just thought i'd post a little update (13 days after fraxel #2)

i think there's definitely an improvement in texture

particularly in the shallow scares which seem less obvious and if you look really hard, you can actually see slightly whiter bits inside them which i'm hoping is remodelling/collagen

i have a few scarred/big pores. don't really see as much of an improvement in them as the other scars. although i guess they do look a bit 'softer'

He talked about "Fraxel", but it's possible he uses that word in the same sense that some people use "Kleenex" for tissue paper. I was a little confused when he explained Fraxel at my initial consultation because he mentioned there were two types: Fractional 1540 and an older, less effective laser (the real Fraxel perhaps?). Now I understand that 1540 is Palomar. When I went for my first treatment I thought he would apply the blue dye, and I was looking for a Reliant logo on the machine. We live in a world where you can't serve Pepsi to a person who asks for Coke, so I think he could do a better job of explaining that Fraxel is a Reliant brand, and that he uses Palomar. Is the deception intentional? I'm willing to give him the benefit of the doubt.

 

Anyone know if the Palomar laser has been FDA approved to treat acne scarring?

Vexed,

You're correct, the Palomar Lux 1540 is less then half the price of the Fraxel laser however, treatments aren't proportionally less expensive as you might think and there does appear to be some controversy about it's effectiveness. For example: The Palomar system lacks the sophisticated optical tracking system present with the Fraxel. Also, early comparisons between the two systems indicate that the MTZ (Micro Thermal Zones) or dots laid down by the Palomar laser are wider in diameter. This is likely the reason there's reports of more bleeding from treatment with the Palomar system if treatment progresses to a higher density.

Moreover, it is unlikely the extra bleeding has anything to do with the 1540 going deeper as both lasers are penetrating well beyond the bleeding point of the epidermis. Consider how easy you can make yourself bleed with a shallow needle prick if the diameter is wide enough. Try the same thing with a fine gauge needle and even deeper with little to no visible bleeding.

As far as Palomar's fractional laser is concerned the larger MTZ's are allowing blood to seep through the surface of the skin before tissue coagulation can take effect. In theory, larger MTZ's are also undesirable when treating at the higher densities required for certain types of acne scarring as the larger MTZ's are capable of connecting together with repeated passes of the laser to form larger wounds delaying reepithelization and increasing the risk of scarring as the body attempts to repair itself through additional collagen synthesis/lysis. An example of this would be #1cubsfan who recently reported excessive bleeding when treated with the Palomar system vs. her previous treatments with the Fraxel, unfortunately she experienced minor scarring from treatment as well.

That being said, I am certain that in the hands of the right doctor the Palomar system can be an effective tool BUT, I would question why one would switch to a different laser system altogether with less proven efficacy and documented results if it were not for the lower cost and enticement of more patients being treated in a shorter time span. (Ultimately leading to much higher profit margins for the Dr. by avoiding the prep time altogether that is required to treat patients with Fraxel).

The other concerns I have with the Palomar system would be that support staff are no doubt performing treatments with this laser without having the "autopilot" benefits of an advanced optical tracking system as found with the Fraxel. This would make it easier to accidentally over or under treat patients by falsely assuming both lasers are the same.

Finally, Palomar's 1540 system is NOT FDA approved for the cosmetic treatment of acne or surgical scars. While it's would be only fair to say that Fraxel was not either during it's introduction, if you are going to compare the efficacy of both lasers it would be wise to consider that there is no guarantee the Lux 1540 will ever pass the rigorous tests required by the FDA to gain approval. I hope this helps shed some light (no pun intended) on some of the questions about the Palomar laser.

Just finished fraxel #4 last night. oooouch!

This doctor goes over my entire face, partial neck and forehead with 4 passes at a lower setting and then 4 more at a higher setting. That 4rth pass even at the lower setting really packs a punch. He presses quite firmly with the laser tip and passes fairly slowly. I don't know if that translates into deeper penetration or more overall energy but if it's "no pain no gain" I'll win!

I'm swolen BIGTIME, eyes are

It's been mentioned before and I think it's a good time to say again that after the early treatments it can be difficult to determine any results. The biggest dissapointment for a lot of people is that after a few days they see tremendous results but the reality is that there is some swelling still present that gives a false impression.

I find that a few days after the treatment, things look there best but then shortly after the swelling lessens that the results can even look worse. I think that the swelling in some areas on my face lessens more than the surrounding tissue and it actually looks like a deeper depression.

Be patient, i,m very pleased with results after 3 treatments and hope to see even more after the 5 that I have scheduled. I,m really happy that people are seeing improvement many months after their last session. I was very very skeptical obout that claim... eeeeh haaaa

Hang in there

Is fraxel treatment painfull? I would like to get it done on my face; however, I cannot bear pain.

just thought i'd post a little update (13 days after fraxel #2)

i think there's definitely an improvement in texture

particularly in the shallow scares which seem less obvious and if you look really hard, you can actually see slightly whiter bits inside them which i'm hoping is remodelling/collagen

i have a few scarred/big pores. don't really see as much of an improvement in them as the other scars. although i guess they do look a bit 'softer'

 

Yeah I have some of those white bits inside the scars. It has been 12 days so far. Skin is still red.

