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A word about excisions:Since there are many posters that have reported marginal results at best with excisions, I took the opportunity today to discuss surgical techniques with a professor of plastic surgery whom I know and trust.
As said, when attempting to avoid a poor surgical outcome the most important consideration aside from the obvious such as avoiding infection and using proper revision techniques ect. are WOUND TENSION as wounds subjected to tension due to motion, facial location, or loss of tissue after excision are at increased risk of the scar of spreading and subsequent atrophy or even hypertrophy.
What I find of particular importance is that poor surgical outcome is almost always avoidable by splinting the tissue with permanent or semi permanent intradermal sutures beneath the skin such as a polyprolene suture that can be left in place for six months. Permanent clear nylon sutures can also be placed deep into the dermis to ensure spreading/atrophy almost never occurs.
He also believes that all absorbable sutures (which are widely used) lose much of their tensile strength in about 4 weeks which is not nearly long enough to splint the wound sufficiently to prevent widening/scar atrophy.
Moreover, it is theoretically possible a full thickness incision that is not splinted properly may heal with such little underlying dermis left intact that its collagen regenerative abilities are severely diminished. This would explain why Fraxel or any other lasers would have little to no effect on these types of surgical scars. Once this happens the only remaining options are re-excision or fillers.
I should add that when excisions are performed properly on a healthy individual they are capable of healing nearly undetectably if they are resurfaced within 4-6 weeks post excision. That said, some people simply heal better then others however these techniques GREATLY increase your chances of receiving a good surgical result.
The above mentioned is all the more reason to be selective of your chosen surgeon as these techniques are not always used in everyday practice.
how then does fraxel work on stretch marks? a stretch mark is similar to an excision gone bad, in that both are thinned out with little dermal structure.
i suppose over many many treatments the dermis at the sides of an excision or striae could be built up until the two sides were touching, no?
I had my first fraxel about a week ago. Because I am dark skinned (Type IV) the doctor suggested that I treat my entire face so that in case I hyperpigment I wont like weird. It hurt like a bitch, i mean it really hurt, but strangely I hardly saw any down time at all. I was a bit red and a bit swollen for like a day and that was about it. I had gotten Cool Touch treatments before and right after the treatment the doctor looked at me surprisingly and said "Most people look a lot worse after the treatment". I dont know if this is a good thing or a bad thing, i'm hoping its a good thing. My face has been itchy all week but that is slowly dying down. The cost in NYC is outrageous 1500 so I'm not sure if this treatment is really worth it especially if it doesnt even work. I thought I'd give it a try and see if I do get any improvements. I will post after my second treatment. If I dont see anything after 3000 dollars then I'll have to stop at that. There were some doctors charging less (not much less) but I opted to see someone with a lot of experience after having read a few horror stories about people getting messed up with fraxel, especially since I'm darker skinned.
No problem motown, does anyone know if we can use retin-a or differin a week after having fraxel. i am getting quite a few pimples perhaps because of the moisterizer i have to use but i recall reading somewhere that patients shoulldnt use differin or retin-a for 14 days after treatment. thanks
Just another question for you guys out there. My main concern is red marks but the Dr tells me that its also from the shallow scarring that the red marks show up from. Im wondering would fraxel be good enough to really treat both or will I need to vbeam later on to take away the red marks? I dont want to pay for two things when I can do it with just one (fraxel). However im not sure if fraxel is optimal in treating redness in the scars themselves.
Christpunchers,
Fraxel can be very effective at evening out skin tone. If your primary objective is to treat only red marks V-Beam treatments will save you a great deal of money over Fraxel and would probably just as effective if not even more as it selectively targets oxyhemoglobin. V-Beam is ineffective for atrophic scars however.
A word about excisions:Since there are many posters that have reported marginal results at best with excisions, I took the opportunity today to discuss surgical techniques with a professor of plastic surgery whom I know and trust.
As said, when attempting to avoid a poor surgical outcome the most important consideration aside from the obvious such as avoiding infection and using proper revision techniques ect. are WOUND TENSION as wounds subjected to tension due to motion, facial location, or loss of tissue after excision are at increased risk of the scar of spreading and subsequent atrophy or even hypertrophy.
What I find of particular importance is that poor surgical outcome is almost always avoidable by splinting the tissue with permanent or semi permanent intradermal sutures beneath the skin such as a polyprolene suture that can be left in place for six months. Permanent clear nylon sutures can also be placed deep into the dermis to ensure spreading/atrophy almost never occurs.
He also believes that all absorbable sutures (which are widely used) lose much of their tensile strength in about 4 weeks which is not nearly long enough to splint the wound sufficiently to prevent widening/scar atrophy.
Moreover, it is theoretically possible a full thickness incision that is not splinted properly may heal with such little underlying dermis left intact that its collagen regenerative abilities are severely diminished. This would explain why Fraxel or any other lasers would have little to no effect on these types of surgical scars. Once this happens the only remaining options are re-excision or fillers.
I should add that when excisions are performed properly on a healthy individual they are capable of healing nearly undetectably if they are resurfaced within 4-6 weeks post excision. That said, some people simply heal better then others however these techniques GREATLY increase your chances of receiving a good surgical result.
The above mentioned is all the more reason to be selective of your chosen surgeon as these techniques are not always used in everyday practice.
how then does fraxel work on stretch marks? a stretch mark is similar to an excision gone bad, in that both are thinned out with little dermal structure.
i suppose over many many treatments the dermis at the sides of an excision or striae could be built up until the two sides were touching, no?
TCBC,
Good question! The underlying dermal components of stretch marks are quite different then with full thickness fusiform excision in that stretch marks represent a stretching and sometimes thinning of the dermis but never complete tissue seperation . Much like epidermal cells the dermal and subcutaneous layers need an abundance of healthy cells to promote regeneration. This is one reason why skin grafts which naturally contain an abundance of healthy donor cells are often needed for 3rd degree burns to prevent contracture. Also, Fraxel's effectiveness with stretch marks have been anecdotal at best.
No Im not seeing Dr seskel. Im in Vancouver, I think that guy is from the states.
The clinic that offers laser genesis is not a skin care centre, theyre more about plastic surgeries (breast implants/reductions, lipo, facelifts, etc etc). They didnt push me into anything, and they were in awe that Ive already spent so much money with little to no results to speak off. They told me to go read up on laser genesis, vitalize peels (for the scars and red marks), and cosmelan, as they have all 3 services and thinks I will have a lot of improvement if I choose any one of them.
Maybe I should go for vbeam with a couple sessions of fraxel. I heard vbeam is good at taking out redness but the results are not permanent? Is this true?
Once again, many thanks to you guys, there just really isnt any source online that has any trust worthy info as this board.
for the asian skin people how long are you preparing your skin before fraxel with retin a and hydroquinone ,my doc has prescribed me for 1 month pre treatment.I wanted to do fraxel every 2nd week but doc says that for asian skin we need atleast a month gap otherwise the skin doesnt have enough time to be prepared again to avoid hyperpigmentation .Can anybody fill me in this?.Has any had darkening of the skin till now cause of fraxel?.
ONe of my main reason to go for fraxel is to treat my syringomas,im worried that it may leave some scarring could someone fill me in on this ?
well guys/gals... im new to the board and had my first Fraxel laser treatment today.
background.... had acne my entire life but mainly i get these "cysts" type of acne more (which is worse) i would rate my acne scars as being moderately bad, not extensive. mainly in the temple and cheek region.
decided to try the Fraxil laser to help smoothen the scars out. Thisis the first time ever trying some type of laser or cosmetic sugery for this problem.
some facts...
1. My entire process consisted of 2 hours total. 24 minutes of pretreamsent consistenting of applying a numbing topical for about 50-60 minutes and the next hour consisting of ht elaser treament and cleanup
2. The Laser treatment didnt hurt much as the numbing topical lotion does it job but you can still feel it especially near the temples, lips,eye area and jaw line
3. the Laser feels about an inch wide and vary narrow. feels like getting sandpaper against your face or getting a "very light" tattoo against your skin.
