuvenation was added to the device. Sublative Rejuvenation using eMatrix provides a safer alternative to traditional facial rejuvenation procedures. eMatrix RF with Sublative Rejuvenation is even available for many people whose skin type or skin color makes traditional ablation techniques impossible. Yes, Sublative Rejuvenation is safe for ALL skin types.

American Health & Beauty www.americanhealthandbeauty.com Source: AHB

Two weeks ago Dr. Persky treated our first two patients with the newest Fraxel laser, the Fraxel Dual Laser System. Both patients already have fabulous "Wow!" results.

Using a new wavelength and Thulium laser, the new Fraxel restore Dual Laser System is set to take fractional resurfacing to a new level. The laser is able to not only restore the skin on the face, but on large portions of the body as well. It treats sun damaged superficial skin and in a single quick and pain free office treatment greatly diminishes brown pigmented skin lesions. Both patients experienced no pain, 2 days of redness and minimal swelling followed by about 4 to 5 days of a thin peel. One patient went to work the next day while the other said definitely stay home for a day or two. At 10 days both patients commented how clear their skin appeared, and the most common reaction from friends and family was that they "had make-up on" when they did not. My initial reaction was the same, I actually asked both if they were wearing make up. There was also a noticeable improvement in volume in the face. Both patients have commented that they want the treatment on their arms, legs, and chest as well.

The machine boasts several advantages, including greater ease of use for the physician and a shorter treatment time. Solta Medical (Hayward, Ca) states that the machine will allow greater comfort for the patient and faster results. Fractional resurfacing is a procedure that has been largely limited to the face so the addition of an effective superficial treatment for the body is welcome.

The Dual Laser will be used to complement the other Fraxel® family of products, which includes the Fraxel restore laser system, the Fraxel repair laser system and the Fraxel refine laser system, which have swiftly become the cosmetic industry standard for fractional aesthetic skin rejuvenation treatment. Fraxel brand fractional laser systems treat only a fraction of skin at a time, leaving the surrounding area intact for fast healing, as opposed to traditional laser treatments which are more aggressive.

Yesterday on the plastic surgery patient chat site RealSelf.com, Carol from La Jolla asked is Fraxel an option instead of facelift "If I don't want to do a Facelift; is the Fraxel laser a good option?" The question stirred many answers (18), so many that after participating in a 12 hour marathon charity golf tournament, I was too late and locked out from answering the question on the site. Here is my answer, "Hi Carol, You have asked a great question and obviously one that strikes controversy in the facial plastic surgery world with close to 20 responses here on RS. To answer your question precisely as you asked it, yes Fraxel repair or Deep FX are excellent options for patients who do not wish to undergo surgical facelift, but desire to look younger, healthier, and natural. Fractionated CO2 lasers will not replace surgical face-lifting (particularly in patients with large amount of excessive tissue), but are one of the best options for those who don't want to have surgery. It is a great treatment for men and women in their 40's and 50's experiencing the dredded early signs of aging, loss of mid facial volume, eyelid wrinkles, and the first appearance of jowling. In many patients who have minimal laxity of their face and neck, there is enough tightening so that face lift is not necessary. Again, depending upon the individual patient's anatomy, there is a subset of patients who will likely not need surgical face-lifting with the combination of fractionated CO2 laser, radiofrequency skin tightening such as Accent XL, and fillers. It also is effective in patients in their 60's and 70's. Great question, please join us at our next plastic surgical meeting on the Controversies Panel. Be well, Dr. P

If you are reading this, you are among the many patients who use the Internet as a source of information, particularily medical/surgical information. As we all know, the Internet is an amazing reference source, but can also be a source of misinformation. Frequently patients ask about the "horror" stories that they read about Fraxel repair on the Internet. I have decided to copy an email answer here for my patients and prospective patients regarding these concerns: "Dr. Persky, thank you so much for your prompt and helpful reply. I need to bother you once more. I have read horror stories about people ending up with oozing sores, slackened facial muscles, damaged facial tissue and other terrible after effects even years after Fraxel repair. I am deeply concerned. What gives?" Fractionated CO2 lasers are very powerful tools to rejuvenate patients in ways that we have not been able to in the past. The treatment is not a commodity, but rather a medical-surgical procedure that needs to be tailored to the individual patient by an experienced, skilled, and caring physician. Even with all of that, there will always be the possibility of complications. Anyone who gives 100% guarantee of results with 0% chance of adverse events is not truthful. Before the treatment, all patients are given an informed consent regarding the possible risks and complications of the procedure, just like with any surgery. There have been and there will be complications with fractionated CO2 lasers. I can only be responsible for my own patients and their well being. Should an adverse event arise, the difference between a good physician and a great physician is how they take care of their complications. I will continue to do my best to insure that my patients have safe and effective results with their Fraxel repair treatments. Be well.

Veteran Los Angeles television journalist Ms. Marta Waller had her second Fraxel repair treatment one week ago. The treatment was "streamed" live over the internet on Livestream with simultaneous live Twitter questions and answers (it was not as exciting as Carnie Wilson's lap band internet surgery) . Additionally, Ms. Waller has documented her 2'nd recovery process as well on Livestream. To watch either her full treatment or her recovery updates go to Livestream http://www.livestream.com/martavision Be well.

I will be performing a Fraxel repair laser skin rejuvenation treatment of the face, neck and chest live tomorrow at 10:30 am PST. It will be on http://www.livestream.com/martavision. There will be a live Twitter feed as well so that questions and comments will be answered during the treatment. See you tomorrow. Dr. P

Adam Lambert of American Idol has incredible talent and we will be seeing him very much for years to come.

Patients have commented to me about the texture of Adam's skin. It appears that Adam has the residual of acne scarring.

His acne scarring would respond well to a series of Fraxel repair treatments. His only problem would be finding the 10 to 14 days to recover with his busy schedule (but not being adverse to wearing make up, he would only need about 7 days to get back to work).

Congratulations to Adam on his American Idol season and his very promising future career.

Our office is now offering Laser Facial treatments. The treatment is quick, easy, and painless. Great treatment for those who want to look their best.

The current April issue of Vogue magazine (the one with Beyonce on the cover) has an excellent article on page 146 entitled "Easy Does It", by Catherine Piercy. The article is the first major beauty/glamour magazine that features fractionated carbon dioxide (CO2) lasers. It touts this incredible technology as "The Next Big Thing in dermatology". We have been using Fraxel repair (a premiere fractionated CO2 laser) for the past year on over 100 patients with excellent results. For more information on how to look years younger, fresher, healthier, while still looking like you, go to other entries here in Dr. Persky's blog.