That's great you are seeing improvement from Fraxel! What type of scars did you have and do you see any difference in wrinkles and texture? Did the treatments tighten your skin?

Just finished fraxel #4 last night. oooouch!

 

This doctor goes over my entire face, partial neck and forehead with 4 passes at a lower setting and then 4 more at a higher setting. That 4rth pass even at the lower setting really packs a punch. He presses quite firmly with the laser tip and passes fairly slowly. I don't know if that translates into deeper penetration or more overall energy but if it's "no pain no gain" I'll win!

 

I'm swolen BIGTIME, eyes are

 

It's been mentioned before and I think it's a good time to say again that after the early treatments it can be difficult to determine any results. The biggest dissapointment for a lot of people is that after a few days they see tremendous results but the reality is that there is some swelling still present that gives a false impression.

 

I find that a few days after the treatment, things look there best but then shortly after the swelling lessens that the results can even look worse. I think that the swelling in some areas on my face lessens more than the surrounding tissue and it actually looks like a deeper depression.

 

Be patient, i,m very pleased with results after 3 treatments and hope to see even more after the 5 that I have scheduled. I,m really happy that people are seeing improvement many months after their last session. I was very very skeptical obout that claim... eeeeh haaaa

 

Hang in there

 

Hello All,

I have been reading this board for weeks trying to decide on Fraxel. In fact, I had a Fraxel appointment, and it was here that I discovered there was a new machine. I cancelled that appointment and found out that my doctor was soon to get the new machine but did not know when. Well, I just had my first Fraxel yesterday and wanted to share since you have all been so helpful to me. If it were not for this board, I would have had the old machine (when the new was available right under my nose) and I would have been going in blind with no idea on numbers or what to expect.

1. It did not hurt nearly as much as I thought it would. I was SO nervous going in. It felt like a small needle roller going across my face. There was never a point when I thought I would have to discontinue or even thought about it and I will not even be nervous to go back. My doc (PA) uses Atavan, 800 Motrin and Percocet before treatment. Afterward, it felt like a sunburn. As far as a derm vs. ps she told me that derms usually won't use medication and that can make all the difference in being able to tolerate the procedure.

2. The new laser 1500 has the cooling (Zimmer?) machine built into it so it goes everywhere the laser goes. It is reported to be less painful than the original Fraxel.

3. The reps from Fraxel were in the room with me during the treatment. They said that many companies with the Palomar laser are misrepresenting that they have the Fraxel. With the new machine, the doc measures your face first with the laser to make sure the area is treated properly. Don't know if the old machine did that. Anyone know?

4. I asked the reps about many acne scar patients being disappointed with their results. They confirmed that the reason for that is because doctors were too afraid to be aggressive with acne scar patients. AGGRESSIVE treatment is a must for acne scar patients. The new machine comes with parameters for acne scars. It was posted on the wall and I am so sorry that I do not have a copy. I will try to get one. The reps said in their "last study" with the new machine they had something like 91% satisfaction with rejuvination patients and 100% satisfaction (not 100% improvement, satisfaction) with acne scar patients. They were VERY confident.

5. When I asked what level I was going to start at, my PA said she was thinking 35-40. The rep said, well start lower and end higher (in later treatments). I said, NO WAY, I want results. So she started at 40, maybe at 45%. I am still not sure what these new numbers mean. Maybe 45% of the face treated? Maybe someone else knows?

6. She told me I would be EXTREMELY swollen today, but I am not. I iced and slept upright. Sleeping upright is key to avoiding swelling. She was very pleased that I was not swollen. She advised more ice today. The new laser is supposed to produce less swelling/redness (I think that's why she was happy to confirm). I am a little red, but not nearly as expected.

7. The PA gave me a nice kit in a metal tin when I left full of products and a prescription in case I breakout which is not expected. The products are a MUST and were FREE. They are by Complex, "Intense Tissue Repair Cream" "Post Laser Lotion" and some face washes and anti-redness creams, etc. She called me today and said moisture is a MUST for several days while healing. Ice and moisture. She stressed moisture and sunscreen if going out. They gave me a special sunscreen too. I am stressing this because from many posts I see people wondering what to use, aloe vera, obagi, etc., and I am very disturbed that the docs did not give or at least recommend something. Also, some people are paying EXTRA for docs products. Please, aren't we paying enough???

