i have fair skin, my first fraxel they did 15 mj's the second they only did 18 mj's. when i asked her to do extra passes on my scared chin, she told me that they don't do that until the third treatment. Should i ask the doctor to go as high at 23 mj's? Or is that to high of a jump?

This is just so hard to deal w/. My surgical scars made things 10x worse. I will ask for photo's this week when i got in for last treatment. I did read trouble's posts regarding fillers n reexcision. I am so confused right now and don't know who to trust anymore. I seriously turned into a monster. I look more rough after fraxel treatment this time. Not sure y. Why r we suffering this?

i just had a second fraxel2 treatment.

the doctor increased the density because i told him i'm not seeing any improvement.

it hurt alot more than the first treatment.

Here's my 9-month post-fraxel update: Skin is still pink and scars still look like crap, despite using EGF and taking MSM and vitamins for months. Three months ago, when I went in for my 6-month appointment, the doctor took pictures of my face in a different room with dark lighting and tried to compare them to my original pictures in fluorescent lighting. This is absolutely ridiculous--just what you'd expect from a dermatologist. I told her that you can't compare pictures if the lighting is different, and we got in an argument in her office. I keep telling myself that my scars could look better once my skin heals, but it's becoming apparent that this is going to take years rather than months.

I just read the fraxel article from vogue issue in april 2006. it is about fraxel for stretch marks. the author had it done and reported improvement, though no pictures.

there is another forum that talk about fraxel. it is a british women's forum. apparently a few posters there had fraxel for stretch marks, though i haven't read through its 200+ pages to see how they rate it.

wow, these recent posts on lack of efficacyare depressing me. Hopefully, you will all see some improvement.

Mz, JJP,

I understand the tremendous difficulty you both must be going through not having seen results at this stage into your Fraxel treatments. As I have said before, treating acne scarring can be a long painfully slow process. If there is one piece of advice that I can give both of you it would be to never give up hope or your resolve to keep marching forward through hard times such as these. Medically speaking we live in an amazing time with more scar treatments then were ever thought possible. I have no doubt that you will succeed in reaching your goals providing they are realistic and you attack them with enough perseverance. With that in mind, I still think it is premature to give up on Fraxel just yet. I know itas difficult but please try to remember that many who have been in your situation before did not begin seeing results from their first treatment until they were well into their 3rd, 4th, or even 5th treatment.

JJP, I have always thought your kJ levels were too low. Reliant has in my humble opinion somewhat prematurely concluded that higher kJ or totally energy is not as important at higher fluences with the SR1500. Their basis is that the increased penetration depth at higher fluences offsets the decreasing density and consequent lower kJ.

The problem I have with this is that if you were to look back at nearly everyone on this forum that has reported good results with Fraxel, they all have higher kJ levels in common. Shyone, Sean, Birch, AnniefromMiami, Nsxlr8, Greenfish, and Blaster just to name a few.

What I find interesting is that Shyone went to the same office as you for her treatments with the SR1500 and was treated by a different physician. Her doctor appears to have taken a very different approach then yours i.e varying the fluence and treatment parameters to bring up total kJ as I have often suggested. The end result was roughly double the kJ levels (amount of energy) then you were getting from your doctor. She claimed that she was VERY happy with the results. While your scars are probably very different then hers I think something can be said for the strong correlation between kJ and efficacy.

wow, these recent posts on lack of efficacyare depressing me. Hopefully, you will all see some improvement.

Ditto, I feel the same way... I am staying focused though, I don't plan to make much judgement on my treatment until my 4th treatment... My doc has told me several times not to expect to see any significant results from each treatment until 2-3 months after each session. So basically I shouldn't see much improvement until i go in for my 3rd/4th treatments... But I have already seen slight improvement in just my skin tone. I have a more even skin pigment and shine.

Also can anyone explain to me what a pass is? Is it each stroke the doc takes across the face without lifting his/her hand?

Thanks!

wow, these recent posts on lack of efficacyare depressing me. Hopefully, you will all see some improvement.

Ditto, I feel the same way... I am staying focused though, I don't plan to make much judgement on my treatment until my 4th treatment... My doc has told me several times not to expect to see any significant results from each treatment until 2-3 months after each session. So basically I shouldn't see much improvement until i go in for my 3rd/4th treatments... But I have already seen slight improvement in just my skin tone. I have a more even skin pigment and shine.

