Flawless skin without acne scars and wrinkles is something many of us aspire to have. The lengths we go to achieve enviable skin seem almost limitless.
I’ve interviewed aesthetic doctors specializing in laser treatments and created this comprehensive guide on fractional lasers to help you determine which treatment will best serve your skincare needs.
What is a laser?
The acronym “laser” represents Light Amplification by Stimulated Emission of Radiation.
Medical lasers are specialized devices utilizing precisely focused light sources to treat or remove tissues. These versatile tools find applications across numerous surgical procedures, including:
- Cosmetic surgery
- Refractive eye surgery
- Dental procedures
- General surgery
What is a fractional laser?
Fractional laser treatment offers a non-invasive approach that employs a device generating thousands of microscopic treatment zones by scanning the target area, treating just a fraction of the skin at once.
Read more: Fractional Laser Costs in Singapore
This process mirrors how a digital photograph gets enhanced pixel by pixel. The untreated tissues surrounding these microscopic zones remain healthy, supporting the wound healing process.
The first fractional laser on the market was the Fraxel® device, which emits a non-ablative 1550-nm wavelength. Today, numerous machines implement fractional technology, including those based on erbium: YAG lasers for superficial treatments and CO2 lasers for deeper ablative treatments. Some examples include:
- Fraxel Repair [Solta Medical]
- Active and Deep FX [Lumenis]
- Quadralase [Candela]
- Pearl Fractional [Cutera])
What can fractional lasers treat?
Fractional laser treatment effectively addresses various skin concerns:
- Wrinkles
- Rhytids
- Fine lines and texture irregularities (furrows)
- Reduction/removal of uneven pigmentation
- Acne scars
While doctors may recommend fractional laser for treating pigmentation disorders like melasma, it’s important to note that the treatment itself can sometimes cause post-inflammatory pigmentation.
Read more: 5 Targeted Areas That Can Be Effectively Treated With Fractional Lasers
Fractional laser treatment can be applied to any body area but proves particularly beneficial for the neck, chest, and hands compared to traditional ablative methods. It may also effectively treat sun-aged skin (poikiloderma of Civatte) and stretch marks.
The versatility of fractional laser treatment makes it suitable for all skin types and patients, though techniques might vary based on age, skin type, sun exposure, and treatment location. Fractional laser treatment can safely complement surgery and other skin treatments.
What can I expect during a fractional laser treatment?
Pre-treatment skin preparation
Your aesthetic doctor might initiate a series of preparatory skin treatments. These typically begin 2 weeks or more before your scheduled procedure. These customized treatments align with your specific skin type to minimize complications and optimize your laser resurfacing results.
Cosmetic laser resurfacing is generally conducted on an outpatient basis and typically takes between 30 minutes and 2 hours to complete.
Managing your discomfort
Laser skin resurfacing can be uncomfortable. Your doctor will numb the skin with local anesthetics to address this.
You might also receive a sedative to help you relax.
For extensive resurfacing, or if you’re undergoing other cosmetic procedures simultaneously, your doctor might recommend general anesthetic instead. Post-procedure, your doctor will prescribe pain relievers to ensure your comfort.
During preparation, your face will be thoroughly cleansed, and you might receive eye protection.
After the procedure
Once the laser resurfacing is complete, your doctor will administer cooling treatments and/or special topical applications to optimize healing.
What are the different types of fractional lasers?
Various laser types are available, differentiated by the medium producing the laser beam. Each laser type has a specific utility range depending on its wavelength and penetration depth.
Ablative Fractionated Lasers
CO2
Utilized to treat deep textural scars like hypertrophic scars, the CO2 laser employs carbon dioxide gas as its medium and emits energy at 10,600 nm. It features the longest wavelength among all market lasers and targets water in abnormal collagen several millimeters below the skin surface.
Erbium Yag
Erbium: YAG lasers reduce mild to moderate wrinkles (rhytides) and depressed skin marks (textural scars).
YAG lasers produce minimal residual thermal injury to underlying skin tissue, resulting in less persistent post-treatment redness and pigmentation changes compared to CO2 lasers.
Ablative laser resurfacing typically requires between 30 minutes and two hours, depending on the technique and treatment area size.
YAG lasers typically emit light with a wavelength of 2940nm, which water absorbs more strongly compared to other laser wavelengths.
Non-ablative Fractionated Lasers
Erbium: Glass
Compared to CO2 lasers, the erbium laser offers a gentler approach as operators can treat much thinner skin layers. Erbium: Glass operates at a wavelength of 1540nm.
Thulium lasers
The thulium fiber laser (Tm: Fiber) commonly treats melasma and mild to moderate photodamaged skin. Its low absorption coefficient with a 1927nm wavelength makes it ideal for superficial epidermal conditions like pigmentation.
Diode lasers
The 1450nm diode laser effectively treats facial acne and improves scar appearance. This non-ablative laser dramatically and safely improves inflammatory facial acne by partially damaging sebaceous glands to reduce sebum secretion.
Non-ablative fractionated laser treatment takes 20 minutes to 2 hours depending on the technique and area size.