8. By the way. She is almost promising me that I will have great results. While she was doing my face she said, "We are going to be great friends, you are going to be sending me a christmas card." This morning when I expressed worry about the procedure working she said, "Oh, those scars are going to be gone." Also, when I walked in the room yesterday, one of the reps said, "Oh, you are going to have great results you have great skin for this." I also think they are VERY confident in this new laser and new acne scar guidelines (aggressive treatment). FYI, I am 37 almost 38, I have light thin skin with many moderate (severe? don't really know) rolling scars with a significant depression on right side and scars in my marrionette lines which make them appear even worse. From the side I swear it looks like I am deformed. I have seen some pictures on this board of people who think they have scars and I just want to...well, leave it at that. I HAVE SCARS. I know that we all have our issues and small scars are important when they are on your face, but I want you to know as far as treatment results go, that my scars are very significant. Of course I am not listening to these reps and docs as I have been very disappointed in the past (two CO2 procedures that I swear made my skin worse!)

9. There is a new blue dye remover coming out that will work better. Also, the reps said that most docs over use the blue dye and it is not necessary. When the assistant was putting on the dye, they were saying it was too much. I still have dye on my face.

10. Cost-I bought a package of 4 for $4K. I am in Los Angeles and that was the best price I could find at a reputable place. They made me pay up front because they said people will take advantage of the package discount and then not show up for the remainder of the procedures. Without the package it is $1400 each. I think that is bogus because who would do only one procedure? Maybe for wrinkles I guess.

Well I hope I didn't bore anyone. I guess if I did, they stopped reading a long time ago! Thanks again for all of your info, sharing and answering questions over and over again. This board was very helpful to me. If anyone has any questions let me know.

Mah, I have all types of scars. The fraxel does seem to tighten the skin a little but not sure if it is tightening it or just an overall increase in cologen.

It's great that this new Fraxel is a lot less painful and hopfully the results are as good or better. I am getting the old fraxel and it is painful to me and I think painful for most.

I have one treatment left. I will take a few months and decide whether or not to go for more sessions. Sounds like I will be looking for the new Fraxel if/when that time comes

Nannie

Great post. Hope what they say comes true.

I doubt it is 45% density. I am wondering if it refers to mjs of energy applied to each mtz. If so, that is very aggressive.

Godd luck and keep us posted.

PS: Could you ask whether new fraxel helps with white line left from excision scar (ie lack of pigmentation) at your next visit.

Thanks

Hello All,

I have been reading this board for weeks trying to decide on Fraxel. In fact, I had a Fraxel appointment, and it was here that I discovered there was a new machine. I cancelled that appointment and found out that my doctor was soon to get the new machine but did not know when. Well, I just had my first Fraxel yesterday and wanted to share since you have all been so helpful to me. If it were not for this board, I would have had the old machine (when the new was available right under my nose) and I would have been going in blind with no idea on numbers or what to expect.

1. It did not hurt nearly as much as I thought it would. I was SO nervous going in. It felt like a small needle roller going across my face. There was never a point when I thought I would have to discontinue or even thought about it and I will not even be nervous to go back. My doc (PA) uses Atavan, 800 Motrin and Percocet before treatment. Afterward, it felt like a sunburn. As far as a derm vs. ps she told me that derms usually won't use medication and that can make all the difference in being able to tolerate the procedure.

2. The new laser 1500 has the cooling (Zimmer?) machine built into it so it goes everywhere the laser goes. It is reported to be less painful than the original Fraxel.

3. The reps from Fraxel were in the room with me during the treatment. They said that many companies with the Palomar laser are misrepresenting that they have the Fraxel. With the new machine, the doc measures your face first with the laser to make sure the area is treated properly. Don't know if the old machine did that. Anyone know?

4. I asked the reps about many acne scar patients being disappointed with their results. They confirmed that the reason for that is because doctors were too afraid to be aggressive with acne scar patients. AGGRESSIVE treatment is a must for acne scar patients. The new machine comes with parameters for acne scars. It was posted on the wall and I am so sorry that I do not have a copy. I will try to get one. The reps said in their "last study" with the new machine they had something like 91% satisfaction with rejuvination patients and 100% satisfaction (not 100% improvement, satisfaction) with acne scar patients. They were VERY confident.

5. When I asked what level I was going to start at, my PA said she was thinking 35-40. The rep said, well start lower and end higher (in later treatments). I said, NO WAY, I want results. So she started at 40, maybe at 45%. I am still not sure what these new numbers mean. Maybe 45% of the face treated? Maybe someone else knows?

6. She told me I would be EXTREMELY swollen today, but I am not. I iced and slept upright. Sleeping upright is key to avoiding swelling. She was very pleased that I was not swollen. She advised more ice today. The new laser is supposed to produce less swelling/redness (I think that's why she was happy to confirm). I am a little red, but not nearly as expected.