Also can anyone explain to me what a pass is? Is it each stroke the doc takes across the face without lifting his/her hand?

Thanks!

 

Chika,

A pass is referred to each stroke the Fraxel head passes over the treated area regardless of direction. The operator lifting his/her hand at the end of each stroke doesn't really matter as long as each stroke is in complete contact with the skin to avoid skipping.

how is subcission and excission different?

also its been awhile since i posted. my last treatment was at 24mjs, fraxel 1. my next and 4th fraxel treatment will be in about 3 weeks or so, and i plan to go 30mjs on scarred areas with extra passes and doing 24mjs on full face, let me know if anyone has any experienced opinions and thoughts....

oh yea, i have very light white skin and fraxel seems to make it whiter, lol, cept i'm still pinkish and reddish at some part.

Simply,

Subcision is a technique where a needle is used underneath the skin to break up connective tissue under the scar and build collagen. It differs from excision in that there is no cutting of skin tissue involved. Often times subcision can be equally if not more effective then excision providing the scar is amenable to the procedure. Hope this helps. How have your Fraxel results been coming along so far?

Mz, JJP,

I understand the tremendous difficulty you both must be going through not having seen results at this stage into your Fraxel treatments. As I have said before, treating acne scarring can be a long painfully slow process. If there is one piece of advice that I can give both of you it would be to never give up hope or your resolve to keep marching forward through hard times such as these. Medically speaking we live in an amazing time with more scar treatments then were ever thought possible. I have no doubt that you will succeed in reaching your goals providing they are realistic and you attack them with enough perseverance. With that in mind, I still think it is premature to give up on Fraxel just yet. I know its difficult but please try to remember that many who have been in your situation before did not begin seeing results from their first treatment until they were well into their 3rd, 4th, or even 5th treatment.

JJP, I have always thought your kJ levels were too low. Reliant has in my humble opinion somewhat prematurely concluded that higher kJ or totally energy is not as important at higher fluences with the SR1500. Their basis is that the increased penetration depth at higher fluences offsets the decreasing density and consequent lower kJ.

The problem I have with this is that if you were to look back at nearly everyone on this forum that has reported good results with Fraxel, they all have higher kJ levels in common. Shyone, Sean, Birch, AnniefromMiami, Nsxlr8, Greenfish, and Blaster just to name a few.

What I find interesting is that Shyone went to the same office as you for her treatments with the SR1500 and was treated by a different physician. Her doctor appears to have taken a very different approach then yours i.e varying the fluence and treatment parameters to bring up total kJ as I have often suggested. The end result was roughly double the kJ levels (amount of energy) then you were getting from your doctor. She claimed that she was VERY happy with the results. While your scars are probably very different then hers I think something can be said for the strong correlation between kJ and efficacy.

Thanks for your kind words Troubled. I have been considering whether or not to have my 5th treatment on Wed or not.

Also what you wrote about the KJ's has had me concerned for a while now but I guess I just brushed it aside saying my doctor knows what he is doing. Now I am starting to wonder. I am going to call my doctors office and at least discuss my major concerns with the nurse who is always with us during my treatments.

Again thanks for the nice encouraging words but I like you, have been fighting and dealing with this for many years. I'm no spring chicken 😉 It's effected a huge part of my life and after this I don't really see any other options for my skin at this point in time.

edited: Ok i went back and looked at Shyone's posts and I can't find the posts where she mentions the KJ settings....I found her Level settings and how many passes but no KJ settings, one post said that the machine didn't register KJ settings.

I did notice that her doctor did lower MJs, 18 and 20 at 10 passes and then her doc went back and did her cheecks and chin at 40 MJ and did an additional 8 passes. wow, that sounds really painful........so she had a total of 18 passes on her cheecks and chin area??? I could see me telling my doctor to go over my scared area's more but honestly my face has different types of scars ALL over it so maybe that is why my doctor is just using the highest setting all over my face with 8 to 10 passes.

Should I ask him to do a lower MJ this last time with 10 passes and then redo it again at 40 MJ's at 8 additional passes?

I'm so confused.........argggggggg.

