As if the emotional toll that cystic acne exerts on its sufferers isn’t enough, scars left in its wake can serve as a daily reminder of days one would rather soon forget.
This type of acne, which is characterized by painfully tender and large fluid-filled bumps that take weeks to months to heal and flatten, can leave behind pitted indents in the skin that last a lifetime.
And while dermatologic technology has soared with all kinds of possibilities over the past couple of decades, indented scarring remains one of the most stubborn and difficult conditions to treat.
I had tried a laundry list of options for what dermatologists termed my mild case of acne scarring. It sure didn’t feel so “mild” when I applied layers of makeup in front of my magnifying mirror every morning in an attempt to spackle complexion potholes.
(Certainly I knew there are those struggling with more severe scarring cases, and I can only imagine how much more difficult it is to contend with; I’m sharing my experience in the hope that you, too, can benefit.)
There was “needling” to break up scar tissue in the hopes of triggering collagen creation, which left me looking like a car accident victim for a week; a plethora of promisingly named lasers like the Matrix; silicone droplet injections; chemical peels; and aggressive at-home skincare regimens.
I was hopeful and excited before trying each one, imagining the radiant and pillow-soft skin that could perhaps be mine after all. Yet little to no change occurred after any, unless you counted my wallet—which was rapidly whittling down like a Jennifer Hudson Weight Watchers commercial.
But when it comes to beauty, I’m not one to throw in the moisturizer. I next decided to give Fraxel a try, after hearing about it from numerous dermatologists I had interviewed for stories.
There are two types of Fraxel lasers: the Repair and the Restore, the latter of which has been most recently updated to the Restore Dual to confuse you even more.
Fraxel Repair is more aggressive and requires at least a week of downtime. It’s still a tremendous improvement over the invasive lasers of yesterday, like the Erbium and CO2 that burned through skin and required weeks of healing time that really only aging Hollywood actresses and trophy wives could afford in both time and price.
Fraxel Restore, which I opted for, is the first non-ablative laser (no burning through skin) to have the same accumulated impact of the aforementioned lasers—but with just a couple days of downtime. Since you don’t wound the top layer of skin, you can apply makeup afterwards and continue on with your schedule—though many prefer to take a couple days at home. A series of five to seven sessions diligently spaced about a month apart is recommended to achieve the same results as more invasive lasers.
“Think of your face as a television screen. The Fraxel laser is like the micro pixels of light that go deep down through your pores and epidermis to directly stimulate collagen-making bundles that build your skin back up,” explains Montclair, NJ, dermatologist Dr. Jeanine B. Downie, M.D.
The laser is safe for all skin types, though it is not recommended for anyone who uses tanning beds, who won’t comply with a daily sunscreen regimen, or who has active cold sores. Those who are prone to cold sores may be put on preventative anti-viral medications during treatment. Smokers can be treated, but won’t enjoy optimal results because their skin doesn’t heal as well.
Yet patients harboring unrealistic expectations are the ones most commonly turned away at Dr. Downie’s office. “I won’t treat anyone with personal theories on how the laser works—like telling me to ‘just turn it up’ to get full results out of like two treatments instead of six,” she says.
It’s crucial that a board-certified dermatologist or plastic surgeon performs the procedure, since the powerful laser must be expertly calibrated with your skin type, color and concern in mind. That makes it all the more efficacious in the right hands, and a potential horror movie (I’m talking Freddy Krueger) in the wrong hands. Skin of color is more susceptible to the risk of rebound hyperpigmentation caused by the laser that can leave shadowy patches on skin.
As someone with a tan complexion, it’s for this reason that I carefully chose Dr. Downie for Fraxel Restore—she’s a woman of color herself who has years of experience treating deeper skin tones with this specific laser. (Well, that, and her skin looks like buttery smooth caramel toffee. And I want in.)
It’s typical pre-Fraxel protocol to stop exfoliating skincare products like retinol and AHAs anywhere from two weeks to a couple days before and after your treatment. Since my regimen keeps my skin in the clear and a breakout is the last thing I want, Dr. Downie advises my use of products right up until the treatment, and resumption shortly afterwards. “I think it’s detrimental to the psyche of acne patients to risk having them break out while doing treatments, and not in keeping with their skin goals,” she says.
Before the first session, I clip my hair up in a bun and work on my laptop as I wait a whole hour for a goopy lidocaine numbing cream to take full affect. I then recline completely as an assistant holds the machine’s fan that blows refrigerated air a few inches from my face to help cool the skin and assuage pain. Note: Some dermatologists save bucks by not purchasing the expensive cooling Fraxel fan attachment and instead using a handheld one; trust me, it’s not the same thing.