7. The PA gave me a nice kit in a metal tin when I left full of products and a prescription in case I breakout which is not expected. The products are a MUST and were FREE. They are by Complex, "Intense Tissue Repair Cream" "Post Laser Lotion" and some face washes and anti-redness creams, etc. She called me today and said moisture is a MUST for several days while healing. Ice and moisture. She stressed moisture and sunscreen if going out. They gave me a special sunscreen too. I am stressing this because from many posts I see people wondering what to use, aloe vera, obagi, etc., and I am very disturbed that the docs did not give or at least recommend something. Also, some people are paying EXTRA for docs products. Please, aren't we paying enough???

8. By the way. She is almost promising me that I will have great results. While she was doing my face she said, "We are going to be great friends, you are going to be sending me a christmas card." This morning when I expressed worry about the procedure working she said, "Oh, those scars are going to be gone." Also, when I walked in the room yesterday, one of the reps said, "Oh, you are going to have great results you have great skin for this." I also think they are VERY confident in this new laser and new acne scar guidelines (aggressive treatment). FYI, I am 37 almost 38, I have light thin skin with many moderate (severe? don't really know) rolling scars with a significant depression on right side and scars in my marrionette lines which make them appear even worse. From the side I swear it looks like I am deformed. I have seen some pictures on this board of people who think they have scars and I just want to...well, leave it at that. I HAVE SCARS. I know that we all have our issues and small scars are important when they are on your face, but I want you to know as far as treatment results go, that my scars are very significant. Of course I am not listening to these reps and docs as I have been very disappointed in the past (two CO2 procedures that I swear made my skin worse!)

9. There is a new blue dye remover coming out that will work better. Also, the reps said that most docs over use the blue dye and it is not necessary. When the assistant was putting on the dye, they were saying it was too much. I still have dye on my face.

10. Cost-I bought a package of 4 for $4K. I am in Los Angeles and that was the best price I could find at a reputable place. They made me pay up front because they said people will take advantage of the package discount and then not show up for the remainder of the procedures. Without the package it is $1400 each. I think that is bogus because who would do only one procedure? Maybe for wrinkles I guess.

Well I hope I didn't bore anyone. I guess if I did, they stopped reading a long time ago! Thanks again for all of your info, sharing and answering questions over and over again. This board was very helpful to me. If anyone has any questions let me know.

 

Thank you for all the great information. You answered my question about the pain being less intense. :dance: How far apart are you getting your treatments done? Please keep us updated!

guys i have a scheduled my first fraxel for tomorrow morning.

i have done subcision about 9 days ago on 2-3 scars hopefully this wont be a problem.

my doc wants to start the treatment like 15 @ 250 or something and then work up to 20 i told him i want aggresive

i guess ill go with it and hope for the best.

Billy Boy:I have no idea what 45% or just 45 means, I was figuring maybe someone here would know. I will try to ask that question about the scar. Don't know if it matters, but the reps told my PA to go very lightly over my chin and mouth because those are the areas prone to hyperpigmentation. I am very light skinned, so I was surprised by that.

Cubsfan:My treatments are every three weeks.

Thanks for the well wishes and I hope everyone here gets some results with this treatment. I think even with the old laser as long as the treatment is aggressive (whatever that means) we can get some good results.

wow, lots of people are getting fraxel now in the fall, good luck to everyone. wildbb99, trust me, if you are asian or have light skin, its best to start at a lower mjs to see how your skin reacts, i wanted 20mjs at first too but my doc said we have to start low, so he put me on 16mjs, results are so far so good.

its been 4 days now, (not counting the day i did it), and i woke up fairly itchy, lol. if i remember right, when you have a scab from an injury, it itches like crazy cause the new skin is building so i guess this applies to the face also. i still have a lot of scales on my face, when i say scales i mean like a rough outter texture skin on top of the new skin, and i do not dare to peel it cuz its best if i dont. now where my whiteheads use to be, it all turned into flakes, so i am acne free. i dont want to peel anything, but yea, like seanskii say, i almost welcome the harsh scales outside and hope they stay on for as long as possible. i am really itchy right now so i think im going to go shower, but i learn that i should be very gentle when cleansing my face with cetaphil for sometimes some of the scale or flakes begin to peel off and i want them on for as long as possible. as far as swelling go i dont really notice much at all, i do see them white patches inside my scars, note that i have shallow scarring, as for pores, i can't really see it, but however the enlarged blackheads or pores on my nose can still be seen. anyone know if they will go away with fraxel? that's it for now, hope that helps, i'll answer any questions also. good luck everyone and God bless.

Nannie

Great post. Hope what they say comes true.

I doubt it is 45% density. I am wondering if it refers to mjs of energy applied to each mtz. If so, that is very aggressive.

Godd luck and keep us posted.

PS: Could you ask whether new fraxel helps with white line left from excision scar (ie lack of pigmentation) at your next visit.

