Fraxel Re:pair (CO2)

It was with some trepidation today that I signed the contract to purchase the new Fraxel Re:pair laser. The laser is quite expensive, but it appears likely to revolutionize the treatment of aging, wrinkled and scarred skin.

The CO2 laser was the first successful skin resurfacing laser, and it has been universally recognized as the most effective resurfacing laser. The problems with the CO2 laser were the relatively high incidence of side effects, particularly permanent lightening of the skin. Scarring was also a risk, although it was uncommon, and there was significant downtime. The CO2 laser was eventually supplanted by safer, cool, resurfacing lasers such as the Sciton which we have. However, these lasers were never able to reproduce the skin tightening seen with the CO2 laser.
When Reliant Technologies released the original Fraxel laser, the results were revolutionary. Instead of treating the entire skin surface, the machine laid down a pattern of microscopic pulses which left a  significant portion of the skin uninjured. The result was a very safe laser that produced significant improvement in skin quality, discolorations of various types and scarring, particularly acne scarring. Improvement in stretch marks was also seen. This was done with almost no downtime. People were usually able to return to work the next day.
The new Re:pair laser is a CO2 laser which has been "fraxellated". The new laser will do everything that the old laser did, and in some situations, such as acne scarring, it apparently will do a better job. The Re:pair has been studied in over 500 patients over 2 1/2 years. No cases of decreased pigmentation have been seen, and the risk of scarring is minimal, with proper treatment parameters. The initial investigators report that it's easy to choose before and after photos because "there are no bad photos". All patients have visible improvement.
The most remarkable feature of this new laser is that it produces skin tightening and significant improvement in lines and wrinkles. It has been speculated that this tightening of the skin will result eventually in a decreased demand for facelifts. Certainly this laser produces the results that we hoped to get with Thermage, but rarely saw.
Unlike the original Fraxel, now confusingly renamed the Re:store, there is some downtime with this laser, and it will require 6-7 days off work. This is much less than was seen with the original CO2 lasers. However, it appears that for most people, only a single treatment will be sufficient , as compared to the series of treatments needed with the original Fraxel laser.
We look forward to having this laser operational soon.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA