What People With Darker Skin Tones Should Know Before Getting Fraxel

When the idea of life returning to a (somewhat) normalcy came into fruition a few months ago, I began looking into professional-grade beauty treatments. You know, so that I could rejoin society with an otherworldly glow. This was how I learned about Fraxel treatments and, consequently, the way they can mess with melanin-rich skin.

My main concern was hyperpigmentation, something that has plagued my skin for as long as I remember. The dark spots on my chest were making me self-conscious at a time when I simply wanted to rejoice and leave the house stress-free in scoop-necked summer dresses. After preliminary research, I decided that Fraxel, a type of laser treatment, was the solution I needed. But my rejuvenation journey quickly hit a speed bump: During a consultation, dermatologist Dr. Dendy Engelman, M.D. told me Fraxel lasers aren’t always the best choice for darker skin tones.

“Ablative treatments can be riskier for people of color,” she tells Bustle (that means, besides Fraxel, treatments like CO2 and erbium lasers are included). “They can lead to hypo or hyperpigmentation.” As in: If you’re a Fitzpatrick skin type IV to VI, you could wind up with the exact complexion issue you sought to get rid of. For those reasons, she suggested I go with a series of chemical peels instead.

For more intel on the complications with using the Fraxel laser on dark skin tones, Bustle spoke with two medical experts from the Skin Of Color Society — an organization promoting further education of darker skin in dermatology — for everything you need to know before booking a treatment.

What Are Fraxel And Ablative Lasers?

First off: Fraxel is a non-invasive skin resurfacing treatment that uses a microscopic laser to rejuvenate your complexion in a number of ways. The purported benefits include stimulated collagen production, healing sun and acne damage, and reducing the appearance of wrinkles.

Fraxel gets its name because it’s a fractionated laser, so it’s hitting a specific area of your skin at a time. And within the fractionated laser world, explains Engelman, Fraxel can fall into two buckets: ablative and non-ablative.

“That basically means: Does it break the skin or does it not?” she says. Ablative lasers are the more intense option — they wound and destroy skin cells on both the dermis and epidermis (the top two layers of your skin) to stimulate cell regeneration for a smoother, more even glow. These are commonly used to heal acne scars (including textural ones), diminish visible signs of aging, and get rid of hyperpigmentation.

Non-ablative lasers, however, heat up the tissue without destroying it. Examples are treatments like Fraxel Dual, CoolTouch, and N-lite. These lasers help stimulate collagen and elastin to combat fine lines and wrinkles. And, because non-ablative lasers are less aggressive, it also means they’ll give you milder results. (That’s not to say non-ablative treatments don’t come with downtime, though — Engelman notes the skin will often be red or swollen for a couple of days.).

How Does Fraxel Work?

According to board-certified dermatologist Dr. Janiene Luke, M.D., who works at Loma Linda University Medical Center, there’s a common misconception that there is only one kind of Fraxel laser — but there are actually two basic different types, both of which operate differently.

• Fraxel Dual: This treatment has two different wavelengths (hence the name), and is a newer version of an older version, Fraxel Re:Store. This laser is relatively mild and targets superficial issues like sun spots/damage and fine lines, says Luke. Because of what it targets, it’s not a common treatment for POC, she explains. “This type of Fraxel laser uses heat in tiny zones that ultimately stimulates collagen production,” Luke says. According to Victor, an aesthetic expert at beauty platform Aedit, these treatments usually run somewhere between $1,000 and $1,200. Because it’s a more mild procedure, patients may need more than one visit depending on the severity of their issues.
• Fraxel Re:pair: Luke explains this kind of Fraxel uses an ablative fractional CO2 laser (carbon dioxide), and it’s the one that is potentially hazardous to POC. It works by wounding and removing the top layer of skin during the treatment. The cost of Fraxel Re:pair varies — it can be anywhere from $800 to $6,500 depending on the area of skin being treated as well as factors like the provider’s cost and location. Because of the severity of Fraxel Re:pair, patients often only need one session.

The Issue With Using Fraxel On Darker Skin Tones

The main problem with using Fraxel (either kind) on darker skin tones — again, Fitzpatrick types IV through VI — is that it generates heat. “This heat can stimulate the melanocytes [melanin-producing skin cells] to create more melanin pigment, and then you would get post-inflammatory hyperpigmentation,” says Engelman. “In very extreme cases, you can get the destruction of melanocytes, which causes pigment dropout or hypopigmentation, aka white spots.”

Because of this risk, Engelman says your dermatologist should make sure they’re being as safe as possible when using a laser on BIPOC skin. “In Fitzpatrick types IV to VI, we tend to handle [lasers] with kid gloves because we never want to do any harm, and those [lasers] have the potential to do so,” she explains.

