Boston Cosmetic
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Boston Cosmetic

Fraxel Fractional LASER

Fraxel Media Sizzle Reel from Dr. Ishoo on Vimeo.

Fractional LASER Skin Resurfacing in Greater Boston

Fractional LASER is considered the most effective treatment option for reversing the signs of skin aging. Skin resurfacing can restore the tone and glow to your face through the formation of a completely new skin layer. This re-epithelialization process along with the formation of new collagen is the quickest way to minimize wrinkles, sun damage, age spots, and skin laxity.

Laser Skin Resurfacing from Dr. Ishoo on Vimeo.

Fractional laser resurfacing is a type of skin rejuvenation that targets small areas of the skin, leaving other areas of the skin untouched. The laser beam is fractionated, or broken up / pixilated, hence the name. This enables your skin to heal more rapidly. Afterward, your skin will be red, similar to a sunburn. You may also experience some peeling after about three to four days. In most cases, your skin will return to its normal appearance in about 7 to 10 days.


  • Improve the appearance of aged and sun damaged skin
  • Reduce wrinkles, lines, and enlarged pores
  • Remove age spots and solar letigines (brown pigment)
  • Tighten loose skin and improve the skin’s overall texture
  • Improve the appearance of melasma
  • Soften acne scars
  • Minimize stretch marks, surgical scars, and traumatic scars

Fraxel®, the leading brand in fractional laser resurfacing, was approved by the Food and Drug Administration in 2007 for ablation, coagulation and skin-resurfacing. Below are some of the general Frequently Asked Questions about Fractional Laser treatment and Fraxel:

How does fractional (Fraxel) resurfacing work?

Fraxel Laser Animation from Dr. Ishoo on Vimeo.

The Fraxel laser creates tiny “microthermal” zones (think pixels) deep into the skin, which the skin repairs by pushing out the old sun damaged skin (the tiny pixels) and replacing it with new skin. Each treatment replaces about 15-20% of the sun damaged, scarred or wrinkled skin. It triggers the body’s natural healing process accelerating the production of collagen and new, healthy skin cells. 1,000-2,000 microthermal zones per are created each centimeter squared.

What are the different types of Fraxel LASERS?
There are two types of fractional lasers now, the more gentle, erbium-type fractional laser, Fraxel Dual containing the 1550 nm and 1927 nm wavelengths (often called “non-ablative” ), and the Fraxel Repair using carbon dioxide (called “ablative”) laser systems.

In general, the ” non-ablative” Fraxel Dual is better for younger patients (under 50), mild to moderate acne scarring, and fine wrinkles. The “ablative” Fraxel Repair is better for older patients, deeper wrinkles, some skin tightening, deeper acne scarring, and other scars. The fractionated CO2 laser can treat more deeply, but it also can require more downtime than the Fraxel Dual.

Can I do the Fraxel with other cosmetic treatments?
Yes. With Expression, Juvederm, other temporary or semi-permanent fillers, wait 1 week after having Fraxel done. For Sculptra, it is best to have the Fraxel treatments first, or you will need to wait 3 months after your last Sculptra injection to begin Fraxel treatment. With Ulthera, wait one week before of after a Fraxel treatment.

How long do the effects of a Fraxel treatment last?
That depends on how well you protect your skin from the sun and your genetic aging process. If you apply sunscreen and wear sun protective clothing, your skin will look good longer than if you are tanning, including tanning booths, or spend a lot of time outdoors. If you are careful with your skin, your skin may continue to look good with annual maintenance treatments.

How long does the Fraxel take to work? When will I see results?
Many people notice results within a week after their first treatment. Their skin feels smoother, looks less blotchy, and has a glow to it. The results depend on which Fraxel laser was used and what your condition is that you want treated. If you are doing a series of Fraxel Dual , you may need to wait the full length of the series, which can be 5-6 months, to see the complete and best results. Fraxel Repair is done once and results are evident starting in 2-3 weeks and continue to improve over the next 3-6 months as collagen will continue to develop.

How are Fraxel laser treatments performed?
You need to arrive about 1-1 ½ hours before your treatment. You or a technician will cleanse the treatment area and then apply a numbing cream to the area to be treated. Then you just relax, read, or listen to music, while the numbing cream takes affect.

