Since its launch in 2004, Fraxel has revolutionised the applicability and possibilities of laser skin resurfacing, creating a brand new subset of patients seeking skin rejuvenation with less downtime and risk of complications.
‘The advent of fractional thermolysis technology was a paradigm shift in laser therapy,’ says Brisbane cosmetic and laser dermatologist Dr Shobhan Manoharan. ‘Fractional thermolysis, both ablative and non-ablative, exemplified most elegantly by the various Fraxel devices, proves to be the gold standard for consistent energy-based technology for rejuvenation and scar treatments.’
‘We started with our first Fraxel Dual unit in 2013 and now have three units across four practices around Brisbane. We also have the Clear and Brilliant,’ he says. ‘Fraxel’s versatility, durability and satisfaction rates for both patients and practitioners over the years, despite competition, is a testament to the technology and the brand. With appropriate patient selection, results are consistent, and it allows for treatment of multiple skin concerns both on the face and body, as well as having a high safety profile and very manageable downtime.’
Dr Nina Wines and Dr Elizabeth Dawes-Higgs, both principal dermatologists at North Sydney Dermatology & Laser, have been using Fraxel for almost 10 years and agree it’s still the gold standard for skin rejuvenation, treatment of wrinkles, texture, pigmentation and sun damage.
‘What makes Fraxel so popular is the extensive options you have to treat patients,’ says Dr Wines. ‘It’s very versatile. We most commonly use Fraxel for treating superficial skin conditions such as skin ageing, sun spots, hyperpigmentation, acne scarring and rejuvenation of the neck and hands. It also allows us to improve deeper conditions such as acne scarring, facial lines and surgical scars. Patients love the results, especially those with sun damage as the results are instant. The recovery process is very quick in all patients, with fewer complications.’
The freedom of versatility
Fraxel is divided into the Dual device with the 1927nm and 1550nm wavelengths, and the Re:pair device which has a 10600nm wavelength. ‘The 1927nm Thulium laser is my favourite wavelength – this is non-ablative, but does a splendid job in reducing actinic keratosis, pigmentation and improving general tone and texture,’ says Dr Manoharan. ‘The 1550nm Erbium: glass is a useful modality for scars and tightening wrinkles with relatively low downtime. The 10600nm CO2 device is better for deeper lines and rhytides, and rejuvenation for patients who require heavier treatment for more severe ageing or sun-related changes.’
‘The versatility of these devices enables us to offer patients combination therapies in the same session, for example 1927nm over full face for pigmentation and actinic keratosis, 1550nm around the eyes for fine wrinkling, and 10600nm Re:pair over the perioral area and neck/décolletage for heavier rhytides and elastosis. All device settings
are customisable for density and fluence, and thus can be tailored for the patient’s concern, skin type, downtime and body area treated,’ he continues.
‘We use the 1927nm wavelength for lifting hyperpigmentation, age spots and pre-cancer spots,’ says Dr Dawes-Higgs. ‘The 1550nm targets skin texture as well as fine line and wrinkles and acne scarring. The versatility of Fraxel allows us to treat concerns on the face, neck, chest and hands. Treatment is relatively non-invasive, making it ideal for most skin types, and can be performed year-round.’
The importance of patient selection
‘I have two groups of ‘typical’ patients,’ says Dr Manoharan. ‘One is a younger age group, in their 40s or so, who have had extensive sun exposure. They are starting to see dyschromia (blotchy skin), getting a few actinic keratoses, and are hoping for a refresh and to prevent progression. My other group are older patients in their 50s and beyond, who have established sun damage, possibly a history of smoking, with quite heavy surface changes and deeper lines, who are seeking a global improvement for all these changes. The versatility of the Fraxel devices enables me to cater for both these groups easily.
‘A big part of my work is the treatment of scars, and the Fraxel 1550nm setting is particularly useful for a range of scarring, such as atrophic surgical scars, acne scarring and striae,’ he continues.
