For now, I would avoid the eye area.

Side effects of Fraxel published include, redness, discoloration of skin, discomfort.

SLC

More info below:

https://www.medicalcosmetic.org/fraxel?gclid=CjwKCAiA35rxBRAWEiwADqB37zUWft5tH8ZWpPWB4yFZqJvQsVW_NyUIlWQz5eBdQLGs_zjkIWBoFRoCr8oQAvD_BwE

Fraxel Laser Resurfacing

SPECIAL – Fraxel full face session $650.

Frequently Asked Questions

WHAT IS  A FRAXEL FACIAL? $325
A microdermabrasion followed by a 5 minute light exfoliating with Fraxel laser. Treatment time is 30 minutes done for exfoliation, skin cell turnover , tone, texture and glowing complexion. Performed to enhance results of microdermabrasion. No downtime, no topical anesthesia required, very mild stinging sensation may occur during the active fraxel time. A good skin maintenance treatment. May feel like a mild sunburn for 30 minutes to 1 hour after the treatment. You can return to your daily routine immediately afterwards. Please note this is not a full fraxel treatment . Not recommended if your goal is for wrinkle improvement, discoloration or acne scaring. Pre treatment requirements : no recently tanned skin , avoid any other exfoliation treatments ( such as peels, laser) 1 week prior to treatment, post care use mild cleanser and sunscreen. $325/session.

Infection

An intact skin barrier is the best layer of defense against infection. By definition, fractionated ablative CO2 laser resurfacing perforates the skin barrier allowing for a potential infection postprocedure. The pathologic organisms that may infect the skin include bacteria, fungi, and viruses. The most common cause of scarring is postoperative infection, which usually presents several days postoperatively as a localized area of delayed healing (Fig. 1). Inexperienced or inattentive surgeons as well as patients may find it difficult to distinguish infection from the normal healing process. When an infection is suspected, it is advised to promptly perform microbiologic culture testing to identify the organism and determine its sensitivity to treatment.

Figure 1

(A) Culture-proven Pseudomonas infection. (B) Source of the infection—Pseudomonas paronychia.

The most common causes of infection include Staphylococcus, Pseudomonas, Klebsiella, and Enterobacter. Candidiasis may be quite subtle and present as prolonged erythema and pruritus.1,2 Herpes simplex virus may disseminate over the entire face without prophylaxis (Fig. 2). Atypical mycobacterial infection has also been reported and may present as papules or nodules.3,4

Figure 2

Culture-positive herpes simplex in a patient on valacyclovir. Further dissemination would have necessitated intravenous acyclovir.

Most patients are prescribed a course of both antibiotic and antiviral medications. The antibiotic is usually selected for Staphylococcus coverage and the antiviral for herpes simplex. Systemic antibiotics are preferable to most topical antibiotics due to the possibility of allergic contact dermatitis, especially to neomycin, polymyxin, and bacitracin.5

Postoperative steroid usage immediately after resurfacing is controversial due to increased infection risk. Of note, recently two cases of infection presumably caused by the substitution postoperatively of a potent topical steroid in place of petrolatum have been reported.6

Scarring and Ectropion

The most dreaded side effect, of course, is scarring.7,8Manuskiatti documented a 3.8% incidence of scarring.9In this series, every case was caused by infection, highlighting the need for surveillance, and proper skin care including possible antibiotic and antiviral prophylaxis. Another cause of scarring represents operator error in the form of excessive fluence or density, too many passes, or pulse stacking.10 If the skin is heated beyond its ability to heal promptly and without excessive fibrosis, scarring will occur (Fig. 3). The neck and chest are more susceptible to scarring than the face and must be treated with caution (Fig. 4).11

Figure 3

(A) Impending disaster caused by excessive fluence with secondary infection. (B) Resolution without scarring. The patient received optimal wound care including five intense pulsed light treatments delivered over 8 weeks.

Figure 4

Scarring on the neck and chest.

