I started having fractional CO2 laser (fCO2) treatments, via Multixel, for my acne scars and in totality, I've already had four. (It's technically 5 but the 3rd one had to be redone). The very first session happened February 2012 while the last, just three weeks ago. Sadly, I haven't been a good patient to follow up according to my doctor's prescribed interval because of the discouraging downtime.

I know I shouldn't be expecting outstanding results for my ill-compliance but I'm relieved to see that there are improvements both in the scars and in my skin's overall texture.

Fractional CO2 laser Treatment 2 (taken March last year) versus the recent Treatment 4, show improvement even for the more problematic side of my face. The edges of my acne scars have greatly softened and they look a lot more shallow now. Photo-wise and in real life, the results are commendable.

I don't know if you see the improvement but most of my bukbok (acne scars)-there's just no better way to say it- have resurfaced, most notably those on the upper area of my right cheek. The improvements are still below perfect but I'm really not complaining.

Inefficiency Issues

There's a claim that fractional CO2 laser is ineffective as the scars revert to its original depth a couple of months after. However, this doesn't hold true for me. I have carried over the good results to this very day.

The resurfacing of scars is naturally heightened throughout the course my skin is inflamed but I can say that after all the residual swelling has gone, the depressed areas are a lot more shallow.

Rough Conclusion

• Doctors Know Best. I've had two major faults during my experience which I hope my readers would learn from: not following up within the prescribed treatment interval and asking for low-powered & less dense fractional CO2 laser settings to evade the pain & shorten the downtime. These two have cost me the unmet treatment goals I and my derma, Dr. Six Foronda, have set prior to the first laser encounter. 

• Pore Problem Unaddressed. My pores still look like an orange peel perhaps because I "controlled" the treatment settings-- I wanted less obvious scabs and faster healing! If you plan to have this treatment, be a doll and let your doctor cover ALL your targetable skin concerns.

• Lookin' Better in Makeup.  I find that I am able to make foundation work without slapping on a lot of product just to cover up the scars on my cheeks. I truly appreciate this the most!

• Anticipate the Cost. I have to say that this skin rehab treatment is not for the budget-conscious. Have the treatment only if you have already saved up for the recommended number of sessions. It is also wise to be ready with back-up funds in case you'll be needing an additional one or two more. 

• Resurfaces the Skin. I can firmly conclude that I have improved. I can see more skin now than depressed parts which I am truly happy about.

Before subjecting myself to the treatment, I hoped for a perfect skin after only a couple of  fractional CO2 laser sessions. I honestly ruminate about the "if only's" more than enjoying my skin's current state, which is of course, sad. I encourage those wanting to get rid of acne scars via fCO2 laser therapy to: (1) follow up treatment regularly; (2) be ready for the long downtime and embarrassment; and (3) go for the favored settings. If you're not ready for all three, don't go for it yet. It pays to be compliant with the treatment program as results may turn out to be more phenomenal than what I enjoy now. 

A good reader emailed me to ask about the machine my derma, Dr. Sixta Foronda, uses for my fractional CO2 laser treatment, and it goes:

I know that you mentioned that it was a MULTIXEL. How different it is from FRAXEL RESTORE and FRAXEL REPAIR, did your doctor tell you? I believe that the one being offered in BELO is FRAXEL RESTORE, and they don't have the FRAXEL REPAIR. Now my question is, did you actually have a FRAXEL REPAIR through MULTIXEL? Is MULTIXEL the equivalent of FRAXEL REPAIR?

If you are unaware, Repair and Restore are two different modes of the treatment along with Refine (not mentioned above). Refine is non-invasive and is the mildest mode; Repair is more ablative than Restore. In the fraxel mode spectrum, it's Refine, Restore and Repair.

                                    The R2D2 of beauty - the MULTIXEL machine that my doctor uses

Reader L asked a good question to which I responded to:

Multixel and Fraxel are brand names for machines that utilize Fractional CO2 Laser in treating skin concerns. It's really FCO2 that we talk about here; Restore & Repair (popularized by Fraxel brand i believe) denote variations in the setting of the realease of FCO2. Multixel can do both restore and repair. I've had restore and repair done for my skin in one session; my doctor pretty much targets most, if not all, of my skin concerns without having to switch machines.

Multixel is indeed multifunctional and I'm happy to receive two modes of fractionalized CO2 laser therapy for my skin in one go, without having to pay extra. Speaking of extra payments, did you know that in the U.K., the different modes of Fraxel charge differently? Refine ranges from £500-£800; Restore at £600 to £1000; and Repair costs a whopping £1800 and £3000 (source)!. If there's a good thing about living in a developing country, beauty-wise, it's having access to beauty treatments like these at a way lower price!

Skin resurfacing using fractional CO2 laser has a more severe downtime than my well-loved pampa-blooming TCA peel procedure. Despite this unfortunate consequence, it is able to improve my deepest & most discouraging acne scars better than any chemical peel. 

But before you commit to a more aggressive acne scar treatment, you may want to check the kind of downtime this scar-busting procedure can give your skin. 

Day 0: I look severely, overly, very, annoyingly RED immediately after the treatment (as shown on my first fraxel* post). Positive facial swelling. Dot marks on the skin only visible upon close scrutiny.

Self-Consciousness Factor: 4/5 

I feel abnormally self-conscious because I came to the clinic with a normal-looking face and went out looking bloody red. However, since I come out of the clinic after dusk (around 7pm), I get less uncomfortably conscious about my reddened face making the 4/5 rating drop to 2/5.

