Jump to content
Acne.org
Search In
Find results that contain...
Find results in...
claisen

Erbium Glass Fraxel vs CO2 Fraxel

I have very deep scars of all types so my derm recommended a combination of fraxel (Erbium) and one/two dermabrasions - He does not have CO2 fraxel, leaving me to wonder if his recommendation would've been different if he had owned one. Then he guaranteed I would get at least 50% improvement (or he will keep doing fraxels for free) so I jumped the gun without doing more research (I've been out of the loop for a year on what is 'best' out there.)

Then coming here, I received some advise about ActiveFX, DeepFX and further surfing had me almost convinced that I made an error because it turns out that the 'gold standard' everywhere now, as advocated by majority of dermatologists, seem to be DeepFX, ActiveFX or Re:pair (Re:store?) CO2 fraxels. Most are touting this over the last generation of fraxels (Non CO2 ones). Rubbing it in was some of their claims: 5 'regular' fraxels comes CLOSE, but not quite, to 1 CO2 Fraxel. Of course, "regular", is so meaningless because it also depend on the setting that was used and expertise of the derm.

When I confronted my derm with this, he said that the Erbium Fraxel is not dated, it is one of the newest on the market. To him, given the cost/time and final result, he believes this is the best choice for me. Further he warns that even CO2 fraxel would not get rid of my deep scars, that I would further require dermabrasion - to do some serious protein denaturing at the scar surface - to achieve the result I'm looking for. He insists that the fraxel model he has can go deeper than most fraxels.

My curiosity got the best of me and I called my local derm that offered the CO2 fraxel. Looking at the pictures, it is obvious that I would require more than 1 treatment... But the shocker here is the price: At 5-6 times the cost to Erbium fraxels. Hm...

I did come across a Erbium Fraxel clinical study:

http://www3.interscience.wiley.com/journal...=1&SRETRY=0

The research pointed out 90% of patients received 50-75% improvement after 3 Fraxels for moderate atrophic acne scars. Well, to the CO2 enthusiasts, that could be almost 100% improvement after 1 CO2 fraxel?? Ok, I'm being sarcastic. Still, I'm thinking perhaps CO2 fraxel isn't as effective as they claim and that non-CO2 fraxel isn't as ineffective as they claim.

Of course there are tons of positive articles regarding CO2 fraxels. Anyways, given the cost, I think I'll just stick with my program for now and hope that I won't be the unlucky 10% that get no benefit from fraxeling. And I think I would make this decision again had I known about CO2 earlier - mainly due to the high cost.

List of most popular fraxels on the market today:

http://www.miinews.com/pdf/TAG0908_SkinRej...rtv6_101008.pdf

Share this post


Link to post
Share on other sites

claisen, never had laser but I hope you get great results. looks like you have researched well. when are you getting this done??

Share this post


Link to post
Share on other sites

I feel that most of the doctors out there will recommend the lasers they have purchased regardless if it's the best treatment plan for the patient. Let me give you an example, I found a article written by a Dr. Grant Stevens stating that "Co2 with a combination of punch excision beforehand is the best way to treat ice pick scars and that Fraxel alone would not provide results for ice pick scars". So I called his office and spoke with his nurse I asked if they still treated acne scars and asked her what type of lasers they used. I also explained that I had ice pick scars. She told me that Fraxel is the laser they use for ice pick scars. I then explained that I had just read a article that Dr. Stevens wrote himself about Fraxel not working for ice pick scars. Let's just say the phone went totally silent. She then tried to make up some B.S. but you could hear in the tone of her voice that she knew that she was selling people on something that wasn't going to work.

Share this post


Link to post
Share on other sites

After reading these forum responses up and down, and with talking to MDs, I have some of my opinions for you. Deep FX (or Total FX if you have pigmentary issues as well), Fraxel Repair (not restore), and maybe even Profractional are the best to use. From reading people's comments, dermabrasion, microdermabrasion, and fraxel restore are almost useless.

I had 2 profractionals done with maybe 30-40% improvement for 3 small boxcar scars on my nose, yet it's been 5 months and my skin has still not faded back to its original color. It is very confusing trying to understand the difference between these lasers, but I truly feel that anyone trying to push Fraxel restore is just trying to sell what they have. Everyone who has had this reports doing 5 sessions with 10-20% improvement. Profractional seems to give about 30-50% improvement with 3 sessions. I went for a consultation 5 days ago to the mgh laser cnter in Boston, and to my surprise, the surgeon said that he felt that 6 fraxel restores would be best. I will not be seeing him again.

