Dr. Dele-michael

Pixel Fractional Ablative Laser

Laser Resurfacing at Radiant Skin Dermatology and Laser in NYC

Laser Resurfacing is a great way to restore a youthful glow to aging or aged skin and sun-damaged skin, it is also very effective in delaying the onset of aging if it is incorporated early in one’s anti-aging program. It can improve the appearance of wrinkles, skin discoloration, scars, acne scar and irregular textures and promote a healthy, radiant glow.

Laser skin resurfacing uses intense light energy to heat or remove skin layers with precision. The new skin cells that form during healing give the skin a tighter, youthful radiance. The procedure can be done alone or with other cosmetic procedures on the skin.

There are different types of laser resurfacing lasers. In order to understand the technology, we need to discuss the terminologies.

Ablative vs. Non-Ablative

Ablative lasers: use light energy to vaporize or remove the epidermal layer of the skin, producing dramatic results. The lasers quickly superheat water molecules in the skin. When the water turns into gas, the skin cells are vaporized in a precise skin-peeling effect. This effect promotes collagen formation and contraction of the dermis and epidermis to tighten the skin. Erbium:Yag and CO2 lasers are examples of ablative lasers.

Non-Ablative lasers: These lasers leave the epidermis intact and use light energy to heat the treated skin prompting a healing response and rejuvenation. Because the skin is intact, minimal recover time is required, side effects are milder but results are moderate after multiple treatment compared to ablative lasers.

Fractional vs. Non-Fractional Lasers

Fractional lasers treat a fraction (usually 20-40 %) of the skin, the sparing of normal skin allows for faster healing and fewer complications. (See the pictures below of skin treated with a fractional laser). In non-fractional lasers, the entire skin is treated so healing time is prolonged. There are two types of fractional resurfacing lasers: fractional ablative and fractional non-ablative

Fractional Ablative Laser:

(Erbium:Yag) e.g our Alma Pixel vaporizes a fraction of the skin allowing the surrounding, untreated skin to repair the wound faster (See the pictures below). This leads to minimal downtime and lower risks of side effects. This is great for ice-pick/box-car acne scars, wrinkle treatment, smoker’s lines, crow’s feet, texture changes and discoloration. Because it is an Erbium laser, it is safe in all skin colors. You should consult with a board-certified dermatologist if you are interested in pursuing Fractional Ablative laser resurfacing treatment.


  1. About 3 days of downtime, less than C02 lasers
  2. Average wrinkle reduction six months after one treatment is 80%!
  3. Can be used to treat pigment disorders such as melasma
  4. Safer in darker skinned individuals due to lower risk of PIH
  5. Minimal discomfort

Fractional Laser Resurfacing Fractional Laser Resurfacing




Fractional Laser Resurfacing (note the columns of untreated skin)

CO2 laser e.g. Fraxel Re:pair is the most aggressive of the fractional lasers. Although more skin tightening is seen initially post treatment, the recovery time is more prolonged due to higher thermal injury to surrounding tissue produced by the CO2 wavelength. The average wrinkle improvement six months after one treatment is 40-50%.


  1. Significant recovery time ~2 weeks or longer
  2. Average wrinkle reduction six months after one treatment is 40-50%
  3. May require anesthesia e.g. regional blocks
  4. May cause post inflammatory hyperpigmentation (PIH) especially in darker skinned individuals

Fractional Non-Ablative Laser resurfacing e.g our Fraxel Restore uses light energy to heat a fraction of the skin similar to the grid patterns in the pictures above. Controlled heating of the skin causes thermal injury which initiates wound healing. Because there are no “open wounds” there is much less downtime. Therefore multiple treatments can be utilized to maximize results yet minimize significant side effects. We recommend 6 treatments for maximal results. The average result after multiple treatments is 20% improvement in wrinkles.


  1. Minimal downtime
  2. Need multiple treatments usually six sessions
  3. Average wrinkle reduction after 6 treatments is 20%
  4. Reduced risk of post-inflammatory hyperpigmentation (PIH) especially in darker-skinned individuals
  5. Safer in darker skinned individuals due to lower risk of PIH

What results can I expect with the different procedures?

Peak improvement should be expected at 6 months since laser treatments stimulate collagen production and remodeling and these processes take 6 months to complete.

Method Average Wrinkle Improvement
Erbium:YAG laser resurfacing e.g. Alma Pixel 80%
CO2 fractional ablative e.g. Fraxel Re:pair 30-50%
Erbium Fractional non-ablative e.g. Fraxel Re:store 15-30%

Potential side effects

  1. Prolonged redness
  2. Scarring
  3. Discoloration: hypo and hyperpigmentation
  4. Infection

Special considerations
Avoid laser resurfacing for six months after Accutane therapy and during pregnancy.