JJP,

An experienced practitioner can accurately assess kJ based on the fluence used, number of passes and overlap. In other words, using the SR1500 for example, a medium sized face treated at 18mJ treatment parameter 10 with 50% overlap will achieve nearly identical kJ level as another medium face using the same overlap, fluence and treatment parameter. In that sense, it isnat necessary for the practicioner to document kJ. Comparing the above mentioned indicators from Shyone's to yours, I can tell you with certainty she received more then double the kJ you did. (Reliant trains all practitioners to use 50% overlap so it is unlikely there is any difference to take into consideration in that respect).

Without getting overly technical, it is important to understand that beyond fluences of 20mj/cm2 the SR1500 begins dialing down density more significently then at fluences below the 20 mj threshold. This has a decreasing effect on kJ. What this means is that while a higher energy (mj/cm2) is used, the treatment area still receives less overall energy because much less density is distributed over the treatment area. Reliant feels that this is justified in order to decrease the tremendous pain that no doubt would be experienced if higher density were used at fluences that are that high. They claim the deeper penetration provided at higher fluences offsets the fact that less energy is applied to the face.

This assertion however contradicts what many physicians have learned thus far about treating acne scarring with Fraxel and not surprisingly, some of the more experienced doctors are finding better results by taking advantage of the deep penetration ability of the SR1500 by treating at higher fluences but still covering the face with several passes at lower fluences 20-25mJ in order to distribute greater energy to the face. I believe this is the correct approach as the SR750 has been around much longer and there is more clinical data available to support the correlation between higher kJ and better efficacy in relation to treating acne scarring. Hopefully that clears up any confusion you might have about treatment settings.

You have a couple of options at this point, the first would be to continue with your final treatment and wait it out to assess your results. The second would be to sit down and have a candid discussion with your doctor about your concerns although I suspect he will tell you that you are still too early into your treatment to determine your results. Also, keep in mind that if you arenat happy with your results sometimes it is easier and less stressful on you the patient to change doctors then it would be to take on the responsibility of changing your doctoras approach to treating your acne scars.

I had a full face fraxel treatment two weeks ago. Since everyone here has been reporting on their experiences I thought I'd do the same. I didnt have much swelling or much downtime. I had a couple of rolling scars which seemed to respond well to the fraxel however the scarred pores and ice-picks seem to look worse right now. I had TCA cross done before on the scarred pores and ice-picks and noticed that they got bigger during the first three weeks and during the fourth week they reduced in size. I am hoping this will be the same thing or else I may regret having gotten this done. I am Type IV skin and havnt had any pigmentiation problems so far, I didnt really bronze too much and wasnt red for too long. If anyone might be able to share their experiences about scarred pores or ice picks and fraxel that would be great. I know the fraxel website claims that pores are reduced in size but I am not too sure now.

how is subcission and excission different?

also its been awhile since i posted. my last treatment was at 24mjs, fraxel 1. my next and 4th fraxel treatment will be in about 3 weeks or so, and i plan to go 30mjs on scarred areas with extra passes and doing 24mjs on full face, let me know if anyone has any experienced opinions and thoughts....

oh yea, i have very light white skin and fraxel seems to make it whiter, lol, cept i'm still pinkish and reddish at some part.

Simply,

Subcision is a technique where a needle is used underneath the skin to break up connective tissue under the scar and build collagen. It differs from excision in that there is no cutting of skin tissue involved. Often times subcision can be equally if not more effective then excision providing the scar is amenable to the procedure. Hope this helps. How have your Fraxel results been coming along so far?

 

some people do this with a sterile needle themselves. i tried it and it helped once scar but made the other much worse. i think some skill is involved so its worth it to see a derm for subcision.

Is it possible that having Fraxel now can contribute to premature aging of the skin down the road?

I've read that cells can only divide 75 times before they die. . .

My scared pores (tiny ice picks) have not responded to fraxel. So far, it seems to work only on my shallow, rolling scars.

I was looking at the acne scarring pics at www.fraxel.com. It's obvious that patient still has acne scars. But its also obvious that there was some improvement.

So I thought to myself, well how much improvement do I see when I look at the before and after. I'd say I see 40-50 percent. The best areas a little more and the worst areas a little less. All of the pictures show at least some improvement though.