Thanks

 

45% density would severely delay wound healing and increase the propensity of scar formation at the depth Fraxel works so I can confirm that is definitely not the case. It would be nice though if that were true and you could accelerate the results down to two treatments and get nearly 100% coverage. 😀 The 45 setting refers to mjs.

Title: Plastic surgeon's technique with skin not so good on layers of Word document

Authors: Sturgeon, Jeff

Source: Roanoke Times, The (VA); 09/29/2005

Document Type: Article

Accession Number: 2W61563887320

Persistent link to this record: http://search.ebscohost.com/login.aspx?dir...site=ehost-live

Database Newspaper Source

Plastic surgeon's technique with skin not so good on layers of Word document

~~~~~~~~

Jeff Sturgeon

Sep. 29--Have you ever wondered how the world really works? If so, pay attention to this cautionary tale from the somewhat odd world of medical publicity.

Here's the story: A local plastic surgeon buys a cutting-edge piece of high-tech equipment designed to reduce wrinkles, age spots and blemishes.

What's not to like about that?

The doctor also gets a computerized, fill-in-the-blank press release from the manufacturer to help him persuade the local newspaper to print his story.

His office manager works through the press release using the software Microsoft Word, dropping in some pertinent facts to localize the story and, in a few places, toning down the manufacturer's hype about the Fraxel Laser Treatment system.

After some back and forth -- some changes and polishing -- it's ready to go, and the office manager sends it to his local newspaper, The Roanoke Times.

However, the smarter-than-you Microsoft program processor has saved every editing change along the way. The medical practice could have deleted the early drafts, but overlooked that step. So, when the reporter opens the document, bingo-presto, all the earlier versions show up.

And that's where the story starts to get interesting.

Remember, doctors are looking for better ways to serve their patients.

Publicists -- professional or stand-ins -- are working to help their clients get ink in local newspapers. And reporters, well, they are always on the hunt for a story that will interest their readers.

The manufacturer, Reliant Technologies of Palo Alto, Calif., ships its Fraxel system with a suggested press release as "a benefit that we give to our purchasers to help promote the use of our technology in their practices," said company spokesman Michael Hromadik.

Detailing the success of the marketing strategy, he said several television news organizations quoted liberally from the Reliant release, defining Fraxel with the exact phrases Reliant desires to see used.

Roanoke County plastic surgeon Enrique Silberblatt bought a system and turned to his practice administrator, Don Mundy, to notify media groups about the $750 treatment.

According to Mundy, the treatment has widespread appeal over conventional skin resurfacing for several reasons, including that patients can resume normal activities quickly. After spending $105,000 to acquire the technology, the practice wanted to get word out that the treatment is available.

"We're not trying to make a killing here," Mundy said. "We're not trying to make all our money back. We're trying to provide a service for our patients, so we priced it so people could afford it, [and] so over a period of several years we will see a return on our investment."

It made sense to issue a version of Reliant's suggested press release, because it came from the product's maker, said Mundy, adding, "We're not news people. We want to be doctors. We want to be medical people."

But the electronic release went out with saved earlier versions shuffled to the background, though not deleted. In this case, the drafts revealed how Silberblatt's practice relied on Reliant to help promote the new line.

For instance, Reliant's original press release template suggested the doctor call himself or herself as "one of the first" specialists to offer Fraxel treatment. The press release issued by Silberblatt's office goes further, describing him as "one of the first plastic surgeons in the country" to offer Fraxel treatment, a true statement. Silberblatt, a plastic surgeon with 20 years of experience, operates a skin-care practice known as Advanced Medical Skin Care and his surgical practice, Aesthetic Surgery of Virginia, from an office on Brambleton Avenue.

But rather than hype the new laser device, the practice generally toned down the manufacturer's recommended claims as Mundy performed the editing, with some help from Silberblatt.

"We really are trying to be truthful as much as possible," Mundy said.

In the press release template, the procedure "takes about 30 minutes"; in the Silberblatt press release, the procedure "takes about 1 to 2 hours."

Reliant Technologies wrote that Fraxel works "without the downtime and risks" of traditional methods; the Silberblatt press release said Fraxel works "with minimal downtime and risks."

Silberblatt's office deleted the phrase, "Virtually no risk of complications or adverse events" and inserted language about resuming normal activities on the day of treatment.

Mundy said he wishes the release had not gone out in the form it did. He said he would consider using a templated press release again in the future, but "I think I will be more careful."

To see more of The Roanoke Times, or to subscribe to the newspaper, go to http://www.roanoke.com . Copyright ? 2005, The Roanoke Times, Va. Distributed by Knight Ridder/Tribune Business News. For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

--------------------------------------------------------------------------------