Radiofrequency Systems
Fractional Radiofrequency with micro-needling
RF excellently treat atrophic acne scars, improve skin texture/rhytides, and reduce pore size. Treatment time ranges from 5-10 minutes per unit area.
Similar to laser systems, RF systems achieve results by denaturing existing collagen, stimulating newer and shorter collagen production for tissue tightening, fibrous band destruction, and subcutaneous fat reduction.
Fractional RF with microneedling technology uses insulated sharp microneedles to heat the dermis depth, promoting dermal collagen remodeling.
Combination platforms
Some laser machines or energy devices combine technologies or mediums to generate different laser wavelengths targeting specific skin chromophores. These procedures take 15-30 minutes. Examples include:
- Fraxel Dual (combining 1927nm and 1540nm)
- Fotona Dynamis Pro (combining 1064nm and 2940nm)
- And many others
What are the downtimes for fractional lasers?
Non-ablative lasers often require no downtime, while ablative lasers may necessitate a 2 to 3-week healing process, depending on treatment depth, before the new skin fully heals and final results become apparent.
What are the costs of fractional resurfacing laser treatments in Singapore?
Here are the costs of fractional resurfacing laser treatments in Singapore:
| Types | Treatment Names | Cost |
|---|---|---|
| Ablative Fractionated Lasers | CO2: Ecoxel, EDGE, MiXTO, SmartXide, Fraxel re:pair, Lumenis Erbium: YAG: Lotus 3, Alma PIXEL, SP Dynamis | $300 – $1200 |
| Non-ablative Fractionated Lasers | Erb-Glass lasers: Sellas Evo, Mosaic, Fraxel re:store Thulium lasers: Lavieen BB Laser, LaseMD Diode lasers: Clear and Brilliant | $300 – $1500 |
| Radiofrequency systems | Microneedling RF: Infini, Intracel | $850 – $2500 |
| Combinations platforms | Combination platforms: De Oro Dual, Fraxel Dual | $300 – $1000 |
Am I suitable for fractional laser treatment?
You’re a suitable candidate for fractional laser treatment if:
Your skin tone is light enough (for CO2 laser)
Traditional CO2 lasers can create issues for darker skin tones due to increased post-inflammatory hyperpigmentation risk.
Patients with darker skin should consider alternative options like non-ablative fractionated resurfacing lasers, radiofrequency systems, or combination platforms.
Your problem spots are identified and expectations discussed prior to the procedure
Remember, fractional lasers only work on the skin’s upper layers. Some deep scars or discoloration may lie beyond the laser’s reach, often requiring combination treatments.
You have specific kinds of skin issues
Lasers can significantly improve shallow wrinkles, acne scarring, and brown spots. For instance, diode lasers can greatly improve skin with active acne or abnormal blood vessel formation due to UV damage response.
However, some skin concerns, such as stretch marks or deep wrinkles, may not respond as well to other resurfacing lasers.
You have problem areas on other body parts besides your face
Fractional lasers can treat issues beyond the face. Fractional resurfacing lasers commonly address neck rejuvenation, stretch marks, and post-pregnancy loose skin reduction.
Your skin sagginess is not your main concern
While laser resurfacing can tighten skin somewhat, it minimally affects loose, sagging skin in the jowls. For significant jowl tightening, your doctor will likely suggest a facelift instead.
You don’t have a severe active acne flare-up
Though laser resurfacing effectively smoothens past acne breakout scars, it can exacerbate acne flare-ups after treatment.
People prone to frequent acne breakouts should reconsider intensive laser resurfacing treatment or combine it with active acne breakout treatments.
You don’t frequently get cold sores
Laser skin resurfacing can increase cold sore susceptibility immediately after the procedure.
If you’re prone to cold sores, your doctor may prescribe preventative antiviral medications leading up to your procedure to minimize cold sore-related complication risks.
Are fractional lasers painful?
Fractional laser treatments often cause some discomfort. Individual experiences vary: some patients describe merely a “pins and needles” sensation, while others report more significant pain.
To alleviate discomfort, numbing cream is typically applied before the procedure.
For best results, avoid caffeine and follow your doctor’s pre and post-treatment advice to reduce related discomfort.
How safe are fractional lasers?
Fractional lasers are considered a very safe procedure. Most patients tolerate fractional laser treatment well.
You can apply tinted sunscreen or mineral makeup shortly after treatment. Usually, you can return to work immediately after treatment or the following day, depending on your skin condition and treatment intensity.
How long does the effect of fractional lasers last?
Most atrophic scars improve permanently.
For photoaging skin, result longevity depends on sun protection and genetic aging processes. If you apply sunscreen and wear sun-protective clothing, your skin will maintain its appearance longer than if you tan (including tanning booths) or spend extensive time outdoors.
With proper skin care, your skin should continue looking good with regular maintenance treatments.
What are the risks and side effects of fractional laser treatments?
Possible side effects of fractional laser skin resurfacing include:
- Redness, swelling, and itching: Treated skin may become itchy, swollen, and red. Redness intensity depends on treatment depth and can be intense, lasting several months. Aggravation of pre-existing skin conditions like rosacea can contribute to redness.
