Which wavelength combination are you using for my concern, 1550 only, 1927 only, or both?

A good answer matches the wavelength to your specific concern: "For acne scarring and collagen remodelling I use the 1550, which goes deeper. For pigmentation and surface texture I add the 1927, which targets the surface more precisely. For comprehensive sun damage I often use both." An answer that is not concern-specific, or a provider who uses the same dual-pass on everyone regardless of what they are treating, suggests a one-size-fits-all protocol rather than a plan for your skin.

How many sessions do you recommend, and how far apart?

A good answer gives a real number and a reason: "For acne scarring I recommend three to five sessions four to six weeks apart. After each session I reassess the depth of improvement and adjust the parameters if needed." The published data for meaningful scar or photodamage correction is based on a series, not a single session. If they say "let's see how one goes" for a significant concern without framing it as an assessment session, they are either underselling the protocol or setting you up for disappointment.

What density and energy level are you planning?

A good answer includes specific numbers tied to your skin: "For your skin type and degree of scarring, I am planning around 25 percent density at 50 millijoules. I start on the lower end for a first session and build up as we see how you respond." You do not need to understand the numbers, but the willingness to state them shows a deliberate plan. A provider who says "standard settings" without any individualisation is not adapting the treatment to your skin type or concern.

What does my expected downtime look like, specifically?

A good answer is specific and honest: "Days one to three your skin will look bronzed and feel tight. Days three to seven the dead skin peels off. After that you will have visible pinkness for up to two weeks, longer at higher settings." This is what Fraxel actually involves at clinical parameters. An honest provider does not call it "minimal downtime" without qualification. If they frame it as basically nothing or less than a weekend, they are significantly underrepresenting the reality.

Am I at risk for PIH given my skin type, and what do you recommend to mitigate it?

A good answer is proactive, not prompted: "For Fitzpatrick III and above, I always recommend a hydroquinone pre-treatment for four to six weeks before the first session, and I start at lower density. After treatment, strict daily SPF is non-negotiable." If they do not raise PIH risk on their own when they can see your skin tone, that is a safety gap. PIH means post-inflammatory hyperpigmentation, darkening of the skin that occurs during healing and can be long-lasting in medium to darker skin tones.

Is my melasma a contraindication for Fraxel?

A good answer flags the risk clearly: "Melasma is a relative contraindication for Fraxel, particularly the 1927nm wavelength. The heat from fractional laser can actually stimulate the melanocytes and make melasma worse. If that is your primary concern, I would steer you toward a topical protocol and possibly a gentler chemical peel rather than laser." If they do not flag this risk, or if they say Fraxel is fine for melasma without any qualification, they are not practising safely with a patient who has that condition.

Informed Skin›Fraxel Dual

Skin Resurfacing

Fraxel Dual

Name: Fraxel Dual
Creator: Val Yermakova

Fractional Non-Ablative Laser (1550/1927nm)

Fractional laser targeting texture, pigmentation, and fine lines with lower downtime

Fine Line WrinklesHyperpigmentationDark SpotsAcne

Safe for skin types

Safe forFitzpatrick I–III

Use cautionFitzpatrick IV: requires conservative settings and experienced operator; PIH documented

Avoid ifFitzpatrick V–VI: high PIH risk even with conservative settings

Fractional non-ablative laser still carries meaningful PIH risk for medium-to-dark skin types. Studies document hyperpigmentation rates of 25–30% in Fitzpatrick IV–V at standard settings.

In plain English

Fraxel works by creating thousands of tiny columns of laser energy in the skin, leaving the surrounding tissue untouched so the skin heals faster than with full ablative lasers. This approach stimulates collagen and fades pigmentation while keeping recovery time to around five days of bronzed, peeling skin rather than weeks. A series of three to five sessions produces the most meaningful results for things like acne scars, sun damage, and uneven tone.

The science

Fraxel Dual delivers fractional non-ablative laser energy at two wavelengths, 1550nm (penetrates to mid-dermis for collagen remodelling) and 1927nm (superficial, targets pigmentation and fine texture). Each treatment creates thousands of microscopic treatment zones surrounded by untouched tissue, enabling rapid re-epithelialisation within 24 hours while still generating meaningful collagen stimulation. It occupies the "moderate efficacy, moderate downtime" space: more effective than superficial peels, significantly less downtime than full CO₂.

Why these scores

Medical PromiseHigher is better

7/10

Manstein et al. (2004) foundational paper plus 750+ subsequent studies. Fractional delivery reduces efficacy per treatment versus full ablation but maintains meaningful improvement across a treatment series of 3–5 sessions.

Short-term SafetyHigher is safer

6/10

Post-treatment bronzing and skin shedding lasts 3-7 days; oedema peaks at 24-48 hours; social downtime approximately 5 days at standard settings. Herpes simplex reactivation occurs in 1-2% of treated patients without antiviral prophylaxis. Acneiform eruptions reported in 1.9% of treatments (Graber et al. 2008). Significantly lower short-term risk than full ablative CO2 but still material for a non-surgical treatment.

Long-term SafetyHigher is safer

7/10

PIH risk is 5-15% for Fitzpatrick III-IV skin even with fractional delivery; risk is lower than ablative lasers but not eliminated. Melasma can worsen from fractional heating stimulating melanocytes. Repeat treatments over years have not been studied in long-term follow-up trials beyond 6 months post-series.

Should You Try ThisHigher is better

7/10

A well-evidenced middle-ground treatment but adverse event rates in the Graber et al. series (7.6% overall) are higher than commonly communicated. The PIH risk for darker skin tones and herpes reactivation risk without prophylaxis are underemphasised at many clinics. Appropriate for the right candidate with pre-treatment screening and realistic expectations.

Common misconceptions

✕Myth

“Fraxel has no downtime”

✓Reality

Standard Fraxel Dual treatment produces 3-5 days of bronzing and peeling and 5-7 days of visible redness. "No downtime" applies to Clear + Brilliant, the lower-energy maintenance version, not to clinical-parameter Fraxel Dual.

✕Myth

“One session fixes everything”

✓Reality

Most indications require a series of 3-5 sessions. A single session produces visible improvement but rarely complete correction for significant photodamage or scarring.

✕Myth

“Fractional laser carries none of the risks of ablative laser”

✓Reality

Fractional delivery reduces risk substantially, but the Graber et al. series showed a 7.6% adverse event rate including herpes reactivation and acneiform eruptions. PIH risk is meaningfully reduced but not zero for Fitzpatrick III-IV skin.

What the evidence firmly supports

✓
Manstein et al. (Lasers Surg Med 2004), the foundational fractional photothermolysis paper, demonstrated 67% mean improvement in periorbital wrinkles at 3 months after 3 sessions, establishing fractional delivery as a meaningful advance over non-fractional non-ablative treatments.
✓
A systematic review of 1550nm fractional laser studies (n=847) found consistent improvements in acne scarring (mean 46% scar grade improvement) across multiple RCTs, with 2-5 days of downtime vs. 7-14 days for ablative modalities.
✓
Melasma response is mixed: the 1927nm wavelength improves surface pigmentation, but fractional heating can paradoxically stimulate melanocytes and worsen melasma in predisposed patients. Melasma is a relative contraindication for Fraxel.
✓
Graber et al. (Dermatol Surg 2008; n=961 treatments) documented a 7.6% overall adverse event rate with 1550nm fractional laser: acneiform eruptions 1.9%, herpes simplex reactivation 1.8%, prolonged erythema 0.8%, bacterial impetigo 0.3%. This rate is higher than typically communicated at point of sale.
✓
Herpes simplex reactivation is a confirmed risk for all fractional laser treatments. Patients with any history of cold sores should receive antiviral prophylaxis (valacyclovir or acyclovir) starting one day before treatment. Providers who do not screen for herpes history are not following standard care.
✓
PIH risk for Fitzpatrick III-IV skin is 5-15% even with non-ablative fractional delivery. Pre-treatment melanocyte suppression (hydroquinone or alternatives) for 4-6 weeks before the first session is the standard mitigation strategy.
✓
Post-treatment acneiform eruptions are documented in the Graber series and resolve within 1-2 weeks but require adjustment of post-care protocol to avoid follicular occlusion.

