Fraxel and erbium laser treatments can improve acne scars, wrinkles, pigmentation and sun-related skin changes, but they work differently and can involve different recovery times. In this comparison, “erbium laser” refers specifically to the Er:YAG 2940 nm laser used for ablative resurfacing; other erbium-based lasers use different wavelengths and are not the focus of this article.
Fraxel DUAL is a non-ablative fractional laser system using 1550 nm and 1927 nm wavelengths, while Er:YAG can provide ablative resurfacing at 2940 nm. You and your dermatologist can consider your skin tone, the correction you need and how much downtime you can manage before choosing the treatment that suits you.
What Is an Erbium Laser?
An erbium laser, usually an Er:YAG laser, uses a 2940 nm wavelength that is strongly absorbed by water in the skin. This allows precise removal of very thin layers of tissue, making Er:YAG an ablative resurfacing treatment.
Your erbium laser treatment may be full-field or fractional, depending on your skin concerns and the device used. Ask your dermatologist which Er:YAG treatment depth and settings are being proposed, as the term “erbium laser” can describe procedures with very different levels of intensity and recovery.
What Is the Main Difference Between Fraxel and Erbium Laser?
Fraxel is generally a non-ablative treatment that creates controlled thermal zones while preserving your skin’s surface. In contrast, an Er:YAG 2940 nm laser is ablative and can remove very thin layers of tissue because its energy is strongly absorbed by water.
Your Er:YAG treatment may therefore provide more intensive resurfacing but involve a longer recovery, depending on the settings used. Your dermatologist can recommend an appropriate level of resurfacing after considering your skin, concerns and treatment goals.
How Does Fraxel Work Within Your Skin?
Fraxel uses fractional photothermolysis to deliver controlled laser energy into microscopic treatment zones while leaving intervening tissue untreated. This fractional pattern supports healing and collagen remodelling.
With Fraxel DUAL, the 1550 nm wavelength reaches deeper into your skin and may be used for concerns such as acne scars and uneven texture, while the 1927 nm wavelength works more superficially and can be used for selected pigmentation and sun-damage concerns.
How Does Er:YAG Laser Resurfacing Work?
Er:YAG uses a 2940 nm wavelength that is strongly absorbed by water in the skin, allowing very precise tissue ablation. Because much of the energy is absorbed superficially, Er:YAG can remove part of the skin surface with relatively limited residual thermal injury to adjacent tissue.
Your Er:YAG treatment may be fractional, creating microscopic columns with untreated skin between them, or full-field, treating a larger continuous area. Ask your dermatologist about the proposed treatment depth and intensity, as your recovery will depend greatly on the approach used.
Which Treatment Is More Intensive?
Traditional ablative Er:YAG can be more intensive than non-ablative Fraxel because it removes part of your skin’s surface. This can provide a greater degree of surface resurfacing for selected wrinkles, scars and photodamage, but your recovery may also be more involved.
Treatment intensity depends on the settings and technique rather than the device name alone. Ask your dermatologist about the proposed treatment depth and how it relates to your skin concerns and goals.
Which Is Better for Acne Scars?
Both Fraxel and Er:YAG may improve selected atrophic acne scars, but scar type should guide treatment. Fraxel DUAL 1550 nm and fractional Er:YAG can both be considered in selected cases, with the choice depending on scar depth, tethering, skin tone, treatment settings and acceptable downtime.
Rolling, boxcar and ice-pick scars can respond differently and may need additional procedures such as subcision or targeted treatment. Your dermatologist can assess the scar pattern and discuss whether combination treatment is more appropriate than simply increasing laser intensity.
Evidence Note
Research supports fractional laser resurfacing as an option for some atrophic acne scars, but studies use different devices, settings and treatment schedules. This means there is no single laser approach that can be considered best for every type of acne scarring.
Which Is Better for Fine Lines and Wrinkles?
Fraxel may improve fine lines and early signs of skin ageing through collagen remodelling. Er:YAG provides more direct ablative resurfacing and may be considered when greater surface renewal is appropriate, although recovery can be longer.
Your result will also depend on what is causing your wrinkles, as lasers cannot fully correct volume loss, muscle movement or loose skin. Your dermatologist can assess your skin and discuss a treatment intensity that matches your concerns and recovery preferences.
Which Is Better for Sun Damage and Pigmentation?
Both Fraxel DUAL and Er:YAG may improve selected sun-damaged or uneven skin concerns, but the right option depends on the type and depth of your pigmentation. Your dermatologist should assess the cause before recommending treatment.