4. The treament is a total in and out procedure, rather simple
5. I would suggest bring Chapstick with you as the cold air that they spray on you as they do th elaser chaps your lips and its actually very cold so i also suggest bringing a sweatshirt with you to keep the rest of your body warm during the procedure. I actually think shivering during the treatmnet was more uncomfortable than the acutal laser 
6. I paid $750 a treament and after 4 treatments you get the 5th free. I woulde classify my doctor as a higher end dermatologist as he has a very well oiled office with lots of employees and very clean. I was actual suprised on the cost of $750 after reading some people paid in the 1k-2k a treatment
7. The doctor also prescribed Valtrex and a topical lotion to help healing and keepiing the skin moist. The Valtrex was prescribed cause some people i guess get "cold sores" after treatment. ive never experienced a cold sore ever in my life so i doubt i will get them now, but who knows.
8. After treament you can definately go back to work as my only effects so far is a light redness as if i got a slight sunburn, nothing extreme
9. My next appoinment is in 2 weeks so i will update after that
thanks
Steve
I agree troubled,
Fraxel for stretch marks is anecdotal. But here are three different doctors who have pics on their website and there are many more who mention it (but no pics). They are saying 50-75 percent improvement after 5 treatments.
If anyone knows of any clinical studies being done for striae (stretch marks) please let me know!
http://www.westlakedermatology.com/fraxel.htm
http://www.shorelaser.com/FractionalAblativeLaser.html
http://www.reflectionscenter.com/laser-tre...retch-marks.php
http://209.85.165.104/search?q=cache:TARyP...t=clnk&cd=6
This last one is a video. Click the little icon that shows a blue belly with the fraxel wand going over it (to the right of the text).
--------------------------------------------
Better Body: Fixing Stretch Marks
Lisa Gonzales
Reporting
(CBS 13) SACRAMENTO After having a baby new mothers get a bundle of joy but many of them also get stuck with stretch marks. Now a treatment that gets rid of under-eye wrinkles can help.
4-year-old Courtney Wellet has already left an impression with her mother - stretch marks.
"They were very large, very wide, very saggy skin. It kind of just ruined my belly," she says.
Debbie's stretch marks got so bad after her pregnancy, she didn't want to show her stomach to anyone. Stretch marks usually occur after a rapid weight loss or gain and are frequently associated with pregnancy. There's no cure for stretch marks. But dermatologists are discovering a new treatment called Fraxel is improving the skin.
aoeWe've had a lot of success in treating stretch marks. To date were finding an average 50 to 75 percent improvement in stretch marks with a series of 3 to 5 treatments," says Dermatologist Dr. Mitchell Chasin.
But Chasin says the eye doesn't lie when it comes to the final results.
"There are some individuals that will find improvement right after the first treatment, others will take about 4 to 6 weeks to see the change but the improvement continues for up to six months," says Chasin.
After four sessions of Fraxel Debbieas stomach was still a little red from the treatments, but doctors say that redness disappears in days.
"I'm very happy with the results that I have," says Debbie.
Each treatment takes less than an hour, and costs about $600 dollars.
Fraxel is FDA approved for age spots and wrinkles around the eyes. But it is not approved stretch marks and there are no large-scale studies proving it is effective.
-----------------------------------------------------------
Erasing Stretch Marks
March 30, 2006 03:00 PM EST
It's something women have, but no one wants to talk about. For years, they have been told stretch marks are a cosmetic problem and to just live with them.
A medical breakthrough, once used to fight aging, is now helping people conquer stretch marks.
Exercise, weight gain, weight loss and pregnancy are just a few of the things that cause those unsightly ridges known as stretch marks that streak a woman's hips, thighs, buttocks and stomach.
A technique called Fraxel is helping turn back the clock.
Dr. Gregory Nickolaidis is one of 50 dermatologists in the country and the only one in Austin using Fraxel to treat stretch marks.
"We can really make a big change in a majority of patients," Dr. Nickolaidis with Westlake Dermatology said.