I have read the summary of the article which you have referenced which showed about 50% improvement after 3 sessions with fractional CO2. Obviously for icepick scars, I would do a punch excision first and the resurfacing. For rolling, I would do total Fx at the highest settings possible. For boxcars, I'm imagining that profractional, deep Fx, and Fraxel repair are the way to go and that results will be based on the skill of the practitioner and intensity of settings.

Again, that's my opinion being an intelligent person who has read many of the responses on this list and using the internet for what it's worth.

Hope that helps

Share this post


Link to post
Share on other sites

I had Repair done in May with about a 30% improvement. I have another Repair procedure scheduled in Jan 09. My first one was done at 70mj and 60%. Everything is so confusing, but I think it comes down to Repair and FX.

Share this post


Link to post
Share on other sites
claisen, never had laser but I hope you get great results. looks like you have researched well. when are you getting this done??

I just had my 1st Erbium Fraxel 6 days ago.

Pros: Little to no downtime. Face feels smoother, a little tighter. More 'even' complexion.

Cons: Saw little improvement to my scars. Some pinkness, dryness and itchy for few days.

Of course I know I'm not going to get any improvement to my scars the 1st time. But I think there is some improvement overall, elevation of the skin. Won't even try to guess until after my 3rd fraxel. The doc set it at very mild setting (7.5 mj), he will increase it to 10mj or 15 mj next time. My next one is scheduled 3 weeks apart.

Share this post


Link to post
Share on other sites
claisen, never had laser but I hope you get great results. looks like you have researched well. when are you getting this done??

I just had my 1st Erbium Fraxel 6 days ago.

Pros: Little to no downtime. Face feels smoother, a little tighter. More 'even' complexion.

Cons: Saw little improvement to my scars. Some pinkness, dryness and itchy for few days.

Of course I know I'm not going to get any improvement to my scars the 1st time. But I think there is some improvement overall, elevation of the skin. Won't even try to guess until after my 3rd fraxel. The doc set it at very mild setting (7.5 mj), he will increase it to 10mj or 15 mj next time. My next one is scheduled 3 weeks apart.

well any improvement is better then no improvement right. I know you have been at this a long time man and I can certainly relate to what its like dealing with the scarring. I hope this time is the time for you bro. I am keeping you in my thoughts. I'm sure this will be a lengthy proccess but if you can please keep us posted along this journey. :)

Share this post


Link to post
Share on other sites
..... From reading people's comments, dermabrasion, microdermabrasion, and fraxel restore are almost useless.

I had 2 profractionals done with maybe 30-40% improvement for 3 small boxcar scars on my nose, yet it's been 5 months and my skin has still not faded back to its original color...

.... Everyone who has had this reports doing 5 sessions with 10-20% improvement. Profractional seems to give about 30-50% improvement with 3 sessions.

I have read the summary of the article which you have referenced which showed about 50% improvement after 3 sessions with fractional CO2. Obviously for icepick scars, I would do a punch excision first and the resurfacing. For rolling, I would do total Fx at the highest settings possible. For boxcars, I'm imagining that profractional, deep Fx, and Fraxel repair are the way to go and that results will be based on the skill of the practitioner and intensity of settings.

Again, that's my opinion being an intelligent person who has read many of the responses on this list and using the internet for what it's worth.

Hope that helps

Thanks for your inputs. I too believe that CO2 fraxels you described probably gives the best results. Unfortunately, I don't have the luxury to do all the different lasers for different type of scars. I have a budget and hope to make the best of it with that budget. The price of one CO2 fraxel here equals about 5-6 Erbium Fraxels. Going with your estimates, if 5 regular fraxels gives 10-20% improvement where as it takes 3 CO2 fraxels for 30-50% improvements - you are averaging about 2%-4% average improvement for each Erbium Fraxel and 10%-17% for each CO2 fraxel. So for the price of 3 CO2 fraxels here, one can technically have 18 Erbium fraxels. I don't know if having so many is a good idea, or if there is a limit to how much you can achieve with Erbium vs CO2.....I would think, fewer would be better for your skin in the long run. But until the price of CO2 fraxels comes way down, I'm basically stuck with what I paid for and can only hope that my skin will achieve similar results to ActiveFX. On a more positive note, my fraxels will be accompanied by dermabrasion that uses CO2 lasers - supposedly, CO2 fraxels give 80% result of CO2 lasers but at much less downtime and pain. The only difference between them, supposedly, is that CO2 fraxels don't burn all your skin at once like CO2 'full' lasers do. At least that is what I read from some of the MDs on the net.

Also, the article you read is a clinical study on Erbium Fraxels, not CO2 fraxels.

Anyways, hope your skin color returns to normal. From what I read, they all do eventually..

