Adam N. Summers, M.D.
Maryland Plastic Surgery
Cosmetic Surgery & Medical Spa

Fractional Resurfacing

Fractional Laser Resurfacing at the Maryland Plastic Surgery Medical Spa

The Maryland Plastic Surgery Center Medical Spa (located just 15 minutes from Annapolis, Baltimore and Columbia, Maryland) offers a complete spectrum of treatment options to improve the quality and appearance of your skin.  One of the latest advances in skin rejuvenation is Fractional Laser Resurfacing Treatment (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM).  During each treatment, a non-surgical laser procedure is performed in our Medical Spa that gently removes fine lines, reduces unwanted pigmentation and tightens loose skin through collagen stimulation. 

One of the most exciting applications of Fractional Laser Resurfacing Treatments (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM) is for the treatment of striae ("stretch marks").  The Maryland Plastic Surgery Center is enrolling patients from Annapolis, Baltimore, Columbia, Ellicot City, Towson and surrounding areas for a study to evaluate the the appearance and texture of mature (white) striae after 3 treatments performed at moderate settings.  (Note: early results from pilot studies demonstrate an improvement in the depth, width and texture of stria.  Although, post-treatment redness in stria persists longer than on the face, the redness completely fades over time.)

Types of Fractional Laser Resurfacing:

There are a number of different companies (Reliant Technologies, Lumenis, Palomar, Cynosure, Sciton) that manufacture laser devices which "fractionally" resurface the skin.  Although there are technical differences between the devices, and each company makes claims as to differing depths of penetration, the end results are comparable.  Devices which have a shallower depth of penetration may be less painful, but deeper treatments may be more effective.  The Maryland Plastic Surgery Center continually evaluates new fractional technology and recommends the most effective treatment for each patient's individual needs.

Benefits of Fractional Laser Resurfacing Treatments:

  • Improve texture tone and pore size
  • Erase unwanted brown spots
  • Remove melasma ("pregnancy mask")
  • Smooth wrinkles around the eyes
  • Smooth scars from acne and trauma
  • Rejuvenate your neck, chest and hands
  • Minimal downtime

Examples of Fractional Laser Resurfacing Treatments:

                Brown Spots & Wrinkles Before Fraxel        Brown Spots & Wrinkles After Fraxel
                             Brown Spots & Wrinkles                                        Brown Spots & Wrinkles
                               Before Fraxel® Laser                                            After Fraxel® Laser

                Brown Spots Before Fraxel        Brown Spots After Fraxel
                                    Brown Spots                                                       Brown Spots
                               Before Fraxel® Laser                                            After Fraxel® Laser

                            Hand Brown Spots Before Fraxel                                        Hand Brown Spot After Fraxel
                                     Brown Spots                                                        Brown Spots
                               Before Fraxel® Laser                                             After Fraxel® Laser

                Melasma Before Fraxel        Melasma After Fraxel
                                       Melasma                                                            Melasma
                                Before Fraxel® Laser                                             After Fraxel® Laser

How Fractional Laser Resurfacing Treatments Work:

Each Fractional Laser Resurfacing Treatment (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM) produces thousands of tiny columns of coagulation in the skin, known as microthermal treatment zones.  This treatment eliminates old epidermal pigmented cells and it penetrates deep into the dermis, removing unwanted pigmentation.  Just as important, though,  for every microthermal zone the laser treats, it leaves the surrounding tissue unaffected and intact.  This "fractional" treatment allows the skin to heal much faster than if the entire area were treated at once, using the body's natural healing process to create new, healthy tighter tissue to replace skin imperfections.

How Fraxel Laser Works


During your initial consultation at the Maryland Plastic Surgery Center Medical Spa, we will determine the best treatment plan for your desired results.  Although there is some variability among the various devices, by design, each Fractional Laser Resurfacing Treatment (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM) targets between 20%-25% of the skin's surface.  Because of this, 4-6 treatment sessions are typically required to obtain optimal results (note: 10 treatments or more may be needed to treat severe scarring).  

Immediately following each Fractional Laser Resurfacing Treatment (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM), your skin will be slightly red for about an hour.  Some patients experience minor swelling -- this may resolve within a couple of hours or it may persist for up to 48 hours in patients with sensitive skin.  We can adjust the each Fractional Resurfacing treatment for your comfort and to minimize these side effects.  The laser treatment works with individuals of all skin types.