Ectropion may be the result of cicatrix, but usually results from excessive fluence or density on the thin and highly contractile skin of the lower eyelids.8 Patients with previous subciliary lower blepharoplasty, scleral show, large globes, and lax lower eyelids are particularly prone (Fig. 5).

Figure 5

(A,B) Ectropion following Active FX corrected immediately via canthopexy. A subciliary lower blepharoplasty had been performed previously.

Koebnerization

Any dermatosis that Koebnerizes may be initiated by laser-induced trauma. This includes diseases such as vitiligo and psoriasis (Fig. 6). Eruptive keratoacanthomas have been reported, presumably secondary to Koebnerization.12,13

Figure 6

Persistent erythema 6 months following infraorbital Active FX resurfacing. The patient subsequently developed plaques on her elbows diagnostic of psoriasis. Although the patient did not have a prior personal history of psoriasis, there was a positive …

Dyschromia

Temporary hyperpigmentation, so common following previous generation CO2 lasers in skin types IV and V, is less likely with fractional resurfacing assuming reasonable treatment parameters (Fig. 7).14 Fortunately, delayed-onset permanent hypopigmentation seen in up to 19% of cases with previous generation CO2 lasers is very uncommon.15,16,17,18,19 Nevertheless, fractional lasers are certainly capable of damaging the skin enough to cause excessive fibrosis and disruption of melanogenesis, the causes of hypopigmentation.

Figure 7

Hyperpigmentation in a patient with Fitzpatrick type 4 skin. Severe acne scarring was treated with double-pulsed Deep FX followed by Active FX.

References 2:

LASER TREATMENTS

5 Things You Must Know Before Getting a Fractional Laser Treatment

BY VICTORIA KIRBY    |    OCTOBER 4, 2018

ISTOCK BY GETTY IMAGES / UTKAMANDARINKA

Some things are better the second time around: a vintage Hermès bag, re-binging This Is Us, finding love again. So when I showed up at the dermatologist’s office for my second fractional laser treatment — a collagen-boosting technology that helps reduce wrinkles, dark spots, and other signs of skin aging — I was giddy with anticipation of my soon-to-be glowing complexion. I had good reason: my initial experience took less than 10 minutes and gave me such radiant skin for weeks afterwards that I stopped wearing makeup for almost a month. Yeah, it worked that well.

But three months later when I did my second treatment, it was like the bad sequel to a hit movie. This time, the radiance never came. Instead, a few days later, my face appeared slightly darker and redder than the skin on my neck and around my eyes (the latter had been covered with protective patches during the treatment). There were even visible demarcation lines from where the eye pads had been, making me look like I was permanently wearing way-too-light undereye concealer.

As if this wasn’t enough to manage, my regular skincare products — which had never caused me problems before — suddenly began making my skin turn beet red for up to an hour after I applied them. And even after the flushing subsided, my face was still speckled with small red blotches. My once well-behaved complexion was now throwing daily tantrums, and even after I switched to all ultra-gentle, healing and calming skincare, it took a full year for my skin to finally return to normal.

So what went wrong? Well, it wasn’t the doctor’s fault — both treatments were administered safely, correctly, and spaced apart by three months (more than enough time in between for the type of treatment I had as suggested by the MD). While it’s possible I’m part of a small percentage of people whose skin simply doesn’t tolerate fractional lasers well, I went into the treatments knowing almost nothing about them. Therefore, I didn’t take certain precautions beforehand or afterwards that could have greatly reduced my chances of having a bad reaction.

Just because lasers don’t involve a needle or a scalpel doesn’t mean they should be taken lightly. Few people understand that — and the technology behind them —better than Dr. Macrene Alexiades, a New York City dermatologist who’s authored numerous clinical studies on skin lasers. If you’re considering a fractional laser treatment, follow her five rules for safe and effective beaming.