Share this post


Link to post
Share on other sites
I feel that most of the doctors out there will recommend the lasers they have purchased regardless if it's the best treatment plan for the patient. Let me give you an example, I found a article written by a Dr. Grant Stevens stating that "Co2 with a combination of punch excision beforehand is the best way to treat ice pick scars and that Fraxel alone would not provide results for ice pick scars". So I called his office and spoke with his nurse I asked if they still treated acne scars and asked her what type of lasers they used. I also explained that I had ice pick scars. She told me that Fraxel is the laser they use for ice pick scars. I then explained that I had just read a article that Dr. Stevens wrote himself about Fraxel not working for ice pick scars. Let's just say the phone went totally silent. She then tried to make up some B.S. but you could hear in the tone of her voice that she knew that she was selling people on something that wasn't going to work.

Yes I agree with you. For the most part, we are totally at the mercy of some of these docs who are willing to promise anything to pay off that pricey machine they just paid/took out a huge loan for. Ethics aside, it serves them absolutely little purpose to say their machine isn't as effective as the new pricier model. We are but guinea pigs that just keeps paying and paying for these laser companies' research. It is mostly about profits and helping the patients is an incidental event.. But then I'm sure there are docs out there who are really trying ...

Share this post


Link to post
Share on other sites

Munsoned,

Its been a week and I woke up this morning and I have to say I do see some changes on the whole. Looks like some of the smaller ice picks, pores and wrinkles are begginning to fill in just ever so slightly. You can't really pinpoint much except that my skin is definetely more even colored; looks fresher. But again, I had similar improvement with needling which quickly subsided. For sure I'll keep doing this a few times and post pics after 3rd or 4th fraxel as these gradual changes are impossible to gauge.

Share this post


Link to post
Share on other sites
Munsoned,

Its been a week and I woke up this morning and I have to say I do see some changes on the whole. Looks like some of the smaller ice picks, pores and wrinkles are begginning to fill in just ever so slightly. You can't really pinpoint much except that my skin is definetely more even colored; looks fresher. But again, I had similar improvement with needling which quickly subsided. For sure I'll keep doing this a few times and post pics after 3rd or 4th fraxel as these gradual changes are impossible to gauge.

I know how easy it is to jump the gun and think theres improvements after a treatment. I have been there many times. Its always best to wait til you are certain. But keep our fingers crossed its some real improvement and not just the direct after effects that return to normal.

peace..

Share this post


Link to post
Share on other sites
I know how easy it is to jump the gun and think theres improvements after a treatment. I have been there many times. Its always best to wait til you are certain. But keep our fingers crossed its some real improvement and not just the direct after effects that return to normal.

peace..

Well, I will be doing my 2nd Fraxel 2 days from now. This time, I will specifically ask for much higher level of setting. I may even consider doing laserbrasion (CO2) if I don't see much improvements after my 3rd session of Fraxel.

So far this is what I noticed about Erbium fraxel:

1. My skin has become baby-smooth to the touch. This part hasn't changed.

2. There are some improvements, perhaps minor 'filled-in' of the scar holes but not very noticeable . Still, this is very subjective and I have nothing to quantify this with because I have not taken after 3 weeks pictures to compare.

3. My skin has become 'whiter'.

As for negatives, I notice my skin is breaking out a little more than usual. But still manageable.

Share this post


Link to post
Share on other sites

If your doctor would be willing to continue doing fraxel treatments for free, I would do it (is it if you're unsatisfied, or get less than 50% improvement?) If the fraxel treatments are done at a high setting, you may see more long-term benefit doing repeated treatments than doing one big treatment. Some people see dramatic improvement with CO2, some only get minimal.

Share this post


Link to post
Share on other sites

Yes, since he is guranteeing at least 50%+ and that I would be fully satisfied or he'll keep doing it for free. That is why I jumped the gun without doing more research. He will even do CO2 laserbrasion on top of that for the worst scars (Or just all CO2 if my scars don't respond to Erbium). Of course, a year from now, I'll have lots of pictures to prove/disprove the efficacy of Erbium and Co2 laser.

If your doctor would be willing to continue doing fraxel treatments for free, I would do it (is it if you're unsatisfied, or get less than 50% improvement?) If the fraxel treatments are done at a high setting, you may see more long-term benefit doing repeated treatments than doing one big treatment. Some people see dramatic improvement with CO2, some only get minimal.

Share this post


Link to post
Share on other sites

Thanks, there are some support there for Erbium fraxels as well others swearing by CO2 fraxels. Lots of useful information but still leaving me confused as ever ;). Only time will tell if Erbium will work for me and I'll keep my progress posted.

This might provide you all some interesting reading and debate.

http://www.medicalspamd.com/physician-to-p...ian/post/458703

Share this post


Link to post
Share on other sites

My 2nd Erbium fraxel was more intensive this time. My face looked completely sunburned and felt really hot even an hour later. The doc used 10 mj level, don't know other parameters. He was much more thorough this time, spending close to 25 - 30 minutes, multiple passes, especially all the trouble spots. Pain wasn't bad, I'd say 7.5/10. Can feel that dripping heat burning those scar tissues. Advised to completely stay out of the sun and use a very good sunscreen for the next month. I'm feeling positive about this, there were lots of burning skin tissue, alot more than last time.

Definetely all kinds of microswelling taking place. I can start to see some hope 1st time in my life because this procedure is so different, and the results feel so different than all that I've had before (microdermabrasion, needling, Obagi, Retin-A). Next one is scheduled a month from now. After the 3rd one, me and the doc will sit down, look at all the progress and decide if to do more Erbium fraxel or change to Co2 laserbrasion.

Share this post


Link to post
Share on other sites
My 2nd Erbium fraxel was more intensive this time. My face looked completely sunburned and felt really hot even an hour later. The doc used 10 mj level, don't know other parameters. He was much more thorough this time, spending close to 25 - 30 minutes, multiple passes, especially all the trouble spots. Pain wasn't bad, I'd say 7.5/10. Can feel that dripping heat burning those scar tissues. Advised to completely stay out of the sun and use a very good sunscreen for the next month. I'm feeling positive about this, there were lots of burning skin tissue, alot more than last time.

Definetely all kinds of microswelling taking place. I can start to see some hope 1st time in my life because this procedure is so different, and the results feel so different than all that I've had before (microdermabrasion, needling, Obagi, Retin-A). Next one is scheduled a month from now. After the 3rd one, me and the doc will sit down, look at all the progress and decide if to do more Erbium fraxel or change to Co2 laserbrasion.

So how is your face now?

Share this post


Link to post
Share on other sites

Hello to everybody,

I am a dermatologist in Germany and I worked with almost all lasers on the market.

Would like to give you a better understanding about the difference between CO2 and Erbium-YAG laser systems.

The main difference is the wavelength and the side damage to untreated skin.

Both CO2 and Erbium target water, means the energy of the laser beam is absorbed mainly in water what causes a vaporization. Both are therefore ablative systems. Both can be used in a fractional mode if the equipment is provided, means the laser beam will be split in several smaller beams.

The differences:

The CO2 laser causes more thermal damage to the skin surrounding the treated area. Around the spot that is treated with the CO2 laser the skin shows a necrotic, coagulated zone. The advantage is that ablative treatments do not bleed as much and skin shrinking effect (mainly important if you treat wrinkles and lax skin) is higher.

Disadvantage are longer downtime, because the skin will be eroded and has to heal (up to 5 weeks!) and the CO2 causes often hyper-or hypopigmentation. Risk of infection is higher because the lase causes an open wound. Treatment should be done only in narcosis.

The Erbium-YAG laser does not cause thermal damage to the surrounding untreated skin, that is the reason why it is often called the cold ablative laser system (of course it is also a hot treatment but needs only local anaesthetic if any), bleeding may occur if you go for the ablativ mode, depending how many layers (how deep) you go, but no bleeding in the fraxel mode, from the columns of skin that lay between the treated areas and are uneffected of the treatment the skin has the chance to proliferate quickly with collagen production.

Conclusions:

Treatment with the Erbium-YAG as Fraxel may not be as effective after one treatment, so you have to go for multiple treatments, but costs are only a fraction of one CO2 treatment. The advantage is that you self decide which result you like to achieve, no risk of infections, almost no down times (maybe a few days with redness of the skin or slight peeling in about 5% of patients). No coagulation, means scarring, in the dermal layer of the skin with the Erbium compared to the CO2, no risk of hyper-or hypopigmentation, no narcotics.

After having used both systems I have to say I am a fan of the Erbium laser Fraxel for the treatment of fine wrinkles, keloids and acne scars.

Even in the ablative mode the Erbium is more smooth and safer to the skin because of no thermal damage to the untreated areas and the ability to go for very thin layers step by step to the depth you want to go and not further. Treatment of lentigines solaris on the back of the hands for example or in the face can be treated safely.

Of course it needs with every laser a competent physician and the right settings.

If you have any questions feel free to contact me under [email protected]

Share this post


Link to post
Share on other sites

Wow, this is an old thread. I have had 4 additional Re:pairs since this post. I have found nothing that will take you to 100%, and I actually have an appointment with a Plastic Surgeon today.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Personalized Advice Quiz - All of Acne.org in just a few minutes


×