- Sun spots: Fraxel DUAL 1927 nm can be used for selected superficial pigmented lesions.
- Uneven tone: Er:YAG may improve selected surface photodamage through resurfacing.
- Post-inflammatory pigmentation: Treatment needs extra care because lasers can sometimes worsen pigmentation.
- Melasma: Laser treatment should be considered cautiously and is not a guaranteed solution.
Your skin tone and previous pigmentation changes should also guide treatment. A personalised assessment can help determine which approach is safer and more suitable for you.
UK Guidance Note
British Association of Dermatologists information on melasma advises caution with laser treatment because treatment can worsen pigmentation or cause areas of lighter skin, particularly in people of colour. Your pigmentation should therefore be correctly diagnosed before treatment, with your skin tone, previous pigment changes and the type of pigmentation considered when assessing whether laser treatment is appropriate.
What About Melasma?
Melasma needs particular care when you are considering laser treatment because inflammation can sometimes make pigmentation darker. Fraxel may be considered in selected cases, but neither Fraxel nor Er:YAG is a guaranteed treatment for melasma.
Your dermatologist may prioritise sun and visible-light protection, topical treatments and other pigment-control options before considering laser resurfacing. You and your dermatologist can discuss your skin tone, melasma pattern and previous pigmentation changes before deciding whether laser treatment is appropriate for you.
Clinical Tip
If you have melasma or a history of developing dark marks after inflammation, tell your dermatologist before laser treatment. Pigmentation should be stabilised and correctly diagnosed before choosing a resurfacing procedure because laser-related inflammation can sometimes make pigment changes worse.
Which Treatment Is Better for Overall Skin Texture?
Fraxel DUAL and Er:YAG may both be considered for texture concerns, but the most suitable approach depends on the cause and severity of the changes, your skin type, treatment settings and acceptable downtime. Er:YAG provides ablative surface renewal, while Fraxel DUAL uses non-ablative fractional treatment.
Fractional Er:YAG offers a middle ground by treating microscopic areas while leaving surrounding skin untreated. Your dermatologist can recommend a treatment depth that matches your skin concerns rather than automatically choosing the strongest option.
Which Laser May Be Considered for Different Skin Concerns?
| Skin concern | Fraxel may be considered when | Er:YAG may be considered when |
| Atrophic acne scars | Non-ablative fractional remodelling is appropriate | Fractional or ablative resurfacing is appropriate for the scar pattern |
| Fine lines | Gradual collagen remodelling with less surface disruption is preferred | More direct surface resurfacing is appropriate |
| Photodamage | A 1927 nm fractional approach is suitable for selected superficial changes | Ablative resurfacing is suitable for selected surface damage |
| Pigmentation | The diagnosis is appropriate for treatment with the selected wavelength | Pigment change forms part of broader surface photodamage |
| Shorter recovery preference | A non-ablative fractional approach fits the treatment goals | Lighter fractional Er:YAG settings may be considered |
| More intensive resurfacing | Fraxel settings still meet the treatment goals | Full-field or deeper ablative Er:YAG may be appropriate after careful assessment |
What Is the Difference in Downtime?
Fraxel usually causes redness, warmth, swelling, dryness and some peeling as your skin recovers. Visible recovery is generally shorter than with more intensive ablative Er:YAG, although your exact downtime depends on the treatment settings.
Ablative Er:YAG can involve more significant redness, swelling, sensitivity, crusting and surface healing, particularly with full-field treatment. You and your dermatologist should discuss whether your Er:YAG treatment is fractional or full-field so you have a realistic idea of your recovery.
How Should You Care for Your Skin After Treatment?
After either treatment, follow the aftercare plan provided by your dermatologist and avoid rubbing, picking or removing peeling or crusted skin. Gentle skincare and appropriate moisturising may be recommended while the skin barrier recovers.
Sun protection is particularly important after laser resurfacing because ultraviolet exposure can increase the risk of unwanted pigment changes. The timing for restarting active skincare products should depend on how your skin is healing and the treatment you received.
Is Fraxel or Erbium Laser More Painful?
Both treatments can feel uncomfortable, but your experience depends largely on the treatment intensity. Fraxel may feel hot or prickly, while ablative Er:YAG can cause more discomfort when deeper or larger areas are treated.
Your dermatologist can use topical anaesthetic, cooling or stronger pain relief depending on your treatment. Discuss pain control and aftercare with your dermatologist beforehand, particularly if you are having more intensive resurfacing.