Days 1-2: Less reddish but notably more swollen. Untreated areas of the skin, for some reason, look soft and nice. Dot marks still less visible but begins to turn brownish towards the end of Day 2.

Self-Consciousness Factor: 2/5 

I'm still able to meet people but I'm definitely aware that they're whispering behind my back saying, "mukhang nagpaderma." Definitely not the best time to see someone you have a crush on so better be around two types of people only: those who love you for who you are and those you care less about.

Days 3-4: Burnt-look. Dotted marks start to look very brown, almost scab-like, and micropeeling around the "screen wounds" take place. Skin looks rough especially on the nose area. Facial swelling is remarkably reduced by Day 4 though.

Self-Consciousness Factor: 4-5/5

I hang around with only one type of people: those who love me for who I am. I stay home and refuse to go out by Day 4.

Day 5: Major peeling happens on Day 5. Still, I refuse to leave home.

Self-Consciousness Factor: 5/5 

Days 6,7, 8: Redemption Days. Approx 90% of the scabs completely peel off to reveal better-looking skin on Day 6. The scabs that are the last to go off are those on the sides of my face, nose, and on the temples. Some dot marks especially those on the nasal area may still be rough-looking.

Self-Consciousness Factor: 0-1/5

There may still be scabs and dot marks on some areas of the face but the new skin that has resurfaced definitely makes up for it decreasing the self-conscious factor at its lowest. Still, Day 6 is not the best day to be seen by the guy who makes you swoon --- only because you want everything to be perfect when he's around.

Day 6 of Laser Resurfacing session 2: 90% peeled! Do you notice the dot marks along my lower mandible area?

.................................

This timeline is what has generally happened to my skin post-fractional CO2 laser treatment on sessions 1-3. My latest treatment, just last Thursday, yielded a quicker-paced timeline perhaps because Doctor Foronda shifted my retinoids from 0.05% to a 0.1%. 

There's a catch to the early onset of peeling, though. I've never had post-fraxel peeling as unsightly as this:

Day 4 heavy peeling. Day 3 had more of those unsightly peeling scabs.

It may be a cliche but the good old saying holds very true for skin resurfacing via fractional CO2 laser: No pain, no gain. If you're ready to go through purposeful scabbing while becoming overly self-conscious for days, then you're definitely a step closer to better skin with less embarrassing acne scars!

*fraxel - I only use this term to shorten fractional CO2 laser. The Multixel machine is used for my treatment.

The first few months I was with my derma, Dr. Six Foronda, she recommended that I save up for  Fraxel sessions offered by the Belo Medical Group. She explains how cost-effective and efficient the treatment was for the type of acne scarring I have on my cheeks and temples. 

However, I was reluctant to see a different doctor knowing how my skin felt to be under the best care with Dr. Foronda. And so I told her I'd rather wait till she acquires a Fraxel machine.

During the first quarter of this year, she finally gets a fractionalized CO2 laser machine, Multixel. Let me share with you what happened during my first treatment session --- a giant leap for me in getting the best treatment for my acne scars! (I will be using the term "Fraxel" as we go along as it is a more popular term for and a shorter way to type out "fractionalized CO2 laser"). For the record, the procedure I'm getting is laser resurfacing via fractional CO2 laser using Multixel.

BEFORE TREATMENT

• Prior to the big day, Doc Six requested I stop using tretinoin at least 5 days from the treatment date.

• Topical anesthesia, Lidocaine, was applied on areas to be treated (pretty much the whole face). My chin area was breaking out that day and so it was spared.

• Doc Six explains what to expect from the procedure while we wait for the anesthesia to numb my skin.

DURING TREATMENT

• At this point, I am unable to take photos. But let me show you what came in contact with my face:

Dr. Foronda explains the pattern that the laser will create on my skin. Using a paper, the laser beam is applied (red light on left photo). Right photo shows the dots that will appear on my skin

• Doc Six customizes my Fraxel treatment: skin resurfacing on the scars and large pore treatment on the rest of the unscarred skin. Oh the wonders of having a good doctor to work on my skin!

• Despite my low pain threshold, I was able to tolerate the very uncomfortable heat form the machine. It just got painful when the light passed through my forehead, nose and temples. 

• At the end of Fraxel, it was already very painful. I felt like fluids were oozing all throughout my face.

• It is also noteworthy to include how it smelled burnt skin all throughout the procedure.

AFTER THE TREATMENT

• I silently prayed for strength from God to cope with the progressing pain. 

• Doc Six handed me an ice roller to help subdue the pain. Answered prayer! (I pay attention to the littlest things like that)

• I was instructed the following: (1) keep face off water until the evening of the next day, (2) resume tretinoin the next day (evening) to prevent any possible PIH, (3) cold compress & analgesics to soothe pain (4) protect skin form the sun at all times.

• Immediately after Fraxel, I was so red. A day after treatment, the redness decreased a bit but my face looked so swollen.

Immediately after Fraxel as the pain continues to build up

I was less conscious of how my face looked like on the fifth day after treatment; it took six days for my skin to completely heal. A month after the treatment, I noticed that my skin further improved versus Day 7 post-treatment. I wrote a more detailed post about my Fraxel timeline, btw.

(N.B. Day 0- treatment day, Day 1 - day after treatment)
You may click to enlarge

Here's an old photo of my skin before laser skin resurfacing taken from this post

There was very little improvement after this first Fraxel experience. It made me think twice about going back for another painful round of skin cooking but waking up to less scarred cheeks (no matter how minute) has motivated me to be patient with my doctor's treatment plan.  I have had three treatments to date and I will post more about my adventures in fractional CO2 laser treatment in the next few weeks!