Stretch marks or striae are one of the most annoying cosmetic skin problems. The second runner up, cellulite, we will talk about another time. What is generally unknown is that stretch marks are common in men as well as women. They are basically a form of scar tissue where the elastic fibers of the skin are overstretched causing a very signature look with some variation in color and quality. Most popularly they come about during pregnancy. There are also very common during puberty during growth spurts. It is in this circumstance that young men often acquire them. In all cases, one’s susceptibility to them appears to have a strong genetic factor but obviously anyone can get them. The more trauma or stretching action to the skin the more likely one is to acquire them. Some lesser known causes include weight gain, development of muscle hypertrophy with exercise, and as a side effect of oral and topical medications particularly steroids.
Up until recently very little could be done. Billions of dollars have been spent on creams and treatments that basically do nothing. Over the past several years though laser technology has made dramatic improvements in their treatment. In the best-case scenario, stretch marks are detected early and some level of redness or inflammation is present. In this case, a pulsed dye vascular laser (V-Beam) can be used to stop their progression. Once the tissue appears stretched, whitish or dark, other technologies must be used, notably fractional non-ablative lasers such as the Fraxel Restore. In general, I am surprisingly impressed by their efficacy. Now, as expected, nothing will remove them completely and several factors such as skin type, severity, and body location will play a strong role in how much improvement can be achieved. What I could say, is that for many patients that are good candidates we can minimize stretch marks by 80+ %. Universally, several relatively simple, low downtime treatments are necessary. Often a combination of technologies mentioned above must be used in conjunction with topical agents. The good news is that we now have pretty solid protocols that will give patients much greater comfort and hope in the improvement of these common scar-like embarrassments.

For the past decade or two, the gold standard for treating deep wrinkles, scars and severe sun damage has been resurfacing with a CO2 laser. This technology replaced deep chemical peels with Phenol and Dermabrasion. Although extremely effective, the original laser technologies were fraught with long recoveries (several weeks) and modest degrees of risk with scarring and altered skin pigmentation.  Although non-ablative technology (non- cutting) has changed the way we resurface the skin, the less invasive technologies still do not have great efficacy on deeper wrinkles and scars, particularly around the mouth and eyes. The Fractional technology I have mentioned before has been recently applied to the old CO2 technology to accommodate these purposes. The two strongest and most effective devices on the market are the Fraxel Repair and the Active/Deep FX. There are many copycat technologies that claim faster healing times and less pain but this is true only because of their lack of power and efficacy compared to the stronger technologies.  Pixel, Affirm, Matrix, eCO2 and many other brands fall into this category. I currently used the Fraxel Repair as i have found that the few devices the company has  to offer provides the full spectrum of treatment options, the greatest amounts of clinical studies and the most powerful technologies.

So…the main goal and advantage of the Fractional CO2 technology is to come close to the efficacy of the old CO2 lasers with significantly greater safety and less downtime.

In my own experience with the Fraxel Repair, I have consistently found recovery to be 1 week at home then an additional week of makeup tricks to cover the remaining redness and mild puffiness. Usually by the end of the second week, only the patient and Dr can appreciate the subtle redness that remains. Patients do need 1 week off from work and 2 -3 weeks before any major social event. I generally tell patients 1-2 weeks for 15 years off the skin….which is exactly the results I have been getting. The procedure is done under local anesthetic and although the look of recovery is tough, it is painless. I do have all the other less invasive Fraxel technologies in my practice but for significant wrinkles or scars, the Fraxel Repair has certainly been the most effective. For the many who cannot afford the downtime, the Fraxel Dual can be performed. Check out pfrankmd.com to read more about the fractional technologies.

With so many lasers on the market, patients get very confused on what is what, particularly when it comes to fractional laser technology. Fractional lasers are devices that deliver laser energy in a novel way that has changed the landscape of laser surgery forever. The technology has been around about 4-5 years with advances developing every couple years. Fractional resurfacing offers an improved balance between safety, efficacy and recovery time by treating skin in a ‘pixelated’ fashion.  Although the entire skin surface visually appears treated, microscopically there are treated areas separated by untreated areas. In effect, the healing tends to be quicker and safer. These areas of treatment are called microthermal zones, and they have changed the way we treat the skin.; allowing us to deliver laser energy to greater depths into the skin without increasing risks. Now the name Fraxel is actually a name brand of a laser developed by a company called Reliant that innovated the technology (now it is Solta medical).  Since its release about 5 years ago there are numerous copy cat technologies out on the market – pixel, active FX, matrix, Pearl. Deka, accent and so on. The differences between them all go beyond this discussion but the long and short of it is that I prefer and own the Fraxel brand of technologies. They are, in my opinion, the Rolls Royce of such technologies with the greatest clinical research and certainly the most progressive innovations. They have three different fractional technologies, providing a huge array of clinical applications and a broad spectrum of options for patients who have different needs in regard to results , recovery and risk. I will in, future blogs,  address each of these technologies which represent significant part of my laser practice. Now I am not saying that the Fraxel namebrand is the only effective technology. As with most technologies, the clinical results depends mostly on how the device is used, meaning the skill of the doctor to select the appropriate patient and then use the device to provide an expected result.