1. Understand what a fractional laser does to your skin.

Just as you wouldn’t swallow a pill without knowing what it is, you want to be certain of how lasers treat your complexion. These are not the intense resurfacing lasers of the ’90s that destroyed the outer layer of skin and required weeks of recovery time. “A fractional laser emits thousands of tiny micro-beams that treat a fraction of the skin’s surface,” says Dr. Alexiades. Basically, it punches teeny holes in the skin that are invisible to the naked eye, but are enough to activate the skin’s wound response. This signals your complexion to create collagen.

Fractional lasers are either ablative (meaning they create micro-wounds in the skin to trigger collagen) or non-ablative (they use heat to get your collagen cranking). Neither device causes much discomfort: though you may feel a mild, prickly stinging sensation, your dermatologist will numb your skin beforehand. “Ablative lasers tend to do better at reducing wrinkles and sun damage than non-ablative ones,” says Dr. Alexiades. “Plus, with some ablative lasers you need only one treatment, whereas the non-ablative ones may require up to five monthly treatments.”

2. Use these devices to treat a specific issue, not for an overall complexion boost.

Be warned: Fractional lasers aren’t facials with benefits. I got the treatment because I saw how great other people looked after trying it, and I wanted in. But that’s like going to physical therapy when you don’t have an injury. “Some doctors push these lasers as quick, easy rejuvenation treatments even when there’s nothing to rejuvenate,” says Dr. Alexiades. “Tell your dermatologist what your skin issues are that you’d like to address, then let him or her advise the best course of action. You shouldn’t just pick a service off the shelf, because it may not be ideal for your skin.”

3. Take precautions pre- and post-treatment.

Even the slightest change in your skin can increase your chance of having an adverse reaction to a fractional laser. Because of this, Dr. Alexiades advises her patients to follow this protocol: “During the four weeks both before and after each treatment, avoid significant sun exposure, and don’t start any new topical or oral medications or introduce any new skincare products into your routine,” she says.

In my case, I failed to mention to my dermatologist that I’d been on antibiotics less than a month before my second fractional laser appointment. As it turns out, antibiotics can make skin more vulnerable to light-induced damage and irritation for weeks after you finish the medication. Plus, I had my second session just two weeks before going on a beach vacation. (Not wise, I know.) Another smart safety measure recommended by dermatologists, especially if you’re a first timer: do a patch test of the laser on a small area of skin behind your ear. Wait a week to see if you have any redness or irritation there. If you do, don’t move forward with the treatment.

 [Editor’s Note: Please note that some laser treatments may include up to three months of avoiding sun exposure.] 

4. Stick to the advised number of treatments.

I’ve heard of women getting fractional lasers done every two weeks, indefinitely, just to maintain their skin. “This is where people can really get into trouble,” says Dr. Alexiades. “When women — especially those under 40 — use these devices too often, their skin sometimes develops a shiny plastic appearance due to too much wound-healing response.” (Have you ever burned your skin on the stove and noticed that the area looks shiny during the healing process? A similar reaction takes place when you overdo fractional lasers.)

“For some patients, their skin is never quite the same — even after they stop the lasers,” adds Dr. Alexiades. While there are different courses of treatments for different devices, no skin issue should require more than three to five monthly fractional laser treatments — period.

5. If you have an adverse reaction to a laser, tell your licensed provider ASAP.

If you see something, say something. When my skin began reacting a few days after my second treatment, I figured it was temporary and would clear up in a week or two. When it didn’t, I waited until my next appointment with my dermatologist — which wasn’t for another three months — to tell her about it. Big mistake, says Dr. Alexiades.

“Inform your dermatologist right away of any unexpected changes in your skin post-laser,” she warns. “If you allow redness or irritation to persist for too long, it becomes a lot harder to treat and may not go away for up to a year.” (Sounds familiar!)

Despite my complicated experience, I still believe that fractional lasers do a lot more good than harm. As long as you know the basic rules — and, of course, know that this professional treatment is not to be treated as casually as a facial — lasers can light the way towards a balanced, beautiful complexion.

Dr. Macrene Alexiades is a paid Allergan consultant.