Fraxel is like Photoshop for the skin. For instance, you can erase lines in the skin. With Fraxel, you're using a laser to target points in the skin.
"It creates tiny, tiny injuries in the skin, and we actually make about 10 passes with the Fraxel to the skin called microthermal zones and you can't see them with the naked eye," Nickolaidis said.
Patients say that it feels like a pinprick.
"Three to five days of redness and swelling so you can certainly go back to work the same day," Nickolaidis said.
"It took six years to find a solution, but I did," Fraxel patient Kristen Cruz said.
Cruz travels from Corpus Christi to Austin just to get that solution.
"I'm not a vain person at all," Cruz said.
It was while she was pregnant with her son six years ago that the stretch marks happened.
"I didn't feel like myself anymore, and after having just no stretch marks whatsoever and going from that to going to a lot of stretch marks and having them pretty much everywhere on my abdomen, it was a big change," Cruz said.
Four Fraxel treatments cost about $1,200. Cruz feels it was money well spent.
"Very much more confident, much more stronger about my body and about myself, and it's been a great experience," Cruz said.
More companies are expected to come out with competing technology, which means ultimately lower prices for consumers and hopefully the solution to the problem no one wants to talk about.
-------------------------------
I agree troubled,Fraxel for stretch marks is anecdotal. But here are three different doctors who have pics on their website and there are many more who mention it (but no pics). They are saying 50-75 percent improvement after 5 treatments.
If anyone knows of any clinical studies being done for striae (stretch marks) please let me know!
http://www.westlakedermatology.com/fraxel.htm
http://www.shorelaser.com/FractionalAblativeLaser.html
http://www.reflectionscenter.com/laser-tre...retch-marks.php
http://209.85.165.104/search?q=cache:TARyP...t=clnk&cd=6
This last one is a video. Click the little icon that shows a blue belly with the fraxel wand going over it (to the right of the text).
--------------------------------------------
Better Body: Fixing Stretch Marks
Lisa Gonzales
Reporting
(CBS 13) SACRAMENTO After having a baby new mothers get a bundle of joy but many of them also get stuck with stretch marks. Now a treatment that gets rid of under-eye wrinkles can help.
4-year-old Courtney Wellet has already left an impression with her mother - stretch marks.
"They were very large, very wide, very saggy skin. It kind of just ruined my belly," she says.
Debbie's stretch marks got so bad after her pregnancy, she didn't want to show her stomach to anyone. Stretch marks usually occur after a rapid weight loss or gain and are frequently associated with pregnancy. There's no cure for stretch marks. But dermatologists are discovering a new treatment called Fraxel is improving the skin.
We've had a lot of success in treating stretch marks. To date were finding an average 50 to 75 percent improvement in stretch marks with a series of 3 to 5 treatments," says Dermatologist Dr. Mitchell Chasin.
But Chasin says the eye doesn't lie when it comes to the final results.
"There are some individuals that will find improvement right after the first treatment, others will take about 4 to 6 weeks to see the change but the improvement continues for up to six months," says Chasin.
After four sessions of Fraxel Debbies stomach was still a little red from the treatments, but doctors say that redness disappears in days.
"I'm very happy with the results that I have," says Debbie.
Each treatment takes less than an hour, and costs about $600 dollars.
Fraxel is FDA approved for age spots and wrinkles around the eyes. But it is not approved stretch marks and there are no large-scale studies proving it is effective.
-----------------------------------------------------------
Erasing Stretch Marks
March 30, 2006 03:00 PM EST
It's something women have, but no one wants to talk about. For years, they have been told stretch marks are a cosmetic problem and to just live with them.
A medical breakthrough, once used to fight aging, is now helping people conquer stretch marks.
Exercise, weight gain, weight loss and pregnancy are just a few of the things that cause those unsightly ridges known as stretch marks that streak a woman's hips, thighs, buttocks and stomach.
A technique called Fraxel is helping turn back the clock.
Dr. Gregory Nickolaidis is one of 50 dermatologists in the country and the only one in Austin using Fraxel to treat stretch marks.
