I Tried Fractional Laser Resurfacing—It Did What Skin Care Couldn’t for My Acne Scars

Few treatments can compete with lasers for targeting fine lines, wrinkles, and other skin texture concerns. Fractional lasers (often called Fraxel, the most widely known brand of these treatments) are known for impressive results and comparatively limited downtime. So how do they work? Fractionated lasers cause micro-injuries to only a portion of the skin, leaving the rest untouched. This way, they spur collagen production (which smooths skin) without the need for lengthy downtime. They can treat all kinds of texture concerns, from wrinkles and fine lines to acne scars and (to a degree) pore size, pigmentation, and sun damage.

This summer, I did one session of ResurFX, a nonablative fractionated laser, for acne scars. A bad bout of cystic acne from a few years ago left me with hyperpigmentation and atrophic scars across my cheeks and chin that no amount of retinol could erase. I hoped that fractional laser would help me achieve the smooth, even-toned skin I craved.

Ahead, find a full breakdown of my experience, plus expert input, including cost, how much it hurt, and my results.

Meet Our Expert

• Dendy Engelman, M.D. is a board-certified dermatologic surgeon at Shafer Clinic Fifth Avenue and the director of dermatologic surgery at New York Medical College.

• Joshua Zeichner, MD, is a board-certified dermatologist, an associate professor of dermatology, and the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital.

• Dr. Kunal Malik is a board-certified dermatologist and an assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai.

How Fractional Lasers Work

In the simplest terms, fractional lasers work by activating the body's healing response, explains dermatologist Dendy Engelman, M.D. "When we cut ourselves, our body recruits all these macrophages, histiocytes, and fibroblasts to heal the skin, and that creates collagen and elastin, the structural components of the dermis." Lasers can deliver such dramatic results because they penetrate the skin and trigger the same response, prompting the body to produce additional collagen and elastin, which improves skin texture.

Fractional lasers are considered the gold standard for treating wrinkles, which occur partly because of the loss of collagen that comes with age. After 30, we lose around one percent of our collagen each year, which can be degraded even further with sun exposure and pollution, Dr. Engelman says.

Early lasers removed the entire top layer of the skin, which came with weeks to months of downtime and a high risk of complication. However, technological advancements allowed lasers to be fractionated, meaning they hit only a fraction of the skin. (Though people use the brand name "Fraxel" colloquially, almost any laser can be fractionated, Dr. Engelman says.) If you've seen post-laser skin that has a grid pattern on it, the grid reveals which spots were hit and which remained untouched. This allows for a much shorter and less intense healing period than non-fractional lasers, which impact the entirety of the skin's surface.

Types of Fractionated Lasers

More recent advancements have allowed laser treatments to become even more targeted and less invasive. Today, fractional lasers (including the brand name Fraxel lasers) come in ablative and non-ablative forms. Early lasers were ablative, meaning they removed the top two layers of the skin. Now, some fractional lasers are non-ablative, meaning they bypass the epidermis, impacting deeper layers of the skin while leaving the surface intact. Non-ablative lasers come with even less downtime and leave skin looking far less irritated afterward.

• Ablative: Impacts both the surface of the skin and deeper layers.

• Non-ablative: Bypasses the outer layer of the skin, leaving it intact while penetrating deeper layers of the skin.
  

Combined, fractional non-ablative lasers are even less invasive. Because these lasers are fractional, only portions of the skin are targeted, and because they're non-ablative, the entirety of the epidermis is untouched.

A dermatologist can help you determine which type of laser is best for your specific skin concerns. "While ablative lasers have the potential to give greater degrees of skin improvements, they also come with more downtime and potential side effects. Since ablative lasers target the outer skin layer, they can leave the skin open and broken in the healing process, which can increase the risk of infections or scarring," says dermatologist Joshua Zeichner, M.D. "For deep wrinkles, CO2 ablative lasers remain the gold standard. For milder acne scars, non-ablative fractional lasers can be very effective while offering a gentler approach," says dermatologist Kunal Malik, M.D.

While there are plenty of photos online of post-laser people who look like they survived a fire, modern lasers take a much gentler approach. "We used to do full face resurfacing where we fully ablated with non-fractionated CO2. People looked amazing, but it took about four to six weeks to heal and months for the redness to go away," Dr. Engelman says. "That was a very high-risk procedure. Nobody does that anymore."

Skin Tone Considerations

Because lasers heat up the skin, they can activate the cells that produce melanin and cause hyperpigmentation. This risk is greater in people with darker skin tones. "The risk of post-inflammatory hyperpigmentation increases significantly in Fitzpatrick skin types IV-VI," says Dr. Malik. That said, a trained dermatologist can tailor treatment to reduce that risk. "For darker skin tones, we often prefer non-ablative fractional lasers with lower energy settings and longer pulse durations (all aimed at minimizing any unneeded heat exposure). We often combine treatments with topical lightening agents," Dr. Malik says.

How to Prepare for Fractional Lasers

Before treatment, you'll have to avoid the sun for one month and discontinue retinoids or any other exfoliants for at least a week. "Sun damage or exposure prior to laser treatment significantly increases the risk of complications, including burns and hyperpigmentation," says Dr. Malik. "UV exposure can make the skin more sensitive and unpredictable in its response to laser energy. This can lead to uneven results, prolonged healing times, and in some cases, permanent skin discoloration."