- Acne: Applying thick creams and bandages to your face after treatment can worsen acne or temporarily cause tiny white bumps (milia) on treated skin.
- Infection: Laser resurfacing can lead to bacterial, viral, or fungal infections. The most common is herpes virus flare-up, causing cold sores. In most cases, the herpes virus is already present but dormant in the skin.
- Changes in skin color: Treated skin may darken or lighten abnormally (hyper/hypopigmentation). Post-inflammatory hyperpigmentation occurs more frequently in darker-skinned individuals. Topical retinoic acid or glycolic acid can help treat hyperpigmentation after the treated area heals. Using sunscreen during healing is also essential. Non-ablative fractional photothermolysis may help improve hypopigmentation.
- Scarring: Laser resurfacing carries a slight scarring risk.
What should I take note of during the recovery period?
- Avoid direct sunlight and keep skin moist and cool to aid healing.
- Avoid environmental irritants during healing (e.g., dust, dirt, aerosols, cleaning agents).
- Avoid dryness and excessive heat (e.g., high heat on blow dryer; medium heat is acceptable).
- Avoid vigorous exercise for 2 weeks.
- Stay hydrated, eat healthy foods, and avoid alcohol.
- Redness and sunburn-type sensation normally last several hours.
- Neck redness persists longer, usually lasting several days more than facial redness.
- The face normally bronzes and peels within 3-5 days (note: skin below the neck normally requires up to 2 weeks to bronze and peel).
Right after the treatment:
- Keep treated areas covered with topical ointment/cream as instructed by your doctor.
- Apply cooling compresses (note: do not apply ice directly to the skin and avoid towels as detergents may irritate the skin).
- If desired, spray distilled or spring water mist on your skin.
- Take painkillers if needed.
On the night post-treatment:
- Sleep with your head slightly elevated.
- Place paper towels over your pillow to prevent ointment/cream transfer.
- Use eye lubricant if experiencing eye irritation.
Day 1 (first day after treatment):
- Avoid direct sunlight and excessive heat.
- Begin washing face 2-3 times daily with room temperature water and gentle cleanser.
- You may shower and wash your hair, but try to avoid hot water.
- Re-apply hydration and moisturizers to the treated area. Ensure skin remains consistently moist.
- Use non-irritating sunblock SPF 30+ with zinc oxide (7-9%) and/or titanium dioxide when going outside.
- You may apply mineral makeup (powder).
Day 2:
- Swelling should subside, and skin may bronze and feel gritty.
- Itching, particularly along the jawline, typically begins this day.
- Continue applying ointment/cream and cool compresses if needed.
- Continue washing face with gentle cleanser and room temperature water.
- For extreme itching, apply hydrocortisone cream (OTC 1%). DO NOT pick and/or scratch.
- Use non-irritating sunblock SPF 30+ with zinc oxide (7-9%) and/or titanium dioxide when going outside.
- You may apply mineral makeup (powder).
Day 4 – 7:
- Itching usually subsides during this period.
- Begin more aggressive washing with fingertips to promote further exfoliation (do not pick).
- Use non-irritating sunblock SPF 30+ with zinc oxide (7-9%) and/or titanium dioxide when going outside.
- You may apply mineral makeup (powder).
Day 7 – 28:
- Continue using moisturizer until skin returns to its usual hydration level (3-4 weeks).
- Resume your regular skincare regime as long as you avoid exfoliation.
- Continue applying non-irritating sunblock (SPF 30+) and use mineral makeup (powder) to protect treated areas.
- Avoid excessive sunlight exposure for up to 4 weeks. Use headwear or clothing to protect treated areas.
- You may resume exercising.
Why do lasers cause PIH and acne flares after sessions?
Post-inflammatory hyperpigmentation (PIH) represents a common problem and the aftermath of various cutaneous disorders and therapeutic interventions.
PIH pathogenesis involves increased melanin production and abnormal pigment distribution. Following trauma or cutaneous inflammation, melanocytes may react with increased or decreased melanin production, clinically manifesting as hyperpigmentation or hypopigmentation.
Post-inflammatory hyperpigmentation is likely the most common adverse effect of laser treatments in dark-skinned individuals.
Acne-prone patients will be informed about potential post-treatment flare-ups.
Some acne-prone patients undergo 4-6 weeks of pre-procedural treatment with topical retinoic acid to minimize flare-up likelihood and severity.
If a flare-up occurs, it likely results from the treatment’s heat and inflammatory response, post-procedural treatment ointment clogging pores (petrolatum-based), or a combination of both.
Topical retinoic acid will be prescribed or restarted once epithelialization completes if a flare-up occurs.
Interested in other aesthetic treatment options? Learn all about High-Intensity Focused Ultrasound (HIFU) in our guide.
To summarize
Singapore offers numerous fractional laser treatment options. However, you should be fully informed about treatment expectations, the process, potential risks, and recovery period considerations.
I hope this article helps you choose the best treatment to achieve your desired glow. If you have additional questions regarding fractional lasers, consult your trusted doctor.