"We can really make a big change in a majority of patients," Dr. Nickolaidis with Westlake Dermatology said.
Fraxel is like Photoshop for the skin. For instance, you can erase lines in the skin. With Fraxel, you're using a laser to target points in the skin.
"It creates tiny, tiny injuries in the skin, and we actually make about 10 passes with the Fraxel to the skin called microthermal zones and you can't see them with the naked eye," Nickolaidis said.
Patients say that it feels like a pinprick.
"Three to five days of redness and swelling so you can certainly go back to work the same day," Nickolaidis said.
"It took six years to find a solution, but I did," Fraxel patient Kristen Cruz said.
Cruz travels from Corpus Christi to Austin just to get that solution.
"I'm not a vain person at all," Cruz said.
It was while she was pregnant with her son six years ago that the stretch marks happened.
"I didn't feel like myself anymore, and after having just no stretch marks whatsoever and going from that to going to a lot of stretch marks and having them pretty much everywhere on my abdomen, it was a big change," Cruz said.
Four Fraxel treatments cost about $1,200. Cruz feels it was money well spent.
"Very much more confident, much more stronger about my body and about myself, and it's been a great experience," Cruz said.
More companies are expected to come out with competing technology, which means ultimately lower prices for consumers and hopefully the solution to the problem no one wants to talk about.
-------------------------------
TCBC,
Great info. I certainly hope Fraxel is able to improve stretch marks by 50-75% but I have to say I' m cautiously optimistic about such claims. For one stretch marks are notoriously difficult to treat and it would be far beyond an incremental leap in technology to suddenly achieve that level of improvement from everything we know about stretch marks thus far. Also, when making such an expensive decision, I think it's always wise to consider the extreme over abundance of cosmetic laser systems literally flooding the market. All of which have a barrage of very convincing before and after photos and videos to substantiate their carefully orchestrated marketing campaign. This is not to take anything away from Fraxel. I believe it shows the most promise of any laser system ever developed as of today. As time marches on we can look forward to seeing some controlled data on Fraxel that will hopefully reflect real world results.
i read that to prep your skin before co2 ultrapulse laser you should use retin-a and hydroquonin cream a few weeks before treatment. should you do that before you do fraxel?
it is diff necc if you have darker skin/brown etc for hyperpigmentation. In any case it is good to use retin A pre any treatment since it will remove the dead cells otherwise you may end up with a breakout after the procedure.Stoping 4-5 days is safe enough.
Troubled-
since you have alot of knowledge on the fraxel i wanted to take your opinion ,will the fraxel help on syringomas? if yes -will it do it without scarring? how many treatments will i need?.One of my main reason for doing fraxel is syringomas ,they are hardly visible unless i look in certain lighting and i cant feel them with m fingers.They are lighter in tone than my surrounding skin and no facial hair comes from there,they're in clusters both sides of my mouth.I though tthey were deep epidermal cysts but now my doc says they are syringomas.Accutane,peels,over the counter exfoliation creams have done nothing in the past 5 years.
I have noticed that alot of you had 20 mj's on your second treatment, while i only had 18, do you think i should as the doctor to be more aggressive?
I would. I started noticing a big difference once he went to 20 and higher. It's a little more painful, but the results are definetely worth it.
I saw some protocols that acne scars should be treated at level 20+ if safe. I have been going higher, as I seem to tolerate fine and am light compexion with tan, with no pigment problems to date. With Sr 1500 they often go to 40mjs for scars, but the density automatically dials down to avoid too large of surface injury from the wider columns of tissue injury.
I have noticed that alot of you had 20 mj's on your second treatment, while i only had 18, do you think i should as the doctor to be more aggressive?I would. I started noticing a big difference once he went to 20 and higher. It's a little more painful, but the results are definetely worth it.
Cubsfan,
I would like to be able to go to a higher level as well. The doctor's concern is that I have an olive complexion and they don't want to put me at risk for hyperpigmentation. Is your complexion fair?
Thanks,
Annde