After you numb for about an hour, the numbing cream will be removed. You’ll be taken to the laser room, made comfortable. The treatment takes about an hour for a full face and feels a little like a “pins and needles” sensation. The discomfort ranges from mild to moderate. Plan on being in the office for 2 ½ hours total. Most people drive to and from their own Fraxel appointments.

Is there anything I should do before and after a Fraxel treatment?
Here are examples of the type of instructions you may be given by Dr. Ishoo.

  • Stop use of Accutane at least 12 months before any treatments


  • Buy several bags of ice packs/frozen peas
  • Buy Cetaphil or another gentle cleanser
  • Stop use of Asprin, Advil and Aleve if possible. Tylenol is ok.
  • Stop use of all Retinols/Retin-A
  • Renova, Tazorac, “anti-aging” products
  • Stop use of all glycolic acid treatments
  • Avoid sun exposure 2 weeks prior to your treatment
  • Stop minocycline, doxycycline and tetracycline
  • Stop waxing
  • Stop abrasive scrubs and microdermabrasion treatments
  • Call your doctor if you have a history of cold sores- you may need a prescription for Valtrex or Famvir to begin the day before


  • VERY IMPORTANT – BE ON TIME – You will need the full time for numbing and photos
  • Eat a meal 1-2 hours before your treatment – this prevents feeling jittery with the numbing cream
  • No caffeine for 4 hours before your treatment
  • Wear comfortable/ washable sweats or clothes
  • Arrive with no make-up or eye contacts
  • Bring a wide brimmed hat to your appointment to wear after your treatment.
  • Are you pregnant or breast feeding?
  • If so, you are not a candidate at this time
  • Tendency to hyperpigment?
  • Talk to Dr. Ishoo about starting a bleaching regimen four weeks before your treatment series

Here are examples of instructions Dr. Ishoo might give you for care after your Fraxel treatment.

  • Ice for ten minutes every hour for the next 5 – 6 hours to reduce swelling. Use a bag of frozen peas covered with a thin clean cloth/towel.
  • Avoid scratching or rubbing the treated skin – do not put adhesive dressings over treated areas.
  • Men may shave 1-2 days post-treatment but be gentle
  • Avoid all saunas and hot tubs. Showers can be taken, but avoid hot water and direct shower spray to treatment area for 3 days following treatment.
  • Avoid strenuous exercise for 48-72 hours (this includes all yoga).
  • Avoid alcoholic beverages for 24-48 hours.
  • Sleep with 1-2 extra pillows at night to keep head raised for the two nights.
  • Avoid direct sunlight for a minimum of 4 weeks after your treatment and wear a sun block with 10% zinc or titanium for the next 4 weeks. If actively outdoors, you should reapply your sunscreen every 2-4 hours and wear a wide-brimmed hat
  • Do not use any retinoid, Retin-A or glycolic products for 1-2 weeks post-procedure. Do not use any non prescription creams without checking with your doctor first.
  • Refrain from any chemical peel treatments or microdermabrasion for 4 weeks post-procedure.

What is a Fraxel laser treatment?
Fraxel is a revolutionary laser treatment that helps you to remove years from your appearance. Fraxel is the pioneer of “fractional photothermolysis”, a technology in which thousands of microscopic laser columns – each just one-tenth the diameter of a hair follicle – treat a fraction of the skin at a time without affecting the surrounding tissue. These laser columns stimulate the production of younger, smoother, healthier skin to replace damaged tissue.

Fraxel Re:pair is an ablative fractionated laser that vaporizes tissue in a precisely controlled manner to promote new collagen formation and skin rejuvenation. Recovery time is longer and can range from a few days to a few weeks. Ablative lasers are most useful for improving scarring, moderate wrinkles, severe sun damage, moderate skin laxity, mottled pigmentation and cosmetic tattoos.

Fraxel Dual™ is a non-ablative fractionated laser that stimulates collagen growth in the skin resulting in a healthy glow, smoother texture and improved appearance. The laser energy produces a wound healing response without injuring the skin surface, allowing for a faster recovery time, typically 1-3 days. A series of non-ablative laser treatments can improve fine lines, mottled pigmentation, melasma, acne scars, surgical scars, stretch marks and enlarged pores.

Because Fraxel laser systems are the most technologically advanced on the market today – and because they spare healthy surrounding tissue – and because they can be used for treatment on and off your face – and for many other reasons – Fraxel is the treatment patients ask for by name for acne scar and skin texture irregularities. Dr. Ishoo owns and utilizes both devices and can help you decide which laser is more appropriate for you.

