“We’re making these tiny, hot holes in the skin."
You already know that the British Isles are a damp, grey, and blustery place where the sun may not convincingly crack through heavy skies for weeks on end. What you may not know about is what happens when the clouds do break and the temperature gets above 70 degrees fahrenheit or, as Britishers reckon it, around 21 degrees celsius.
Backyard grilling, picnics, and trips to the seaside are hastily organized and prioritized over long-standing commitments; ordinarily inhibited men think nothing about striding around their towns and villages bare-chested; and people get a refresher on the speed at which you need to eat ice cream cone when your breath doesn’t produce steam.
With what the rest of the world might consider “summer weather” amounting to a few weeks scattered between mid-April and late-September, the islands’ inhabitants broil their sun-starved skins at every opportunity. Many have heard of sunblock and some even use it, though most are so hopped up on Pimm’s, charred sausages, and the sudden influx of Vitamin D that they forget that it needs to be reapplied.
Into this milieu, I was born and raised. Although I left my English hometown twenty years ago for locales with distinct and identifiable seasons, the thought of wasting a moment’s sunshine still makes me sick to my stomach. Even so, I haven’t been especially careful with protecting my face from ultraviolet rays and consequently, I’m on a fast track to have a face like an elephant’s nut sack. Now that my carelessness is making itself known, I want a chance to undo some of the damage my rapacious sun worshipping has provoked. That is the promise of Fraxel laser skin resurfacing.
Chemical peels, microdermabrasion, injectable fillers, and neurotoxins are all methods for improving the appearance of skin that’s been damaged by sun, the aging process or a skin condition. Photorejuvenation refers to another category of interventions and includes intense pulsed light (IPL) photodynamic therapy (PDT) or lasers. Fraxel, a brand name derived from “fractional laser photothermolysis,” is in this latter category.
The technology was developed at the beginning of the 21st Century and is different from the other types of skin resurfacing with lasers because it’s non-ablative. (Ablation, I learned, means the removal of material from the surface of an object by erosive means. I’m talking chipping, scouring or, in the case of what’s known as CO2 laser skin resurfacing, the vaporization of the top layer of skin with frickin’ laser beams.)
“As you might expect, the downtime from an ablative CO2 laser is considerably greater than with Fraxel,” says Schweiger Dermatology Group dermatologist Jeremy Fenton as I plonk myself down in a chair in his office. Fenton, who looks like the love child of a young George Clooney and a Disney prince, tells me that because skin damage is cumulative, Fraxel is a better fit for most people in their 30s, 40s, and 50s, while the scorched-earth CO2 laser is busted out for heavy duty jobs. “Interestingly though, the CO2 laser causes less discomfort, even though it’s ablative and may leave your skin red for months.”
Fraxel doesn't break the surface of the skin but rather perforates it like cleats perforate a football field. “It’s a gentler way to resurface your skin with a laser because it’s not taking off a whole layer,” he says. “We’re making these tiny hot holes in the skin.” Fenton explains that while Fraxel will cause the top layer of my skin to flake or peel off, revealing a softer layer in just a few days’ time, the laser treatment’s second affect—the stimulation of collagen production in my skin—should become evident in the weeks ahead. Collagen is a naturally occurring wrinkle-preventing protein that keeps skin plump and youthful looking.
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I checked in with Cleveland Clinic dermatologist Shilpi Khetarpal about how Fraxel stacks up against other methods of skin resurfacing. “Other procedures like chemical peels do not have an end point and there is no way of knowing how deep in the skin you are causing an effect,” she tells me, adding that chemical peels can cause pigment alteration in patients of color by interfering with their natural pigment—melanin. “Because the Fraxel Dual delivers heat to the deeper portions of the skin, deeper than where the natural pigment is, it is much safer and more effective,” she says. She goes on to say that microdermabrasion and chemical peels are typically very superficial, penetrating at around 0.5 mm in the skin. The Fraxel however, is able to go much deeper, 1.5 mm into the skin, causing “more benefit and improvement in one's overall complexion.”
The particular type of device Fenton uses on my leathery mug is called the Fraxel Dual because it has two wavelength settings: one that’s used to treat sun spots, pre-cancers, and those greyish/brownish patches called melasma, and a deeper one that is used to treat “textural irregularities” like acne scarring, fine lines, enlarged pores, wrinkles, as well as areas of uneven pigmentation.