Luke also points to studies that have found ablative lasers used on darker skin types resulted in complications. “Studies done have found [ablative] Fraxel to be associated with acne breakouts, swelling, hyperpigmentation, and prolonged redness or swelling,” she says.

Alternative Treatments To Fraxel For BIPOC

It’s not all doom and gloom — there are treatments for hyperpigmentation and acne scars that are safe for BIPOC skin. Here’s what the experts recommend.

Microneedling: Microneedling essentially uses tiny needles to puncture the skin to trigger fast healing and a boost of collagen to improve pigmentation and texture and diminish acne scars. You can get this done at your derm’s office or DIY with a microneedling tool (which have surged on beauty shelves). Both are safe for all skin tones since they’re not compromising the epidermis. That said, using the device at home requires regular use to see results. Davis’ tip? If you want to see the best improvement in your skin, stick with professional treatments.

Radiofrequency microneedling: Radiofrequency microneedling is a souped-up version of the treatment you can get at a dermatologist’s office. Engelman points to the Genius Laser as a great example within this category: “The needles are coated with radiofrequency at the tips, so, with the coating, it doesn’t generate heat in the dermis,” she says. This means the needles bypass the melanocytes in darker skin tones to stimulate collagen, so there’s no risk of pigmentation. Engelman recommends this treatment if you’re concerned with textural changes or boxcar acne scars. People typically need around four to six treatments to treat the entire face, and the price can start at $100 per session and increase depending on your specific circumstance.

Chemical peels: Chemical peels are a better choice when you’re treating hyperpigmentation or surface-level concerns, says Engelman. You can do at-home peels or get these done in an office, and there is a platter of different options to choose from — including glycolic acid, salicylic acid, and retinoic acid. Luke recommends consulting your dermatologist to determine which is right for you as the specifics of the peels vastly vary.

All in all, it’s important to do your research before booking any kind of laser treatment since there are higher risks of scarring and inflammation in darker skin types. This is especially the case if the operator doesn’t have experience working with people of color, says Dr. DiAnne Davis, M.D., a board-certified dermatologist with North Dallas Dermatology Associates. Her advice? Before confirming your treatment, ask some basic questions (besides first making sure your practitioner is licensed, of course): “How much experience do they have in treating POC? Is the particular treatment safe for POC? How many treatments have they performed on POC? Have they had any complications in treatments on POC? What are alternative treatment options? Do they have before and after photos of treatments they can show you?” Getting all the intel ahead of time can help ensure you don’t wind up with any adverse reactions.

Studies:

Aust, M. (2008). Percutaneous Collagen Induction Therapy: An Alternative Treatment for Scars, Wrinkles, and Skin Laxity. Plastic and Reconstructive Surgery. https://pubmed.ncbi.nlm.nih.gov/18349665/

Badawi, A. (2011). Retrospective Analysis of Non-Ablative Scar Treatment in Dark Skin Types Using the Sub-Millisecond ND:Yag 1,064 NM Laser. Lasers in Surgery and Medicine. https://pubmed.ncbi.nlm.nih.gov/21384394/

Chandrashekar, B. (2014). Evaluation of Microneedling Fractional Radiofrequency Device for Treatment of Acne Scars. Journal of Cutaneous and Aesthetic Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134659/

Conceição, K. (2017). Chemical Peels for Dark Skin. Chemical and Physical Procedures. https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-20252-5_16-2

Gold, M. (2010). Update on Fractional Laser Technology. The Journal of Clinical and Aesthetic Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921736/

Mirza, H. (2020). Outcomes and Adverse Effects of Ablative vs Nonablative Lasersfor Skin Resurfacing: A Systematic Review Of 1093 Patients. Dermatologic Therapy. https://onlinelibrary.wiley.com/doi/epdf/10.1111/dth.14432

Morais, O. (2013). The Use of Ablative Lasers in the Treatment of Facial Melasma. Anais Brasileiros de Dermatologia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750887/

Patil, U. (2008). Overview Of Lasers. Indian Journal of Plastic Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825126/

Preissig, J. (2012). Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Seminars in Plastic Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580982/

Singh, A. (2016). Microneedling: Advances and Widening Horizons. Indian Dermatology Online Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976400/

Experts:

Dr. DiAnne Davis, MD, FAAD, at North Dallas Dermatology Associates

Dr. Dendy Engelman, M.D., board-certified dermatologist based in New York City

Dr. Janiene Luke, MD, FAAD, at Loma Linda University Medical Center