How does Fraxel® work?
Fraxel® treats a fraction of tissue at a time with thousands of microscopic laser columns before your own body completes the process by healing from the inside out replacing damaged tissue with healthy skin.

What results can I expect after a Fraxel® treatment?
You can expect two levels from your Fraxel® treatment that include immediate and progressive results. Immediately after the initial healing is complete, the surface of your skin will feel softer and the tone will become more even and progressive results occur over the next 3-6 months as the deeper layers of skin continue to heal.

What is recovery after a Fraxel® treatment like?
New epidermal skin will develop immediately (within 24 hours) after your Fraxel® procedure and during this process mild bronzing of the skin and some exfoliation can be expected. Moisturizing the skin will help alleviate any discomfort and using a sunscreen is strongly recommended. The staff of skin care specialists at Boston Skin Essentials and Cosmetic Surgery Center will customize a skin care program specifically for your condition and skin type for best results.

What will I look like right after the treatment and what is the healing time?
During the first 24 hours after treatment, your skin may feel as though it is sunburned. Ice packs or frozen peas are used 5-10 minutes per hour for the first 5-6 hours after the treatment.

Your skin will look very red immediately after the treatment and will fade over the next 1-3 days. Usually you can go back to normal activities including work, with make-up, within 1-3 days (your doctor will estimate for you). Occasionally, the redness may take longer to resolve. Make-up can be worn to reduce the red. Rarely, bruising may develop, which can take up to two weeks to resolve. Allow 2-3 weeks for weddings, reunions, family pictures, etc just to be safe.

Within a few days after each treatment, a “bronzed” look to the skin is common, which can last 1-2 weeks. Your skin may flake and exfoliate a little. Using a moisturizer will help reduce the appearance of dry flakes. Remember, it will take several treatments to obtain optimal results.

How many treatments will I need?
The number of treatments you need will depend on your goals and desired outcomes as well as your lifestyle. This varies from person-to-person and in most cases, 3-6 treatments are required for optimal results. Additional treatments can be scheduled monthly or spaced at longer or shorter intervals depending on the patient’s needs.

What makes Fraxel® different from traditional laser treatments?
Unlike traditional laser devices, Fraxel® brand laser systems treat microscopic volumes of skin with each unique pulse, leaving the surrounding area intact stimulating the body’s own capacity to heal quickly.

Have Fraxel® treatments been approved by the FDA?
Fraxel® lasers have received multiple FDA clearances and have been found safe and effective in treating many areas of the face and body.

How long do Fraxel® treatments take?
The length of a Fraxel® procedure depends on the size, location, and condition of the area to be treated. Sixty minutes prior to a Fraxel® treatment, your skin will be cleansed and numbed with a topical anesthetic ointment and typically the procedure takes 20-30 minutes for a full face.

What precautions will I need to take after my Fraxel® treatment?
You will be instructed to wear a sunscreen with an SPF of 30 or higher and avoid direct sun exposure while you are healing (at least three months).

Do Fraxel® treatments hurt?
A topical anesthesia will be applied before the procedure and cold air will be used on the treatment area during the procedure to minimize discomfort. After treatment, most patients report a tingling sensation similar to a sunburn and this usually subsides in 1-3 hours.

What are some of the side effects involved with a Fraxel® treatment?
As with any laser skin procedure, there is the possibility of side effects and the most common involves the reddening of the treated area often described as having a sunburn. This will lessen and take on a bronzed appearance after a few days and the skin may begin to peel. Rarely, infection occurs which can be treated with antibiotics.

How long will it take before I can return to work?
Recovery time for a gentle Fraxel Dual® treatment is minimal and patients usually resume their normal activities the next day. More aggressive Fraxel® treatments may require up to ten days recovery time.

Can I go back to work and activities immediately?
No, you will need to take the rest of that day off to ice and care for the treated area. You can go back to all of your activities, including exercise when your doctor approves it, usually 1-7 days after your laser treatment. Swimming in a chlorinated pool is not advised for 1-3 weeks. You may exercise outside with a full brimmed hat and with a high-quality sunscreen with 10% zinc or titanium when your doctor approves it.