What Fractional Lasers Feel Like

Topical numbing cream is applied to the face before treatment to minimize discomfort. Still, I was most nervous about the pain. "I've never had anyone stop it because of pain," Dr. Engelman assured me.

To me, it felt exactly how you would imagine a laser: like a tiny beam of sharp heat. The intensity varied greatly depending on where on my face it was. While some spots felt like nothing at all, a few had me holding my breath. The last up was under the eyes; without a doubt, the worst part. It definitely hurt, but it was manageable and quick—I talked through most of the 15-minute procedure. Luckily, ResurFx only requires one pass. The pain subsided immediately, and I wouldn't hesitate to do it again.

Afterward, my face felt warm and tight, similar to a sunburn. I worried the burning would be intense, but it was subtle, and by the time the numbing wore off two hours later, I felt completely fine. I didn't end up taking Advil or needing the face-shaped ice pack I bought in preparation, though it felt great anyway.

Fractional Lasers Downtime and Aftercare

Your face will likely be red for a few days, so it's ideal to plan treatment during a time when you can lay low. I had my treatment on a Wednesday, and by the time I returned to the office on Monday, my skin was largely back to normal.

After undergoing fractionated laser, experts say to avoid sweating, working out for 48 hours, and direct sunlight for a month. You want to keep your skin clean and avoid introducing new bacteria. Here's how I did that:

InStyle Tips

Experts recommend taking these steps to care for your skin after laser resurfacing:

• Avoid sweating for 48 hours

• Avoid steam for 48 hours

• Don't apply makeup for 3 days

• Avoid retinoids for at least 1 week and up to one month

• Avoid direct sunlight for 4 weeks

• Keep the skin clean and moisturized

• Do not pick at the skin or peel away scabs

• Use vinegar soaks on days 2 through 4

I applied ice packs to calm the skin a few hours after the treatment. Dr. Engelman applied moisturizer after the treatment, and I went to bed without washing my face, as directed.

My skin was red the day after the treatment, but less so than the day before. I washed it with a gentle cleanser and applied a gentle moisturizer and sunscreen (even though I would be staying inside all day). I worried about finding a moisturizer that could adequately hydrate my damaged skin without clogging my pores, as I knew my skin would be particularly sensitive to breakouts in its state. Luckily, Dr. Engelman sent me home with all the cleansers, moisturizers, and sunscreen I needed.

On day two post-treatment, my skin had calmed even further. But it was slightly itchy, and I noticed some flaking. Dr. Engelman directed me to use a vinegar soak on days 2-4, as it acts as a natural anti-inflammatory toner and antiseptic. I mixed equal parts vinegar and water and applied the mixture with a cotton round twice daily. It felt slightly itchy but didn't sting like I feared. I continued my routine of a gentle cleanser, moisturizer, and sunscreen.

Some people use Aquaphor post-procedure to keep the skin hydrated, but given my acne-prone skin, I opted for something lighter.

The most important thing is to stay out of the sun, so Dr. Engelman generally only performs the treatment in the fall and winter. I came in in early July, desperate to get it done before my sister's August wedding. She said she'd make an exception because she could tell I took care of my skin (the best compliment you can get from a dermatologist), cautioning that I would have to avoid direct sunlight completely for the next month. I wore SPF 50 at all times and stayed inside as much as possible. When I did have to go outside, I carried a big sunhat that shaded my whole face and carried a mineral SPF brush to reapply. It was definitely a commitment—I didn't go to the beach or eat outside for a whole month of summer—but one that I think paid off.

Before and After

One month post-treatment, I could see an improvement in hyperpigmentation. Many of the red spots I'd had for months or years were faded. (That said, I did have a breakout that contributed a few new spots.) My skin texture issues hadn't budged, but that's normal. Dr. Engelman says skin can continue to improve for up to six months, as it takes time for the body to produce collagen. "I tell my patients that these treatments are more of a 'trust the process' treatment rather than an immediate home run," says Dr. Zeichner.

In short, a single session of ResurFX improved my skin in ways I haven't been able to achieve with prescription retinoids, azelaic acid, vitamin C, micro needling, or IPL laser. That said, I still have textured skin with visible hyperpigmentation. It didn't give me glass skin overnight, and I don't think it's necessarily a one-and-done treatment.

How Many Treatments Are Needed

For preventative measures and anti-aging, Dr. Engelman recommends one treatment a year. For acne, she says patients can do three to five treatments spaced one month apart.

The number of treatments each person will need depends on their concerns, skin type, and the kind of laser used. Given those variables, Dr. Malik gave the following number of sessions that are generally needed with a non-ablative laser:

• Wrinkles and fine lines: 2-5 treatments depending on severity

• Acne hyperpigmentation: 4-6 treatments

• Acne texture scars: 3-6 treatments, depending on severity

• Sun damage: 2-4 treatments
  

Fractional Laser Cost

Dr. Engelman says that, on average, a full face treatment will cost between $1500-2500. Of course, this varies by location. Dermatologists in certain states advertise treatments starting at $500, while at a high-end clinic in New York, a full face treatment can cost $3500.

Yes, there are Groupons for $200 treatments, but this is not the place to cut corners. Dr. Engelman urges readers to see a board-certified dermatologist with extensive experience in lasers and to avoid medispas that may not have the expertise to personalize treatment to their specific concerns and skin types.

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