Copyright of Roanoke Times, The (VA) is the property of Roanoke Times, The (VA). The copyright in an individual article may be maintained by the author in certain cases. Content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Source: Roanoke Times, The (VA), Sep 29, 2005

Item: 2W61563887320

==========================================================================================================================================================================

Fractional laser helps alleviate acne scarring

BY JOHN JESITUS

STAFF CORRESPONDENT

Atlanta Aaa A new laser appears efFective in treating

acne scars even in darker-skinned patients, says

Edgar F. Fincher, M.D., clinical in.structor of dermatology

at the University of California, Los

Angeles, David Geffen School of Medidne and

lead author ofthe unpublished study.

In the study, researchers treated 12 patients

with moderate to severe acne scarring and skin

phototypes II through V with the Fraxel SR

{Reliant "lechnologies).

"Patients noticed improvement in their scars

after two to three treatments. And all patients

reported impn)vement after the treatment course,

with an average of 2.2 points on a 5-point scale,"

Dr. Fincher says.

"Probably the most amazing finding was that

we were able to treat people of darker skin type,"

he adds. "That's a big advance over previous

lasers such as CO,and erbium lasers. For other

types of scars such as traumatic scars, we've even

treated Afncan-American patients with type six

skin" without any adverse effects.

Hyperpigmentation concern

In the past, he says, he and his colleagues (coauthors

Helen F. Fincher, M.D., and Ronald L

Moy, M.D.) would liave tumed away patients with

darker skin out of concern for creating hyperpigmentation

with CO. and erbium laser treatments.

"The study provides a good

initial iook into how

effective this laser is. Based

on patients we have treated,

the results have been

outstanding."

Aaa Edgar F. Fincher, M.D.

University of Caiifornia, Los Angeles

David Geffen Schooi of Medicine

Skin type notwithstanding, he says, these

lasers, moreover, required at least two to three

weeks' downtime to achieve a s^nificant improvement

in acne scars. Conversely, Dr. Fincher says

nonablative lasers provided only minimal (10

percent to 15 percent) improvement.

However, he says that although no laser can

completely reverse scarring, "llie Fraxei offers

significant improvement and high patient satisfection

with minimal post-treatment recovery.

The ability to safely treat patients of all phototypes

makes this laser especially valuable and

unique."

Study protocoi

The study protocol involved performing a series

of five to six treatments spaced two to four weeks

apart. After each treatment. Dr. Fincher says,

patients experienced redness and erythema for

one to four days. However, no patients required

changing bandages or missing work, he says.

"Our initial result was that we got a faster

and better response with higher treatment energies,"

Dr. Fincher says. "Treatment settings were

considered aggressive, with patients treated at

18 to 21 mj/cm^ and receiving approximately

1,250 to 1,500 microthermal zones (MTZ, the

manufecturer's method of measuring density)."

He explains, "The way the Fraxel works is

that it has a scanner in the handpiece, so it basically

fires a grid of tiny laser beams into the skin.

There are two different density settings Aaa 250

or 125 MTZ per square centimeter."

Although Reliant provided researchers with

no recommended energy levels for treating acne

scars, the company typically recommends a setting

of 10 mj and a density of 250 MTZ for

treating pigmentary changes. Dr. Fincher says.

To achieve the desired response, he says, he and

his coUeagues treated patients for an average of

10 to 12 passes at the 125 MTZ setting.

"It's a new technology and a new method of

treating the skin," he says. "Every other laser we've

used basically treats every square pixel, so to

speak, or skin cell. This one leaves normal sldn

in between" microscopic treated zones.

Study wealtnesses

Potential weaknesses of the study include its

small size and the fact that it relied on investigators

and patients for subjective evaluations of

patient progress. Dr. Fincher says.

However, he says, "The study provides a good

initial look into how effective this laser is. Based on

patients we have treated, the results have been outstanding.

'Ilie lasers ability to treat darker skin types

opens a new avenue to treat a large population of

patients that we previously weren't able to treat It's

a very safe laser, and 1 believe we'll be using it to

treat acne scars for many years." DT

Disclosure: Dr. Fincher reports no financial interests

reievantto this articie.

For more information:

www.dgsom.heaithsciences.iJCLA.edu

SI 6 DermatologyTimes

Fraxel does not do much for enlarged pores on the nose. Pores on the nose are hard to treat with any modality. I notice that I no longer get blackheads like I used to, in fact in the 6 months since my tx. I have not had one blackhead (that I can see anyway). That in itself would make the pores less noticeable.

I did get some improvements in pores on my cheek and temple according to the VISIA post results analysis. I didn't really have enlarged pores in this area, so I'm not sure if those results would be indicative of pores all over the face or not.

Hope this helps.

Peach Pie