What Should Be Checked Before Laser Resurfacing?
Before treatment, your dermatologist should review your medical history, previous reactions to laser or surgery, tendency to develop abnormal scars, history of pigmentation changes and any active skin problems in the treatment area.
You should also tell your dermatologist about prescription medicines, recent cosmetic procedures and any history of cold sores. Do not stop prescribed medication yourself in preparation for laser treatment; your clinician should advise you if any changes are necessary.
Which Is Safer for Darker Skin Tones?
Both Fraxel and ablative Er:YAG need careful planning when you have a darker skin tone because inflammation can cause post-inflammatory hyperpigmentation. More aggressive laser treatment can also cause unwanted lightening, so treatment settings need to be selected carefully.
Fraxel DUAL may be considered when the wavelength, energy and treatment density are selected carefully, while Er:YAG can provide precise ablation with limited residual heat. You and your dermatologist should consider your skin tone, previous pigmentation changes and how your skin responds to irritation before treatment.
Research Insight
A 2020 systematic review included 17 studies involving 453 patients treated with fractional Er:YAG 2940 nm or non-ablative erbium-glass lasers for concerns including acne, skin spots and rejuvenation. The authors found promising short-term results but noted limitations in long-term evidence and substantial variation between studies. The review therefore does not establish one erbium-based laser approach as best for every patient.
How Many Treatment Sessions Will You Need?
You may need several Fraxel sessions when you want to improve acne scars, sun damage or overall skin rejuvenation. Sessions are usually spaced apart to allow your skin to heal and collagen remodelling to continue.
Your Er:YAG treatment schedule can vary depending on how deeply your skin is resurfaced. You and your dermatologist can discuss the treatment intensity, expected results and recovery rather than judging your treatment only by the number of sessions.
What Are the Risks and How Should You Choose?
Both Fraxel and Er:YAG can cause side effects because they deliberately create controlled injury in your skin. Possible effects include redness, swelling, dryness, peeling and pigment changes, while deeper ablative Er:YAG can also cause crusting, oozing, infection and a longer recovery.
Your choice should depend on your skin concerns, treatment intensity and how much downtime you can manage. Before treatment, confirm the exact wavelength and whether the proposed approach is ablative, non-ablative, fractional or full-field.
Myth vs Fact
| Myth | Fact |
| Er:YAG is always stronger than Fraxel | Er:YAG can be delivered at very different depths and may be fractional or full-field. Treatment intensity depends on settings and technique. |
| A stronger laser always gives better results | More intensive treatment may increase recovery and complication risks and is not automatically the most suitable option. |
| Fraxel and erbium laser are the same type of laser | Fraxel DUAL is non-ablative and fractional, while Er:YAG 2940 nm is an ablative laser. |
| One laser works equally well for every acne scar | Rolling, boxcar and ice-pick scars have different structures and may need different or combined treatments. |
| Laser treatment permanently cures pigmentation | Pigment problems can recur, and conditions such as melasma require ongoing management and careful treatment selection. |
Key Takeaways
- Fraxel DUAL and Er:YAG are different laser technologies and should not be treated as interchangeable.
- Fraxel DUAL uses non-ablative fractional 1550 nm and 1927 nm wavelengths, while Er:YAG 2940 nm is an ablative laser.
- Er:YAG can be delivered fractionally or as full-field resurfacing, so its intensity and recovery can vary considerably.
- Neither treatment is universally better for acne scars, wrinkles, pigmentation or skin texture.
- Melasma and darker skin tones require particularly careful assessment because laser-related inflammation can trigger pigment changes.
- Treatment settings, skin type, diagnosis and acceptable downtime are often more important than simply choosing the stronger laser.
Frequently Asked Questions
1. What is the main difference between Fraxel and Erbium laser?
Fraxel is generally a fractional non-ablative treatment that works within your skin while largely preserving its surface. An Er:YAG 2940 nm laser is ablative, so it can remove microscopic or continuous areas of your skin to provide more intensive resurfacing.
2. Is Fraxel or Erbium laser better for your acne scars?
Both treatments can improve your acne scars, but your scar type should guide which approach is suitable. Fraxel DUAL 1550 nm and fractional or ablative Er:YAG may both be considered for selected atrophic acne scars. Your scar type, depth, skin tone, treatment settings and acceptable downtime should help determine which approach is appropriate.
