Resurfacing is a procedure where layers of damaged skin are removed usually by vaporization from a laser.  It can be used to get rid of brown pigment caused by sun damage, decrease wrinkles, shrink pores and tighten skin.  Vaporization is the process of using heat to instantly evaporate water out of the exposed tissue.  Resurfacing not only removes the tissue on top but also heats the tissue below the level of vaporization causing collagen contraction and stimulation.

So then what is fractional resurfacing?  If resurfacing is like mowing a lawn where every blade of grass is cut to a somewhat shallow depth then fractional resurfacing is more like aerating a lawn.  Fractional resurfacing pokes small but deep holes in the skin, but leaves a certain amount of the skin completely untouched.  Because these patch of undamaged skin patient heal much faster with minimal side effects. Fractional resurfacing was developed at The Wellman Center of Photomedicine at Harvard around 2001.  The original fractional laser did not destroy any tissue (non-ablative), it simply applied heat in order to stimulate new collagen formation.  This non-ablative (non-vaporizing) procedure required multiple treatments and has some significant limitations on efficacy.  Around 2005 we started testing fractionated ablative (tissue vaporization) CO₂ lasers (Active FX, Deep FX, Fraxel Re:pair) and found that in a single treatment we could achieve results that were not attainable after 5 or 6 treatments with the non ablative fractionated lasers. The downtime of about 5-7 day was a huge improvement over traditional CO₂ resurfacing (think mowing the law) that can take several months to heel. 

Now the market is saturated with fractionated products and it is hard for the patients to figure out which one is the best for them.  The first thing that separates these devices is the actual type of laser.  There are two main lasers used for resurfacing CO₂ and erbium.  The Active FX, Deep FX and Fraxel Re:pair are CO₂ lasers.  The Pixel and Profractional are erbium lasers.  The CO₂ lasers heat tissue much better causing more skin contraction and more collagen stimulation.  They also cause much less bleeding than erbium lasers.  The clinical results speak for themselves as much more skin damage can be removed with by a CO₂.

Between the CO₂ platforms FX (made by Lumenis) and the Fraxel (made by Reliant), the FX is much preferred by patients.  In 2007 Dr. Robert Weiss performed a split face study at Johns Hopkins using the Active FX on one side and the Fraxel Re:pair on the other.  Nine out of ten patients preferred both the comfort of the procedure and the results of the Active FX.

Ok so the Lumenis FX gives the best results and the most patient preferred procedure. So then what is the difference between Active FX, Deep FX and Total FX?  The Active and Deep FX are different heads that can be attached to the laser.  The Active FX is more shallow (about 1/3 mm) and wide which is better for skin tightening, decreasing pore size and removing pigmented sun damage.  The Deep FX is a narrow beam that goes deep (up to about 2mm) into the skin in order to treat wrinkles and scars.  The Total FX is more a marketing term that describes using both heads during the same treatment (which is how the procedure is normal done).