I think maybe people on acne.org are getting upset because they are expecting/hoping for near perfect skin. They get done and still see scars and think, what the hell? this didn't help at all! It's also easy to forget how bad the scars were before.

I mean think about it. If you have a lot of scars and you go through a lengthy procedure that very gradually lightens all of them more or less the same it'd be difficult to remember or guage improvement without good photos. You might look and see the same scars in the same spots, same shape, and same depth compared to others. When in fact something did change, which is the relative depth. the scars all got raised and remodelled a little. so did the normal skin. so it looks like there is very little change.

how is subcission and excission different?

also its been awhile since i posted. my last treatment was at 24mjs, fraxel 1. my next and 4th fraxel treatment will be in about 3 weeks or so, and i plan to go 30mjs on scarred areas with extra passes and doing 24mjs on full face, let me know if anyone has any experienced opinions and thoughts....

oh yea, i have very light white skin and fraxel seems to make it whiter, lol, cept i'm still pinkish and reddish at some part.

Simply,

Subcision is a technique where a needle is used underneath the skin to break up connective tissue under the scar and build collagen. It differs from excision in that there is no cutting of skin tissue involved. Often times subcision can be equally if not more effective then excision providing the scar is amenable to the procedure. Hope this helps. How have your Fraxel results been coming along so far?

 

HEY troubled,

its always great to hear from you. my fraxel treatment so far is doing good, i think this is the right treatment for me, i felt that being aggressive along with a strict diet is crucial. so far so good, i am very happy with my results so far. some whiteheads wit reddish form on my face right now that is kinda getting me down, oh well, i asked for it bytriggering a higher testosterone effect based upon vivid pictures, lol, thats an intellectual way of saying i saw some nudie pixs, lmao.

i have a question for you troubled! what is the highest mjs you have ever done with fraxel and what is the total number of treatment have you done so far? you probably stated this somewhere int he past but i rather just ask you again for i am considering going to 24mjs full face and 30mjs on bad areas with lots of multiple passes since it will be my 4th one until 6 more months then i will regroup n decide on what to do. yea sorry my typing is a lil bad with slang and spelling, yada yada, lol.

next does anybody know of or recomend a great moisturizer?? i was thinking of creme de la mer today but its somewhat really expensive, apparently $100 for a 1oz jar...uhh, and it claims to be a miracle cream..lol.. i dont know, just tryna stay positive, i sure hope everyone else is doing good!

oh yea, and as far as subcission is, i am considering doing it after my 6 month post 4th treatment of fraxel is done and then going in for another round of fraxel perhaps, i mean my scars are not deep at all, its just the spots that they are located bugs me the most, front right cheek.. my scars are mostly atrophic and hypertrophic acne scars according to my doc's notes. ok thats it for now. hth

how is subcission and excission different?

also its been awhile since i posted. my last treatment was at 24mjs, fraxel 1. my next and 4th fraxel treatment will be in about 3 weeks or so, and i plan to go 30mjs on scarred areas with extra passes and doing 24mjs on full face, let me know if anyone has any experienced opinions and thoughts....

oh yea, i have very light white skin and fraxel seems to make it whiter, lol, cept i'm still pinkish and reddish at some part.

Simply,

Subcision is a technique where a needle is used underneath the skin to break up connective tissue under the scar and build collagen. It differs from excision in that there is no cutting of skin tissue involved. Often times subcision can be equally if not more effective then excision providing the scar is amenable to the procedure. Hope this helps. How have your Fraxel results been coming along so far?

 

HEY troubled,

its always great to hear from you. my fraxel treatment so far is doing good, i think this is the right treatment for me, i felt that being aggressive along with a strict diet is crucial. so far so good, i am very happy with my results so far. some whiteheads wit reddish form on my face right now that is kinda getting me down, oh well, i asked for it bytriggering a higher testosterone effect based upon vivid pictures, lol, thats an intellectual way of saying i saw some nudie pixs, lmao.

i have a question for you troubled! what is the highest mjs you have ever done with fraxel and what is the total number of treatment have you done so far? you probably stated this somewhere int he past but i rather just ask you again for i am considering going to 24mjs full face and 30mjs on bad areas with lots of multiple passes since it will be my 4th one until 6 more months then i will regroup n decide on what to do. yea sorry my typing is a lil bad with slang and spelling, yada yada, lol.