3. Which treatment is better for your fine lines and wrinkles?
Fraxel can gradually improve your fine lines and early signs of skin ageing through collagen remodelling. Ablative Er:YAG provides direct surface resurfacing, while Fraxel DUAL uses non-ablative fractional collagen remodelling. The most appropriate option depends on the type of lines or wrinkles, treatment intensity and the recovery time you can manage.
4. Can Fraxel and Erbium laser treat your pigmentation and sun damage?
Fraxel DUAL’s 1927 nm wavelength can be particularly useful for your superficial pigmentation, including freckles, sun spots and age spots. Er:YAG can improve your uneven tone and photodamaged skin through resurfacing, but it primarily targets water rather than melanin.
5. Which treatment is better for improving your overall skin texture?
Both treatments can improve your uneven skin texture, but Er:YAG can provide ablative surface renewal by removing selected superficial tissue. Fraxel can give you a more gradual improvement by creating microscopic treatment zones while largely preserving your skin surface.
6. Which treatment gives you more downtime, Fraxel or Erbium laser?
Non-ablative Fraxel DUAL often involves less visible recovery than more intensive ablative Er:YAG treatment, although downtime varies considerably with treatment depth and settings. Ablative Er:YAG can give you a more involved healing period, particularly if your treatment is full-field, while fractional Er:YAG usually gives you less downtime.
7. Is Fraxel or Erbium laser safer for your darker skin tone?
Fraxel and Er:YAG may be considered in selected darker skin types after careful assessment, but the choice of wavelength, treatment depth and settings needs to be individualised. Post-inflammatory hyperpigmentation and, with more aggressive treatment, unwanted lightening can occur, so your pigmentation history, treatment intensity and practitioner experience all matter.
8. Can you have Fraxel or Erbium laser treatment for melasma?
You need to be particularly careful if you have melasma because laser-related inflammation can sometimes make your pigmentation worse or trigger recurrence. Your dermatologist may recommend that you focus first on sun and visible-light protection, topical treatments and other pigment-control measures.
9. How many Fraxel or Erbium laser sessions will you need?
You may need a course of Fraxel treatments, particularly if you want to improve significant acne scarring, photodamage or broader skin ageing. Your Er:YAG treatment plan can vary depending on its intensity, as a more intensive treatment may require fewer sessions while lighter or fractional treatment may be performed as a series.
10. How do you choose between Fraxel and Erbium laser?
You should consider the skin concern you want to treat, how much correction you need, your skin tone and how much downtime you can manage. You should also ask which laser, wavelength and treatment mode your dermatologist is recommending, as “erbium laser” can refer to different technologies and treatment intensities.
Final Thoughts: Choosing Between Fraxel and Erbium Laser
Fraxel and Er:YAG laser treatments can both improve acne scars, wrinkles, pigmentation and uneven skin texture, but they work differently and offer different recovery experiences. You should consider your skin concern, skin tone, treatment intensity and how much downtime you can manage before choosing the most suitable option.
If you’re considering Fraxel laser treatment in London, you can get in touch with our team at London Dermatology Centre.
References:
- British Association of Dermatologists (BAD) (2024) Melasma. Patient information leaflet, updated June 2024. Available at: https://www.bad.org.uk/pils/melasma
- Modena, D.A.O., Miranda, A.C.G., Grecco, C., Liebano, R.E., Cordeiro, R.C.T. and Guidi, R.M. (2020) ‘Efficacy, safety, and guidelines of application of the fractional ablative laser erbium YAG 2940 nm and non-ablative laser erbium glass in rejuvenation, skin spots, and acne in different skin phototypes: a systematic review’, Lasers in Medical Science, 35(9), pp. 1877–1888. Available at: https://pubmed.ncbi.nlm.nih.gov/32472427/
- Friedman, P.M. et al. (2022) ‘1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations’, Dermatologic Surgery, 48(2), pp. 195–200. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8806037/
- You, H.-J., Kim, D.-W., Yoon, E.-S. and Park, S.-H. (2016) ‘Comparison of four different lasers for acne scars: Resurfacing and fractional lasers’, Journal of Plastic, Reconstructive & Aesthetic Surgery, 69(4), pp. e87–e95. Available at: https://www.sciencedirect.com/science/article/pii/S174868151500604X
- Ong, M.W.S. and Bashir, S.J. (2012) ‘Fractional laser resurfacing for acne scars: a review’, British Journal of Dermatology, 166(6), pp. 1160–1169. Available at: https://academic.oup.com/bjd/article-abstract/166/6/1160/6613826