With our advanced treatment protocols, Fractional Laser Resurfacing Treatments may be performed as often as every 7 days at the Maryland Plastic Surgery Center Medical Spa.  Depending upon your condition and schedule, you may choose to vary the duration of time between treatment sessions.  For example, spacing the treatment sessions closer improves the results for fine lines and acne scars, whereas spacing the treatment sessions further apart improves the results for epidermal lesions and discoloration.  

The results are immediate and progressive.  However, optimal improvement is usually visible in about 2 to 3 months.  Because Fractional Laser Resurfacing Treatments (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM) spare healthy tissue, they are effective even on delicate skin areas, such as the neck, chest and hands.

Before Treatment

Patients should avoid taking oral retinoids (Accutane) for at least 6 months prior to treatment, and topical retinoids such as Retin-A, Renova, or Avage should be discontinued at least 2 weeks before treatment.  Patients on systemic steroids (cortisone) or with serious underlying may not heal normally and do not typically make ideal candidates for the procedure.  Patients with a history of fever blistering of the lips or elsewhere should take an antiviral prophylaxis (e.g. Acyclovir or Valtrex) before treatment.  Patients who are prone to keloid formation (excessive scarring) may be at increased risk for these problems following fractional resurfacing.  Patients with a history of pigmentation changes developing after trauma (e.g. brown or black scars) are at risk of this occuring following a Frational Laser Resurfacing procedure and should use hydroquinone cream (a skin lightening cream that "turns off" the pigment producing cells) for one month prior to initiating laser treatments. The treatment should be postponed if the area to be treated is swollen for any reason.

After Treatment

You will experience a mild sunburn sensation for about an hour and then minimal discomfort.  The skin will have a pinkish tone for 1 to 2 days.  Swelling is minimal and generally resolves in 2 to 3 days.

You may apply moisturizer, sunscreen and make-up after the treatment.  A hydrocortisone cream may be applied as needed if the skin is irritated.  Men may shave the following day.  Most patients are able to return to routine activities, including work and social obligations, the same day of treatment.  Some patients with sensitive skin or patients who have had more aggressive treatments will have swelling for up to one week and require a little more time for recovery.

Be sure to use sunscreen with an SPF of 30+ at least twice daily to protect your skin from sun exposure during both the healing phase and for several months after treatment.  For added protection, use wide-brimmed hats when in direct sunlight.

As noted above, there are different types of Fractional Resurfacing technologies (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM).  With a moderate Fractional Resurfacing treatment, which is what is typically performed at the Maryland Plastic Surgery Center Medical Spa, most patients do not experience significant discoloration or peeling.  However, more aggressive treatments can involve the following recovery process:

  • Bronzing: Your skin will have a bronze appearance that lasts about 1-2 weeks.
  • Flaking: Your skin will flake and peel as new skin is developed.  Use of a moisturizer is recommended to minimize flaking.

Over the following weeks and months, the body repairs the deeper dermal tissues that have been affected by the Fractional Laser Resurfacing Treatment (e.g. Fraxel®, ActiveFXTM, Lux 1540TM, AffirmTM, ProFractionalTM), producing longer beneficial changes associated with a healthy, youthful appearance.


Complications of Fractional Laser Resurfacing Treatments are rare.  Mild blistering, especially on the chin and temples may occur at higher powers and densities, but these are very rare and, when present, tend to heal nicely.  Patients with a history of fever blistering are treated with antiviral medications just before treatment and for a week after treatment. Scarring from the procedure is virtually unknown.  Hyperpigmentation may occur in darker skinned patients, or patients prone to discoloration.  Such patients should be pre-treated with hydroquinone (a skin bleaching agent) to minimize any tendency towards disoloration.

Trademark Notification

Fraxel® is a registered trademark of Reliant Technologies, Inc.  ActiveFX is a trademark of Lumenis Ltd.  Lux 1540 is a trademark of Palomar, Inc. Affirm is a trademark of Cynosure.  ProFractional is a trademark of Sciton.  The above information is provided for general educational use by the Maryland Plastic Surgery Center and has not been approved by nor is endorsed by Reliant Technolgies, Lumenis, Palomar, Cynosure, or Sciton.

Q: Is Fractional Resurfacing painful?

Q: How was Fractional Resurfacing technology developed?

Q: Which company was the first to develop Fractional Resurfacing technology?

Q: What other procedures does Dr. Summers perform?