Are there any reasons not to be treated with these lasers?
Reasons not to do a fractional laser treatment may include use of medications that increase photosensitivity, use of anticoagulants, history of bleeding disorders, and pregnancy.

Are there any medical or cosmetic side effects?
The main side effects are temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister (like a sunburn blister). The skin care nurse performing your treatment will review with you side effects in your consent form prior to treatment.

With so many different Fraxel® treatments, how do I know which one is right for me?
All Fraxel® laser treatments use fractional technology to heal your skin from the inside out but they have different levels of intensity. The range of Fraxel® procedures vary in aggressiveness, downtime, results, and the number of treatments needed. The most aggressive procedure is Fraxel® Re:pair, which produces dramatic improvement for severely damaged skin. Less aggressive treatments, like Fraxel® re:store dual, can produce significant results for mild to moderately damaged skin over the course of 3-6 treatments. When considering which Fraxel® option is best for you, Dr. Edwin Ishoo and his staff of skin care specialists will evaluate your skin conditions and tailor a plan to meet your circumstances and lifestyle.

Who is a candidate for a Fraxel® treatment?
You are a candidate for Fraxel® if you have wrinkles, fine lines, irregular skin texture, pigmented lesions, sun spots, acne scars, age spots, and vascular dyschromia (sun-induced redness).

The Fraxel® Re:pair treatment is designed for patients in their late 30s-70s seeking treatment for deeper wrinkles and firmer skin without surgery. The newest product in the Fraxel® family, the Fraxel® Re:pair® system is the industry’s first and only Fractional Deep Dermal Ablation (FDDA) treatment that leads to tissue contraction, tightening, and collagen remodeling. During an FDDA treatment, the skin is ablated and coagulated in deep columns called Microscopic Treatment Zones (MTZ) and the Fraxel® Re:pair laser’s advanced high speed optics can deliver thousands of MTZs making it faster than other ablative fractional devices. The strongest treatment in the Fraxel® family, Fraxel® Re:pair is a more aggressive procedure used to treat the most severe signs of skin damage. It is also the only system clinically demonstrated to create zones of treatment beyond 1.5 mm that are spaced evenly across the skin’s surface providing tissue tightening. Fraxel® Re:pair utilizes carbon dioxide laser beams to not only diminish wrinkles, smooth rough skin, and improve discoloration: in addition Fraxel® Re:pair tightens skin because of the increased new collagen found in the dermis.

Fraxel® Re:pair is the procedure of choice for severe skin issues because the technology allows for deep laser penetration and the FDA clearances for this treatment include:

  • Age-related deep lines
  • Hard-to-erase lip lines
  • Pronounced photo damage
  • Sagging face and neck skin
  • Moderate to severe wrinkles
  • Irregular texture and tone
  • Age and brown spots
  • Fine lines around the eyes
  • Rhytides (wrinkles)
  • Pigmented lesions
  • Textural irregularities
  • Furrows

Fraxel re pair Patient Video Loop 2011 from Dr. Ishoo on Vimeo.

Fraxal Dual skin resurfacing is performed on patients from 16 to 60 years old and it is used to treat a number of skin conditions including:

    • acne scars
    • “crepey” skin texture
    • fine lines and wrinkles
    • loss of skin elasticity
    • melasma
    • skin discolorations
    • stretch marks
    • sun damaged skin
    • surgical or traumatic scars

Fraxel DUAL Product Promo Video(1) from Dr. Ishoo on Vimeo.

Unlike other types of laser skin resurfacing, such as CO2 ablative lasers that require significant downtime, fractional non-ablative laser has no significant downtime. Because fractional laser therapy only treats precise areas of the skin at one time, several treatments are required to treat the entire skin surface. Most individuals require anywhere from 4-6 sessions to treat the damaged skin.

If I want a Fraxel® treatment, what is my first step?
The first step in deciding if Fraxel® and Fractional Skin Rejuvenation is right for you is to schedule a consultation with Dr. Edwin Ishoo at Boston Cosmetic Specialists. Dr. Ishoo will thoroughly evaluate your skin and prescribe a treatment plan along with a skin care regimen designed for the corrections that need to be made.

Fraxel Dual Frequently Asked Questions

Fraxel Re:pair Frequently Asked Questions

To learn more about Dr. Ishoo’s Fraxel laser skin treatment or to schedule a free consultation in the Boston area, contact us by phone at 888.380-3222 or contact us today.