‘Patient selection is vital to tailoring settings and minimising complications. I often say that Fraxel can be used to treat all skin types, including skin of colour. It just needs the appropriate preparation and aftercare, and the appropriate settings dialled into the device, for outstanding outcomes for all.
‘My tip for clinicians would be to utilise the great training that Solta offers, start slow and on conservative settings, follow patients up frequently (1 day, 1 week, 1 month, 3 months post treatment) to understand the clinical endpoints and treatment journey under various settings, discuss with others using the devices, and fine-tune and intensify settings as you become more experienced.
‘When experience is gained and patient selection is mastered, this can be an extremely effective device with a high patient satisfaction rate and a real driver within the business. Combine patients on an effective routine of aftercare and repeat treatments to enable best clinical practice and practice growth. It is also a laser that can be delegatable, with nurses and therapists often being technically the best at wielding the handpiece and device.’
Fraxel and Thermage FLX: a winning combination
‘All skin is unique, and the best results are achieved through individualised treatment plans,’ says Dr Wines. ‘Often a multi-layered approach delivers the best results over a period of time. Fraxel can correct skin damage and then Thermage can be used to promote healthy new cells, improving skin health overall.’
Thermage FLX is the latest generation of the popular Thermage radiofrequency treatment device for tissue tightening. ‘The treatment is a lot quicker with the larger tip size,’ says Dr Dawes-Higgs. ‘It’s also more comfortable due to the new cryogen device which allows the skin to cool down as the device heats the deeper, collagen-rich layer of the skin to tighten fine lines and wrinkles.’
‘I love combining Thermage FLX and Fraxel,’ says Dr Manoharan. ‘In fact, we are in the process of conducting a study utilising both devices concurrently with varied intervals.’
‘Fraxel improves the surface of the skin, eradicating sunspots, lightening pigmentation and benefiting tone and texture. However, it does not provide significant lift,’ he continues. ‘This requires a device that can produce targeted heat in the lower levels of skin and subcutis and then cause a tightening and contracture of deeper structures. Thermage FLX is the best non- surgical device I have found for this purpose, and is outstanding for lower and mid-face, eyes and submental region for patients with mild to moderate laxity looking for non-invasive skin tightening. It can also be used off the face in areas that require tightening.
‘The improvements evolve over a period of 3 to 6 months, and typically patients have a treatment every 12 to 18 months to maintain results. I will often combine the Fraxel/Thermage pairing with neuromodulators and fillers to provide an amazing global improvement to the face.’
Solta: Setting you up for success
Incorporating a complete range of aesthetic solutions for the face and body, Solta Medical has earned a stellar reputation for its impeccable products, services and marketing support. ‘In my opinion, Solta is a global leader in the medical aesthetics market,’ says Dr Dawes-Higgs. ‘At NSDL we pride ourselves on providing proven and effective treatments and Solta has always met our high standards through technology and support.’
‘We have an excellent working relationship with Solta,’ adds Dr Manoharan. ‘They are very responsive to client feedback and requests, and are an innovative company in regards to research and development. Their follow- though, post-sales care and marketing initiatives have been great, which is vital when working with a device company.
According to Dr Manoharan, Fraxel is an outstanding group of lasers that can produce consistent improvements for surface changes (pigment and sunspots), fine lines and wrinkles and texture and tone of skin with low downtime. ‘It doesn’t just achieve a great initial response, but also is a fabulous maintenance tool for rejuvenation for the long term,’ he says.
‘I recommend that all my colleagues experience Fraxel as it’s important to understand the treatment journey. Fraxel is one of our most popular treatments due to its effectiveness and therefore high patient satisfaction. The confidence Fraxel gives to men and women of all ages is why I love my job,’ says Dr Wines. AMP
Did you know?
Fraxel is not just for the cooler months. It can be performed year- round. ‘We treat patients with Fraxel throughout the year and have done so successfully for many years. Fraxel is very tunable, and so some patients will opt for heavier treatments in the cooler months and lighter sessions in summer, or choose to have their arms and legs done in winter when it is easier to keep then covered,’ says Dr Manoharan.
