If you want to improve acne scars, uneven texture, pigmentation or early signs of ageing, you may be considering Fraxel or microneedling. Both treatments encourage skin remodelling, but they do so in very different ways.
Fraxel uses fractional laser energy, while microneedling uses fine needles to create controlled microscopic injury. Your dermatologist can assess your skin tone, scar pattern, pigmentation concerns and preferred downtime to discuss which option may suit you.
What Is Fraxel Laser Treatment?
Fraxel is a fractional laser treatment that creates microscopic treatment zones while leaving areas of surrounding tissue untreated. This fractional pattern supports healing and collagen remodelling and may improve selected concerns such as scars, texture and pigmentation.
Fraxel DUAL uses 1550 nm and 1927 nm wavelengths, which can be selected according to your skin concerns. Your dermatologist can select the wavelength and treatment intensity according to your skin and goals; higher-intensity treatment generally involves more noticeable recovery.
What Is Microneedling?
Microneedling uses fine needles to create controlled microscopic injuries in your skin, stimulating a healing response and collagen production. It may gradually improve selected atrophic acne scars, fine lines, uneven texture and the appearance of enlarged pores.
Medical microneedling can reach deeper layers of your skin than home rollers and should be performed by a trained professional. It is also important to distinguish conventional microneedling from radiofrequency microneedling, which adds heat energy.
What Is the Main Difference Between Fraxel and Microneedling?
Fraxel creates controlled microscopic zones of thermal injury with laser energy, while microneedling creates mechanical micro-injuries using fine needles. Both can stimulate collagen remodelling, but Fraxel’s wavelength-specific laser energy can also be used for selected pigmentation and sun-related concerns.
Microneedling does not rely on laser energy and may suit your skin tone or concerns differently. Your dermatologist can weigh your scarring, pigmentation, skin type and treatment goals when recommending the more suitable approach.
Fraxel vs Microneedling at a Glance
| Feature | Fraxel | Microneedling |
| How it works | Uses fractional laser energy to create controlled thermal treatment zones | Uses fine needles to create controlled mechanical micro-injuries |
| Acne scars | May improve selected atrophic scars | May improve selected atrophic scars |
| Pigmentation | Certain wavelengths can target selected superficial pigmentation | Does not specifically target pigment with laser energy |
| Skin texture | Can improve texture through collagen remodelling | Can improve texture through collagen remodelling |
| Downtime | Often more noticeable, depending on treatment intensity | Often shorter with conventional microneedling |
| Darker skin tones | Can be suitable with carefully selected settings | Often considered useful, but pigment changes can still occur |
| Number of treatments | Often requires a treatment course | Often requires a treatment course |
| Main consideration | Wavelength, settings, pigmentation risk and downtime | Needle depth, technique, infection control and pigmentation risk |
How Does Fraxel Stimulate Skin Remodelling?
Fraxel uses laser energy to create microscopic areas of controlled thermal injury, triggering healing and collagen remodelling. Your skin can continue changing gradually for weeks or months after treatment.
With Fraxel DUAL, the 1550 nm wavelength reaches deeper into the skin and can be used for concerns such as acne scars and texture, while the 1927 nm wavelength works more superficially and can be used for selected pigmentation and sun-damage concerns.
How Does Microneedling Stimulate Collagen?
Microneedling creates controlled microchannels in your skin, triggering a healing response and encouraging collagen production. Because collagen remodelling takes time, improvements usually develop gradually rather than immediately.
Your dermatologist can adjust the needle depth for your skin and the concern being treated. Several sessions may be recommended, with time between treatments for collagen remodelling to develop.
Which Is Better for Acne Scars?
Both Fraxel and microneedling may improve selected atrophic acne scars by stimulating collagen remodelling. Neither is automatically the better option, because scar type, depth, tethering, skin tone and treatment settings can all influence the result.
Your acne scar type, skin tone and treatment goals can affect which option suits you. Your dermatologist can assess the type and depth of your scars and discuss which treatment approach best matches your goals.