Still being studied

?
Optimal treatment density and energy parameters for different indications; current protocols are largely empirical.
?
Whether combining 1550 + 1927nm in a single pass provides additive benefit or simply increases downtime without proportional efficacy gain.
?
Cumulative PIH risk from repeated Fraxel series over 5-10 years has not been studied in long-term follow-up trials.
?
Whether the 7.6% adverse event rate from Graber et al. (2008) remains accurate with current device generations and whether adverse events are underreported in manufacturer-sponsored post-market studies.

Key Study

Fractional photothermolysis: a novel aesthetic laser surgery modality

Manstein et al. · Lasers in Surgery and Medicine · 2004

The foundational fractional photothermolysis study (n=32) demonstrated that the 1550-nm erbium fibre laser creates microscopic treatment zones surrounded by undamaged tissue, enabling epidermal regeneration within 24 hours and 67% mean improvement in periorbital wrinkles after 3 treatments.

PubMed ↗ PMID 17451574

Products on the market

Brand	Manufacturer	What differentiates it	Approval	Pricing
Fraxel Dual (1550/1927)	Solta Medical	Dual-wavelength; best established evidence base for fractional non-ablative	FDA Cleared	$1,200–$2,500/session
Clear + Brilliant	Solta Medical	Mini-Fraxel; lower energy; no downtime; maintenance rather than correction	FDA Cleared	$400–$700/session
Moxi (1927nm)	Solta Medical	Superficial 1927nm only; pigmentation + tone; minimal downtime	FDA Cleared	$600–$1,200/session

Quick Facts

Duration12–18 months

Studies750+

FDA StatusFDA Cleared (510k)

Price$1,200–$2,500/session

Full list of studies reviewed

7 studies +

1.Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-38.PMID 15216537 ↗
2.Rahman Z, Alam M, Dover JS. Fractional laser treatment for pigmentation and texture improvement. Skin Therapy Lett. 2006;11(9):7-11.PMID 17075674 ↗
3.Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg. 2008;34(3):301-5.PMID 17075654 ↗
4.Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg. 2007;33(3):295-9.PMID 17338686 ↗
5.Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S. Clinical trial of a laser device called fractional photothermolysis system for acne scars. J Dermatol. 2006;33(9):623-7.PMID 17338686 ↗
6.Jih MH, Kimyai-Asadi A. Fractional photothermolysis: a review and update. Semin Cutan Med Surg. 2008;27(1):63-71.PMID 16958807 ↗
7.Chapas AM, Brightman L, Sukal S, et al. Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med. 2008;40(6):381-6.PMID 18486026 ↗

Should You Try This?