next does anybody know of or recomend a great moisturizer?? i was thinking of creme de la mer today but its somewhat really expensive, apparently $100 for a 1oz jar...uhh, and it claims to be a miracle cream..lol.. i dont know, just tryna stay positive, i sure hope everyone else is doing good!

oh yea, and as far as subcission is, i am considering doing it after my 6 month post 4th treatment of fraxel is done and then going in for another round of fraxel perhaps, i mean my scars are not deep at all, its just the spots that they are located bugs me the most, front right cheek.. my scars are mostly atrophic and hypertrophic acne scars according to my doc's notes. ok thats it for now. hth

 

Simply,

I have experimented with the original Fraxel 15-25 mj 1500-2000mtz but discontinued and changed doctors early in favor of seeing a friend who practices plastic surgery in Chicago as he is in the process of upgrading to Fraxel 2. The upgrade is expected to be finished in early February so I have been patiently waiting until then.

Regarding settings, I would recommend following Billyboy's treatment protocol since he has gone about as aggressive as can safely be done with the original Fraxel short of going for 3 rounds of treatments.

I am curious, how have your hypertrophic scars responded to Fraxel? Any changes?

T_S

My scared pores (tiny ice picks) have not responded to fraxel. So far, it seems to work only on my shallow, rolling scars.

Thanks billyboy for your response. Just curious, did the ice-picks or scarred pores in fact look worse after treatment or were they prettty much the same? Mine definetly look worse and I am wondering if this will change or not.

how is subcission and excission different?

also its been awhile since i posted. my last treatment was at 24mjs, fraxel 1. my next and 4th fraxel treatment will be in about 3 weeks or so, and i plan to go 30mjs on scarred areas with extra passes and doing 24mjs on full face, let me know if anyone has any experienced opinions and thoughts....

oh yea, i have very light white skin and fraxel seems to make it whiter, lol, cept i'm still pinkish and reddish at some part.

Simply,

Subcision is a technique where a needle is used underneath the skin to break up connective tissue under the scar and build collagen. It differs from excision in that there is no cutting of skin tissue involved. Often times subcision can be equally if not more effective then excision providing the scar is amenable to the procedure. Hope this helps. How have your Fraxel results been coming along so far?

 

HEY troubled,

its always great to hear from you. my fraxel treatment so far is doing good, i think this is the right treatment for me, i felt that being aggressive along with a strict diet is crucial. so far so good, i am very happy with my results so far. some whiteheads wit reddish form on my face right now that is kinda getting me down, oh well, i asked for it bytriggering a higher testosterone effect based upon vivid pictures, lol, thats an intellectual way of saying i saw some nudie pixs, lmao.

i have a question for you troubled! what is the highest mjs you have ever done with fraxel and what is the total number of treatment have you done so far? you probably stated this somewhere int he past but i rather just ask you again for i am considering going to 24mjs full face and 30mjs on bad areas with lots of multiple passes since it will be my 4th one until 6 more months then i will regroup n decide on what to do. yea sorry my typing is a lil bad with slang and spelling, yada yada, lol.

next does anybody know of or recomend a great moisturizer?? i was thinking of creme de la mer today but its somewhat really expensive, apparently $100 for a 1oz jar...uhh, and it claims to be a miracle cream..lol.. i dont know, just tryna stay positive, i sure hope everyone else is doing good!

oh yea, and as far as subcission is, i am considering doing it after my 6 month post 4th treatment of fraxel is done and then going in for another round of fraxel perhaps, i mean my scars are not deep at all, its just the spots that they are located bugs me the most, front right cheek.. my scars are mostly atrophic and hypertrophic acne scars according to my doc's notes. ok thats it for now. hth

 

Hi Simply Me, Congrats on your improvement. I'm very happy for you. I had never used a moisturizer before because I have oily skin, so I thought I didn't need one. Someone recommended md formulations moisture defense antioxidant hydrating gel(a long name, huh?) and I love it. It's actually for oily and problem prone skin. I don't know if you're dealing with that or not, but it feels wonderful on my skin. It's not too cheap. The cheapest I've found is $44.00, but it lasts quite awhile. Good luck on your future Fraxel!