Evidence Note
A 2021 systematic review included nine randomised controlled trials of microneedling for atrophic acne scars and found consistent evidence of improvement, with no serious adverse effects reported in the included studies. However, study sizes were generally small and treatment methods varied, so the results should not be interpreted as proof that one protocol is best for everyone.
Does the Type of Acne Scar Change Which Treatment You Need?
Yes, your acne scar type can affect which treatment is most suitable. Tethered rolling scars may need subcision, while some shallower boxcar scars may respond to fractional laser resurfacing or microneedling.
Your ice-pick scars may need a different approach because they are narrow and deep. Your dermatologist can assess your overall scar pattern and may recommend a combination approach rather than using one technique for every scar.
Which Is Better for Uneven Skin Texture and Pores?
Both treatments may improve uneven texture and make enlarged-looking pores less noticeable through collagen remodelling. The more suitable option for you depends on the cause and severity of the texture change, your skin type and how much downtime you can manage.
Your pores cannot be permanently removed, but collagen remodelling can help them look smaller. You can discuss the severity of your texture concerns, any other skin problems and the recovery time you can realistically manage with your dermatologist.
Which Is Better for Pigmentation and Sun Damage?
Fraxel DUAL may be considered when your main concerns include selected pigmentation and sun-related changes because its 1927 nm wavelength is indicated for pigmented lesions such as age spots, sun spots and freckles. Conventional microneedling mainly stimulates tissue remodelling and does not use a pigment-targeting laser wavelength.
Your pigmentation should be correctly diagnosed before treatment, as melasma, freckles and sun spots may need different approaches. Your dermatologist can advise whether Fraxel, topical treatment, sun protection or a combination approach is most appropriate for the diagnosis.
Clinical Tip
If pigmentation is your main concern, have it diagnosed before choosing a resurfacing treatment. Melasma, sun spots and post-inflammatory pigmentation can look similar but may respond very differently to laser treatment, and some pigmentation can worsen after inflammation.
Which Is Better for Fine Lines and Skin Rejuvenation?
Both Fraxel and microneedling may improve early fine lines and skin texture through collagen remodelling. Your choice may also depend on whether pigmentation or sun-related changes are present, together with your skin type, treatment goals and preferred downtime.
Neither treatment can provide the lifting effect of surgery or fully correct lines caused by repeated facial movements. Your dermatologist can assess whether the concern relates mainly to skin quality, collagen loss, volume loss or muscle movement before discussing treatment options.
Is Microneedling Better for Darker Skin Tones?
Conventional microneedling may be considered if you have a darker skin tone because it does not rely on laser light interacting with melanin. However, post-inflammatory hyperpigmentation can still occur after microneedling because the treatment creates inflammation in the skin.
Fraxel may also be considered in selected darker skin types when the wavelength, energy and treatment density are chosen carefully by an experienced practitioner. You and your dermatologist should consider your skin tone, pigmentation history, treatment intensity and how your skin usually responds to irritation.
Research Insight
A randomised clinical trial involving 46 patients compared three monthly sessions of conventional microneedling with a 1340 nm non-ablative fractional laser for atrophic acne scars. Both groups improved, with no statistically significant difference in overall effectiveness. Redness lasted longer after laser treatment, and 13.6% of the laser-treated patients developed post-inflammatory hyperpigmentation, compared with none in the microneedling group. Because the laser was not Fraxel DUAL, these findings should not be treated as a direct Fraxel comparison.
What Happens During Fraxel and Microneedling Treatment?
Treatment usually begins with cleansing the skin and may involve a topical anaesthetic. Fraxel can feel warm or prickly, while microneedling may feel like pressure, vibration or repeated prickling, with pinpoint bleeding possible at deeper needle settings.
Your skin may look red and feel warm or tight after either treatment. You and your dermatologist should ensure that the laser energy, needle depth and treatment passes are carefully selected for your skin and concerns.
When Might Treatment Need to Be Postponed?
Fraxel or microneedling may need to be delayed if your skin is not ready for treatment. Your dermatologist should assess your skin and medical history before proceeding.
- Active infection: Treatment should usually wait if you have an infection or cold sore outbreak.