Over my skin, Dr. Downie repeatedly passes the laser head, which I can hear crackle as it snaps like a rubber band against my skin. It’s uncomfortable enough for white knuckles, but the thought of smoother skin somehow makes it more bearable. It takes 15 to 20 minutes to do the entire face, and Dr. Downie instinctively pauses at just the right times to give me a breather during the treatment. She is also plenty chatty to help keep me distracted.
Even though the scars I want to target are on my cheeks, we do the entire face while we’re at it. Fraxel rejuvenates the top layer of skin, so it will also improve texture, fine lines and pigmentation issues while we’re also treating acne scars—so why not?
I’m sent home with instructions to use a healing cream twice a day for two weeks, to avoid sun exposure on my face, and to practice vigilant sunscreen use. Dr. Downie also prescribes a four percent lightening hydroquinone lotion (MyBody Sledgehammer, available only through physician’s offices) for all her Fraxel patients to preempt any possible pigmentation reaction the laser may stimulate. I use the product twice a day as directed for a week, and experience no adverse shadowing through six sessions even though I have a higher risk complexion color.
After care experiences can vary depending on the strength of treatment received and your skin type. Immediately, my skin feels very hot. The burning is alleviated when I hold an ice pack provided by the office to my skin. After about an hour, the sensation stops, and my skin appears just slightly swollen the rest of the day. Easy enough, I think.
The next morning, I awaken to the lovely vision of lots of tiny whiteheads clustered on my chin and lower cheeks. I learn that this can be a common side effect of the laser that for some reason is rarely mentioned anywhere. As long as you don’t touch, it completely resolves in about a day. It’s harmless, but makes me want to hide out at home like a Jackson.
Days two and three, the top layer of my skin becomes scaly and darkens and feels itchy, and then breaks into flakes. Attempting makeup on top of it would be very challenging at this stage. Fortunately, the little bits shed rapidly and easily as I gently cleanse my face in the shower. As I look into the bathroom mirror, the fresh, bright and glowing skin that emerges before my eyes gives me instant amnesia to the previous three days.
After session one, I feel softer skin but see no perceptible change in scarring. Three sessions later, the cashier at my grocery store tells me over cartons of strawberries on sale that I have such beautiful skin. I’m dumbfounded, because I don’t have a stitch of makeup on.
Fast forward to sessions four and five, and I’m noticing that not only are my scars visibly improving, but that fine lines and discoloration are disappearing and the size of my pores actually look smaller. My pores have a long history of behaving in no such way.
Session six, and I now have to tilt my head, lean in closely and use a finger to point out what remains of the scarring for someone else to see. The collagen building that is stimulated will continue on for weeks after the treatment.
Yet I have to be honest with one very real aspect of treating acne scarring that I’ve since found many other Fraxel patients concur on. Once you experience solid improvement, it’s likely you’ll start to pine for nothing less than completely smooth skin.
Laser treatments still can’t promise perfection, and it’s important to come to terms with that or else face disappointment. And even though I know this is the case, I’m still planning a couple more sessions to see what more results I can eek out. (See?)
Fraxel is not cheap. Depending on the depth, area of country and the doctor, a single full face treatment can run anywhere from about $800 to $2000. Packages of sessions may be discounted, and treating a smaller area for less money may also be possible. Keep in mind that accompanying healing lotions are usually not covered by insurance since they’re considered cosmetic. During your consultation (and you should always have a consultation), ask your dermatologist what related costs you should expect to get a true sense of your bottom line.
Also make sure that you are actually getting Fraxel by confirming that the machine in the doctor’s office is labeled as such. It’s unfortunately become a common practice to use the word Fraxel almost like “Kleenex” to describe any type of rejuvenating laser. “No other laser can reach deep enough to treat acne scarring with anywhere near the same kind of results,” says Dr. Downie.
And finally, the million-dollar question: Is the high cost and all the fuss warranted?
Now that I’m about six months out of my sixth treatment, I can tell you this: I’m thrilled to pieces with the progress. I would easily do it all again if given the choice—the laser, the downtime and hiding beneath a pink Yankees cap while clutching a bottle of Lancôme Bienfait UV SPF 50+.
Finally, something that works! The quality of life dividends I’ve reaped have already been well worth it, and more.
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