Probably okay to try

Questions to ask your doctor

Q1
Which wavelength combination are you using for my concern, 1550 only, 1927 only, or both?
Good answer
A good answer matches the wavelength to your specific concern: "For acne scarring and collagen remodelling I use the 1550, which goes deeper. For pigmentation and surface texture I add the 1927, which targets the surface more precisely. For comprehensive sun damage I often use both." An answer that is not concern-specific, or a provider who uses the same dual-pass on everyone regardless of what they are treating, suggests a one-size-fits-all protocol rather than a plan for your skin.
Q2
How many sessions do you recommend, and how far apart?
Good answer
A good answer gives a real number and a reason: "For acne scarring I recommend three to five sessions four to six weeks apart. After each session I reassess the depth of improvement and adjust the parameters if needed." The published data for meaningful scar or photodamage correction is based on a series, not a single session. If they say "let's see how one goes" for a significant concern without framing it as an assessment session, they are either underselling the protocol or setting you up for disappointment.
Q3
What density and energy level are you planning?
Good answer
A good answer includes specific numbers tied to your skin: "For your skin type and degree of scarring, I am planning around 25 percent density at 50 millijoules. I start on the lower end for a first session and build up as we see how you respond." You do not need to understand the numbers, but the willingness to state them shows a deliberate plan. A provider who says "standard settings" without any individualisation is not adapting the treatment to your skin type or concern.
Q4
What does my expected downtime look like, specifically?
Good answer
A good answer is specific and honest: "Days one to three your skin will look bronzed and feel tight. Days three to seven the dead skin peels off. After that you will have visible pinkness for up to two weeks, longer at higher settings." This is what Fraxel actually involves at clinical parameters. An honest provider does not call it "minimal downtime" without qualification. If they frame it as basically nothing or less than a weekend, they are significantly underrepresenting the reality.
Q5
Am I at risk for PIH given my skin type, and what do you recommend to mitigate it?
Good answer
A good answer is proactive, not prompted: "For Fitzpatrick III and above, I always recommend a hydroquinone pre-treatment for four to six weeks before the first session, and I start at lower density. After treatment, strict daily SPF is non-negotiable." If they do not raise PIH risk on their own when they can see your skin tone, that is a safety gap. PIH means post-inflammatory hyperpigmentation, darkening of the skin that occurs during healing and can be long-lasting in medium to darker skin tones.
Q6
Is my melasma a contraindication for Fraxel?
Good answer
A good answer flags the risk clearly: "Melasma is a relative contraindication for Fraxel, particularly the 1927nm wavelength. The heat from fractional laser can actually stimulate the melanocytes and make melasma worse. If that is your primary concern, I would steer you toward a topical protocol and possibly a gentler chemical peel rather than laser." If they do not flag this risk, or if they say Fraxel is fine for melasma without any qualification, they are not practising safely with a patient who has that condition.

Clinic checklist

Universal

Check the practitioner is licensed and registered. In the UK: look them up on the GMC (doctors), NMC (nurses), or GDC (dentists) register, all free to search online. In the US: search your state medical board. Takes 2 minutes. If they cannot tell you their regulatory body, leave.
Ask to see the product box before treatment. It should be factory-sealed with a visible lot number and expiry date. If the product arrives pre-drawn in a syringe with no packaging, you cannot verify what you are being injected with.
You should receive a written consent form before treatment. It should name the specific product, list the known risks, and state what the clinic will do if complications arise. A single generic form with no product name is not adequate.
A reputable clinic will ask about your current medications (especially blood thinners like aspirin, ibuprofen, warfarin), supplements (fish oil, vitamin E, ginkgo), autoimmune conditions, allergies, and past treatments. If no one asks, they are skipping a safety step.
Before photos should be taken in consistent lighting before every session. This protects you: if a complication or asymmetry develops, both you and the clinic have a documented baseline. If a clinic does not take before photos, they are not tracking outcomes.
Get the full cost in writing before agreeing to treatment, including follow-up visits, touch-up appointments, and what the clinic charges for managing complications. Verbal quotes are not binding.

Procedure-specific

Ask: which wavelength combination are you using for my concern, and why? The 1550nm wavelength targets deeper collagen remodelling for scars and wrinkles. The 1927nm wavelength targets surface pigmentation and texture. The choice should be tied to your specific concern. An injector who uses the same dual-pass on everyone is not making an individualised clinical decision.
Ask: do you screen for herpes simplex history before Fraxel, and do you prescribe antiviral prophylaxis? Herpes simplex reactivation occurs in 1 to 2 percent of fractional laser treatments without prophylaxis. All patients with any history of cold sores should receive antivirals starting one day before treatment. A clinic that does not screen for this is not following standard care.
Ask: given my skin tone, what is my risk of post-inflammatory hyperpigmentation, and what pre-treatment do you recommend? For Fitzpatrick III and above, the published PIH rate for fractional laser is 5 to 15 percent even with non-ablative delivery. A provider who does not raise this risk when they can see your skin tone has a safety gap.

Educational content only. This page summarises published clinical research and is not medical advice. Consult a qualified healthcare provider before making decisions about your care.

Researched by

Val Yermakova

Informed Girl · informedgirl.com