The new Fraxel sound much better than the old Fraxel. Does energy level 40 means the same with the old fraxel? That is real high sounds more promising. I want to be able to go that high as well. I'm not seeing much improvement yet. I'm so frustrated and depressed right now. I went ahead and took some pictures. I'm embrassed to show any photos cause my skin is real gross. It is flaky from Obagi + red. I took couple in Flash and it isn't showing my redness much. I also took several in normal settings. Could someone who's had 2 or more treatments help me critique my scars. I want to know if Fraxel would be benefical to my type of scarring. Do you think my skin is light enough for higher energy level? I was wondering if my largest scar would benefit from the Fraxel. That one is so depressing to look at. It draws the most attention. Also my scars are so noticeable (overall look and feel of them), I guess Its cause the new layer hasn't grew out yet. I can't stand the texture. Will Fraxel help make them smoother? Also what type of scars do all of you guys think I have now? Do I still have ice pick scarring? I had excised 4 of those ice pick scars. Are my excision lines visible? What energly level would be best to treat my type of scarring? I started off with 15 and 18. I also have before photos but skin was real flaky from Obagi. What do you think of my pores? Thanks guys.

ps: I'm going to take those photos down in couple days.

ps: Any 2nd opinion would be good for me right now cause I don't want to be biased.

Here is the order of the photos:

1)before photo: Right side before any excisions

2)before photo: Left side before any excisons

3)Post Fraxel 1st tx:Right side

4)Post Fraxel 1st tx:Right side

5)Post Fraxel 1st tx:Right side

6)Post Fraxel 1st tx:Left side

7)Post Fraxel 1st tx:Left side

8)Post Fraxel 1st tx: Left side

9)Post Fraxel 1st tx: Right side (Flash)

10)Post Fraxel 1st tx: Left side (Flash)

Hard to gauge how much improvement you got from those two fraxels since the before pic is also before 4 excisions.

I have't had two fraxels, but I can still see improvement in your pictures!

Looks hyperpigmented though. Didn't you say you did Obagi in between Fraxel 1 and 2? I'm not an expert put doesn't a peel interfere with the fractional remodelling?

I mean the science of fraxel is to treat only 15 percent of the face at once so it can heal without laying down new scar tissue. Doing a peel (even to a small area) would treat 100 percent of the skin in that area. Does your doctor know you are doing Obagi?

Hard to gauge how much improvement you got from those two fraxels since the before pic is also before 4 excisions.

I have't had two fraxels, but I can still see improvement in your pictures!

Looks hyperpigmented though. Didn't you say you did Obagi in between Fraxel 1 and 2? I'm not an expert put doesn't a peel interfere with the fractional remodelling?

I mean the science of fraxel is to treat only 15 percent of the face at once so it can heal without laying down new scar tissue. Doing a peel (even to a small area) would treat 100 percent of the skin in that area. Does your doctor know you are doing Obagi?

 

I only have 1 fraxel so far. I just see improvements form the excision only so far. Yes my doctor is the one put me on Obagi.

I think that Fraxel can help your scars, but honestly it takes more than 1 treatment to see any kind of improvement. I think its too early to judge. Thanks for sharing your photos!

OK I just saw ur reply on the last page. Tazorac? That is a potent retinoid. Many people have been told by their doctor to discontinue using topical retinoids for at least two weeks prior and during treatment with fraxel.

Just using Taz and nothing else usually causes redness and peeling. I can't image Fraxel+Taz+other products! I guess he wants to be aggressive since your scarring is significant, but I have to say I think that it would be best to let fraxel run its course before doing chemical peels.

yo mz43020,

hang in there baby girl, you look great. trust me, those scars are not deep at all, i'm not sure what obagi is but i wouldn't recomend you peeling off the top layer of your dead skin or scales i like to call them. but yea i think your next treatment, you should go more aggressive, try 20 mjs, who knows. but i think them scars are very minor, actually a little bit minor then mine, your so called deepest scar relates to my deepest scar. be optimistic and hang in there, God wouldn't put us through something that we can't get out of. you have 3 treatment left right? i say be more aggressive with them treatment and i'm not sure what obagi is but i dont think its good for you, just my opinion don't quote me on it. however i do think that is it vital that you do not peel off the top layer of skin or any flakes or scabs and just leave it on even though it looks scary, but it help protects the new baby skin underneath (mine's pink, i can see some of it) and it will come off naturally when its ready, maybe the obagi is forcing them to come off earlier.

oh yea, i'm almost 100 percent certain that after more session of fraxel, you should achieve near perfect skin, cause really that is nothing, i kno that we are our own's worst critic. good luck dear, and God speed.

OK I just saw ur reply on the last page. Tazorac? That is a potent retinoid. Many people have been told by their doctor to discontinue using topical retinoids for at least two weeks prior and during treatment with fraxel.

 

OMG, I don't like repeating myself. My doc. told me to go on Obagi and Tazorac a week after Fraxel. I would only use Obagi for 1 week period then I stop and I would have 2 week off before treatment start. So its all planned out.

Hi Nantynannie, I'm in S Calif. as well. Can You please tell us the P.S. you're going to?

Hello All,

 