- Inflamed skin: Significant irritation or an uncontrolled skin condition may need to settle first.
- Recent tanning: Tanned or recently sun-exposed skin may increase the risk of pigment changes.
- Previous skin reactions: Tell your dermatologist about abnormal scarring, pigmentation changes or recent cosmetic procedures.
Your dermatologist should also review your medicines and skincare before treatment. Do not stop prescribed medication or change your routine unless your clinician advises you to.
Which Treatment Has More Downtime?
Fraxel often involves more noticeable downtime than conventional microneedling, although recovery varies with treatment settings and intensity. You should expect redness, warmth, swelling, dryness or flaking after Fraxel, while your skin may recover more quickly after microneedling.
Your recovery will depend on the treatment intensity and your skin. You and your dermatologist should balance the downtime you can manage with the amount of correction your skin needs.
How Should You Look After Your Skin During Recovery?
Your skin may be more sensitive while it heals after either treatment. Follow the aftercare instructions given by your dermatologist, use gentle skincare and avoid picking or rubbing peeling or crusted skin.
Sun protection is particularly important after treatment because inflammation and ultraviolet exposure can contribute to pigment changes. Your dermatologist can advise when to restart active skincare products according to how your skin is healing.
Which Treatment Is More Painful?
Both treatments can cause discomfort, although topical anaesthetic can make them easier to tolerate. Fraxel may feel warm or hot, while microneedling can feel like pressure, vibration or repeated prickling.
Your comfort can also depend on the treatment settings and your individual pain tolerance. You and your dermatologist should discuss the anaesthetic, what you are likely to feel and how any discomfort will be managed.
UK Guidance Note
If you are considering Fraxel in England, check your practitioner’s training, experience, insurance and arrangements for managing complications. GOV.UK states that registered medical practitioners using lasers to treat disease, disorder or injury must register with the Care Quality Commission, while laser treatment carried out exclusively for cosmetic purposes does not require CQC registration under that route. Some local councils also require laser practitioners or premises to register.
How Many Sessions Will You Need and When Will You See Results?
You may need several Fraxel or microneedling sessions rather than one treatment. The number you need depends on your skin concern, scar depth, treatment intensity and how your skin responds.
Your skin needs time to heal and produce new collagen, so results develop gradually over several weeks or months. You and your dermatologist can discuss your expected results and whether Fraxel or microneedling is more suitable for your concerns.
What Are the Risks and How Do You Choose Between Them?
Neither Fraxel nor microneedling is risk-free. Expected short-term effects can include redness, swelling, dryness or irritation, while pigment changes may also occur. Less common complications can include infection, scarring or reactivation of cold sores in susceptible people.
Your choice should depend on your skin concern, skin tone, scar type and available downtime. You and your dermatologist can consider whether Fraxel is better for pigmentation and sun damage or whether microneedling suits your needs while avoiding unnecessary laser energy.
Myth vs Fact
| Myth | Fact |
| Fraxel is always more effective than microneedling | Neither treatment is best for everyone. Results depend on the concern, scar type, skin tone and treatment settings. |
| Microneedling cannot cause pigmentation | Post-inflammatory hyperpigmentation can occur after microneedling, particularly in skin that is prone to pigment changes. |
| One treatment can remove acne scars completely | Both treatments usually improve rather than completely remove acne scars, and several sessions or combination treatments may be needed. |
| All acne scars respond to resurfacing in the same way | Rolling, boxcar and ice-pick scars differ in structure and may need different or combined treatments. |
Key Takeaways
- Fraxel and microneedling both stimulate skin remodelling but use different methods.
- Neither treatment is universally better for acne scars because scar type, skin tone and treatment goals matter.
- Fraxel DUAL uses different wavelengths that can address different skin concerns.
- Microneedling can be useful for many skin tones but can still cause post-inflammatory pigmentation.
- Pigmentation should be correctly diagnosed before laser treatment, particularly when melasma is possible.
- Both treatments usually require realistic expectations, appropriate aftercare and sometimes more than one session.