Sometimes I think they look worse, other times better. Basically, no change. I use them to guage fraxel becasue they are my only scars on central face. Frankly, I really thought Fraxel would wipe them off my face becasue they are tiny and really hard to see unless I bend over sink with reading glasses. But, that has not been the case. I am fairly confidnet that a dermabrasion would have given me better results, but I did not have the stomach for the downtime, or more importantly the pigment risks.

I have not given up hope as I have more treatments and time. Plus, it has helped my skin in other ways, but it has been weak on improving scars.

Sometimes I think they look worse, other times better. Basically, no change. I use them to guage fraxel becasue they are my only scars on central face. Frankly, I really thought Fraxel would wipe them off my face becasue they are tiny and really hard to see unless I bend over sink with reading glasses. But, that has not been the case. I am fairly confidnet that a dermabrasion would have given me better results, but I did not have the stomach for the downtime, or more importantly the pigment risks.

I have not given up hope as I have more treatments and time. Plus, it has helped my skin in other ways, but it has been weak on improving scars.

Billy,

What you need is a more ablative resurfacing procedure for what you are describing. I agree, dermabrasion is too risky. Alternatively You might consider dermasanding which is basically manual abrasion with sterile silicone carbide sandpaper. Abrasion is more controlled and is performed only until tiny pinpoint bleeding is reached. Spread out over several sessions it is said to be as effective as dermabrasion yet the hypo risks are low as the resurfacing stops after the upper papillary dermis has been reached. This technique has been in practice for years but unfortunately since it is not a high priced procedure many derms have stopped performing it in favor of higher income producing laser procedures. Finding a physician that still performs it is difficult but worthwhile.

More info:

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

http://www.cosmeticsurgerytimes.com/cosmet...il.jsp?id=49468

I'm not sure if an ablative laser will help with the scarred pores. I did some research and it says that ablative lasers can often make pores appear larger because it exposes the 'neck' or base of the pore. I think this is what is happening with me with fraxel and perhaps why my pores appear worse. The odd thing is I saw before and after pictures that a doctor had taken himself of one his patients and in fact the only thing that had definetly improved were the scarred pores so I was expecting if nothing else, these would be improved on myself. Troubled Skin, you really seem to know you're stuff. Is fraxel basically doing the same thing as TCA cross? That is, is it creating damage to the scar/pore and then hoping that it will heal better. If this the case, then I think perhaps the enlarged pores are temporary as the same thing happened to me when I had TCA cross done and the final pore size was a lot smaller than the original. Thanks and good luck to all.

I'm not sure if an ablative laser will help with the scarred pores. I did some research and it says that ablative lasers can often make pores appear larger because it exposes the 'neck' or base of the pore. I think this is what is happening with me with fraxel and perhaps why my pores appear worse. The odd thing is I saw before and after pictures that a doctor had taken himself of one his patients and in fact the only thing that had definetly improved were the scarred pores so I was expecting if nothing else, these would be improved on myself. Troubled Skin, you really seem to know you're stuff. Is fraxel basically doing the same thing as TCA cross? That is, is it creating damage to the scar/pore and then hoping that it will heal better. If this the case, then I think perhaps the enlarged pores are temporary as the same thing happened to me when I had TCA cross done and the final pore size was a lot smaller than the original. Thanks and good luck to all.

Doggydogg,

Such risks are from DEEP resurfacing procedures which also pose a greater risk of hypo. Dermasanding and medium depth laser procedures work by superficially and repetitively re-contouring only the top portion of the papillary dermis over several treatment sessions. This "over time" smoothes out scarred areas through reepithelization and subsequent remodeling of the skin. Repeated treatments also stimulate the skin to form new collagen sometimes deeper then the treated area (around the base of the oil glands) which can compress the pore and make it appear smaller. This is how these types of procedures work for scarred pores as often they are too deep to safely abrade for the reasons you mention above.

To answer your question, all of these procedures rely on initial injury/healing of the treated area, Fraxel included! Depending on the severity of your scars and individual healing response Fraxel may possibly help over the long term. Unfortunately scarred pores do not seem to respond as well to Fraxel treatments in some individuals.

All the best to you,

T_S