I have been reading this board for weeks trying to decide on Fraxel. In fact, I had a Fraxel appointment, and it was here that I discovered there was a new machine. I cancelled that appointment and found out that my doctor was soon to get the new machine but did not know when. Well, I just had my first Fraxel yesterday and wanted to share since you have all been so helpful to me. If it were not for this board, I would have had the old machine (when the new was available right under my nose) and I would have been going in blind with no idea on numbers or what to expect.

 

1. It did not hurt nearly as much as I thought it would. I was SO nervous going in. It felt like a small needle roller going across my face. There was never a point when I thought I would have to discontinue or even thought about it and I will not even be nervous to go back. My doc (PA) uses Atavan, 800 Motrin and Percocet before treatment. Afterward, it felt like a sunburn. As far as a derm vs. ps she told me that derms usually won't use medication and that can make all the difference in being able to tolerate the procedure.

 

2. The new laser 1500 has the cooling (Zimmer?) machine built into it so it goes everywhere the laser goes. It is reported to be less painful than the original Fraxel.

 

3. The reps from Fraxel were in the room with me during the treatment. They said that many companies with the Palomar laser are misrepresenting that they have the Fraxel. With the new machine, the doc measures your face first with the laser to make sure the area is treated properly. Don't know if the old machine did that. Anyone know?

 

4. I asked the reps about many acne scar patients being disappointed with their results. They confirmed that the reason for that is because doctors were too afraid to be aggressive with acne scar patients. AGGRESSIVE treatment is a must for acne scar patients. The new machine comes with parameters for acne scars. It was posted on the wall and I am so sorry that I do not have a copy. I will try to get one. The reps said in their "last study" with the new machine they had something like 91% satisfaction with rejuvination patients and 100% satisfaction (not 100% improvement, satisfaction) with acne scar patients. They were VERY confident.

 

5. When I asked what level I was going to start at, my PA said she was thinking 35-40. The rep said, well start lower and end higher (in later treatments). I said, NO WAY, I want results. So she started at 40, maybe at 45%. I am still not sure what these new numbers mean. Maybe 45% of the face treated? Maybe someone else knows?

 

6. She told me I would be EXTREMELY swollen today, but I am not. I iced and slept upright. Sleeping upright is key to avoiding swelling. She was very pleased that I was not swollen. She advised more ice today. The new laser is supposed to produce less swelling/redness (I think that's why she was happy to confirm). I am a little red, but not nearly as expected.

 

7. The PA gave me a nice kit in a metal tin when I left full of products and a prescription in case I breakout which is not expected. The products are a MUST and were FREE. They are by Complex, "Intense Tissue Repair Cream" "Post Laser Lotion" and some face washes and anti-redness creams, etc. She called me today and said moisture is a MUST for several days while healing. Ice and moisture. She stressed moisture and sunscreen if going out. They gave me a special sunscreen too. I am stressing this because from many posts I see people wondering what to use, aloe vera, obagi, etc., and I am very disturbed that the docs did not give or at least recommend something. Also, some people are paying EXTRA for docs products. Please, aren't we paying enough???

 

8. By the way. She is almost promising me that I will have great results. While she was doing my face she said, "We are going to be great friends, you are going to be sending me a christmas card." This morning when I expressed worry about the procedure working she said, "Oh, those scars are going to be gone." Also, when I walked in the room yesterday, one of the reps said, "Oh, you are going to have great results you have great skin for this." I also think they are VERY confident in this new laser and new acne scar guidelines (aggressive treatment). FYI, I am 37 almost 38, I have light thin skin with many moderate (severe? don't really know) rolling scars with a significant depression on right side and scars in my marrionette lines which make them appear even worse. From the side I swear it looks like I am deformed. I have seen some pictures on this board of people who think they have scars and I just want to...well, leave it at that. I HAVE SCARS. I know that we all have our issues and small scars are important when they are on your face, but I want you to know as far as treatment results go, that my scars are very significant. Of course I am not listening to these reps and docs as I have been very disappointed in the past (two CO2 procedures that I swear made my skin worse!)

 

9. There is a new blue dye remover coming out that will work better. Also, the reps said that most docs over use the blue dye and it is not necessary. When the assistant was putting on the dye, they were saying it was too much. I still have dye on my face.

 

10. Cost-I bought a package of 4 for $4K. I am in Los Angeles and that was the best price I could find at a reputable place. They made me pay up front because they said people will take advantage of the package discount and then not show up for the remainder of the procedures. Without the package it is $1400 each. I think that is bogus because who would do only one procedure? Maybe for wrinkles I guess.

 

Well I hope I didn't bore anyone. I guess if I did, they stopped reading a long time ago! Thanks again for all of your info, sharing and answering questions over and over again. This board was very helpful to me. If anyone has any questions let me know.