Frequently Asked Questions
1. What is the main difference between Fraxel and microneedling?
Fraxel uses fractional laser energy to create controlled microscopic areas of thermal injury, while microneedling uses fine needles to create mechanical micro-injuries. Both can stimulate collagen, but Fraxel can also target certain pigmentation and sun-damage concerns.
2. Is Fraxel or microneedling better for acne scars?
Both treatments can improve atrophic acne scars, but the best option depends on your scar type and severity. Your dermatologist may recommend Fraxel, microneedling or a combination with other treatments such as subcision for tethered rolling scars.
3. Is Fraxel better for pigmentation and sun damage?
Fraxel DUAL may be considered when selected pigmentation and sun-damage concerns are important treatment goals because its 1927 nm wavelength can target superficial pigmented lesions and photodamage. Your dermatologist will first identify the type of pigmentation because conditions such as melasma may need a different approach.
4. Which treatment is better for uneven skin texture and pores?
Both Fraxel and microneedling can improve uneven texture and the appearance of enlarged pores through collagen remodelling. The most suitable option depends on the cause of your texture concerns, your skin type, your treatment goals and the amount of downtime you can manage. Both treatments may improve texture, while Fraxel may also be considered when sun damage or selected scarring concerns are present.
5. Is microneedling safer for darker skin tones?
Microneedling does not rely on laser light interacting with skin pigment, which can make it an attractive option for darker skin tones. However, you can still develop post-inflammatory hyperpigmentation after microneedling, so your skin tone, history of pigmentation and treatment settings all need to be considered.
6. Which treatment has more downtime, Fraxel or microneedling?
Fraxel often involves more noticeable downtime than conventional microneedling, although recovery depends on the treatment intensity and your individual skin response. Your skin may recover more quickly after microneedling, although it can still remain red, warm, tight or sensitive for several days.
7. Is Fraxel or microneedling more painful?
Both treatments can cause discomfort, but topical anaesthetic is usually used to improve your comfort. Fraxel may feel warm or hot and prickly, while microneedling can feel more like pressure, vibration and repeated prickling.
8. How many Fraxel or microneedling sessions will you need?
The number of sessions depends on your skin concerns, their severity and how your skin responds to treatment. Your dermatologist may recommend a course of treatments, with improvements continuing to develop over weeks or months as collagen remodels.
9. Can Fraxel and microneedling be used on all skin types?
Both treatments can be considered for different skin types, but your individual pigmentation history and risk factors need to be assessed before treatment. Your dermatologist can adjust the laser energy, wavelength, treatment density or needle depth according to your skin and the concern being treated.
10. How do you choose between Fraxel and microneedling?
Your choice should be based on your main concern, scar type, skin characteristics and how much recovery time you can allow. Fraxel may be considered when pigmentation, sun damage or particular resurfacing concerns are important treatment goals, while microneedling may suit you if you prefer a treatment that uses mechanical stimulation rather than laser energy, with downtime depending on the treatment depth and intensity.
Final Thoughts: Choosing the Right Treatment for Your Skin
Fraxel and microneedling can both improve acne scars, uneven texture, fine lines and overall skin quality, but they work in different ways. Your skin tone, scar type, pigmentation concerns and preferred downtime can all influence which treatment is more suitable for you.
If you’re considering Fraxel laser treatment in London, you can get in touch with our team at London Dermatology Centre.
References:
- 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/
- Cachafeiro, T. et al. (2016) ‘Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial’, Dermatologic Surgery, 42(2), pp. 232–241. Available at: https://pubmed.ncbi.nlm.nih.gov/26845539/
- Sitohang, I.B.S., Sirait, S.A.P. and Suryanegara, J. (2021) ‘Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials’, International Wound Journal, 18(5), pp. 577–585. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8450803/
- Cohen, B.E. and Elbuluk, N. (2016) ‘Microneedling in Skin of Color: A Review of Uses and Efficacy’, Journal of the American Academy of Dermatology, 74(2), pp. 348–355. Available at: https://www.sciencedirect.com/science/article/pii/S0190962215021970
- 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