“Both wavelengths can be used in a single session depending on what a patient’s concerned with,” he says. “In your case, we’re going to be using the deeper setting, which is the more intense of the two.”
Khetarpal told me to expect side effects include swelling, redness, and peeling for a week following treatment, and said I shouldn’t be alarmed by a burning discomfort and some pinpoint bleeding, which “should stop within a few minutes without any lasting effects.”
On the day of, Fenton slathered my face with numbing cream, gave it an hour to take effect, and handed me some pain pills that seemed to kick in within minutes. When he returned, he handed me a pair of goggles to protect my eyes from the laser light and began his not-so-tender ministrations. This led me to wonder if both the pills and the cream were anything more than a gesture.
The sensation of the laser moving over my skin immediately reminded me of the feeling of a Wartenburg Pinwheel (an early 20th century medical device that’s since become commonly used by kinksters for sensation play, for the uninitiated). But instead of one spiky, dime-sized wheel, the laser felt like a row of several red hot and tiny wheels, tilling my face with sharp heat. I’ll be honest: It wasn’t the most pleasant 20 minutes of my life. The laser also provoked an odd sort of pain that had me emitting peals of laughter.
When it was all over, I was beyond relieved. I took a look in the mirror and was quite taken aback by how the swelling altered the topography of my face. I was craggy and swollen, my nasolabial lines deeply hewn into my flesh.
Fenton gave me a bag of miniature, sample-sized tubes of moisturizing cleanser, steroid cream, a moisturizer with SPF and Aquaphor, and a handout detailing how and when to use them all and in what order. Also in the bag was a hand out of post-treatment guidelines that included including avoiding sun exposure, sweating and, once my face began to flake and peel, an entreaty to leave it the fuck alone.
I laid low the first night and awoke the next day to find that my skin looked even redder and felt even tighter. The errands I ran outside in diffused the April sunshine saw me scurrying around the city like a celebrity determined to avoid being recognized. Hat, hood, sunglasses, and a prodigious amount of sunscreen.
I met a friend for a drink once the sun had gone down on the second night, but the red lights in our favorite dive bar rendered the effects of the treatment imperceptible. By the third day, my skin had taken on the texture of a light sandpaper, and later that evening I seemed to have developed dandruff in my beard line and around my temples.
I’d seen plenty of day-by-day video diaries of Fraxel patients’ skin scaling and falling off in certain areas, but my own skin sloughing was markedly less dramatic. I first got a sense of the treatment’s intended result when I touched a particular area of my forehead with my fingers and found it to be incredibly smooth. Over the next two days, the areas that were still scaly had sloughed off too and I had texturally smoother and more velvety looking skin by day five.
My follow-up appointment with Fenton exactly seven days after the treatment confirmed that, despite some residual redness, the treatment had been a success. My recovery was on track and he predicted that the imminent increase in collagen production would make the results more impressive in the weeks ahead. Keeping the newly exposed layer of skin out of the sun, Fenton stressed, would be a key part of realizing the best results and obviate the need for more spikey hotness in the short term.
My upcoming trip to England would be well-timed, I thought; the collagen in my skin would have had a few weeks to do its thing and the low prevalence of sunny skies would mean that I wouldn’t have to scurry from pub to pub in a makeshift niqāb. Furthermore, a trip home tends to underline the fact that time is marching on; something that I tend to forget in the silly life I’ve created for myself. I’m not just talking about my parents’ inevitably snowballing decrepitude but the recent news that someone from my graduating class had become a grandmother at 40.
It was my hope that, under cloudy skies, this sobering fact juxtaposed with my smooth skin would provoke delectable remarks about my agelessness. It didn’t. The few comments that were offered about my appearance were not about my skin or even the fifteen pounds of adipose tissue I left stateside, but rather my microbladed eyebrows and the idea that my teeth were “too white.”
I, however, did and can discern a difference. I see smaller pores, a more even complexion, and a reduction in the fine lines that have been congregating on my face. Another way my trip wasn’t how I envisioned it: It was 80 degrees and sunny every day.
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