Salicylic acids, retinols, antibiotics, IPL, lasers, Accutane — the amount of treatments on the market to combat acne are staggering. And yet, even with all of those options available, some of us just can't seem to escape the vicious cycle of breakouts. I'm one of those people — at 34 years old, I have been fighting moderate acne since my late teens. And I have tried literally every single one of those treatments with not one of them providing a lasting result.
I'm lucky enough to have a job that offers me easy access to the best treatments aesthetic dermatology can dream up, not to mention regular facials, top-tier derms, and a product arsenal that makes Sephora look like a corner bodega. And it all did absolutely bupkis. I even went so far as to go on a full cycle of Accutane, a living hell I would not wish on my worst enemy. But, except for a brief two-month reprieve, even that hardcore drug barely made a dent.
So when a plastic surgeon told me about a machine that he claimed had helped clear up the skin of many of his patients, I was cynical. But Dr. Min Ahn, MD, FACS of the Aesthetic Wellness Center, was adamant that this treatment, called Fractora, was a game changer for patients with mild to moderate acne and scarring.
Fractora is a fractional radio-frequency microneedle device that debuted in June of 2011. For those not well-versed in derm speak, it's a treatment that involves puncturing your face with tiny needles, which then deliver a radio-frequency beneath the skin. This is what makes Fractora different from your run-of-the-mill microneedling treatment — the addition of that radio frequency sends arcs of energy through your skin cells, heating them up to put collagen and elastin production into overdrive, as well as shrink the skin's oil glands. One of the main causes of acne is excess oil, which the p. acnes bacteria feeds on and causes the inflammation that typifies a pimple. By essentially shutting down or shrinking those oil glands, it hinders the skin's ability to produce that trouble-starting sebum in the first place.
Acne was not the primary target for Fractora, though. In fact, initially it wasn't even recognized as a possible treatment option. Fractora's main application was for tightening the skin and correcting crepey texture via increased collagen production. Dr. Ahn explained that it was discovered later on that this combination had a significant effect on acne scarring and, more surprisingly, active acne (i.e. current breakouts).
While microneedling can on its own be a useful in-office treatment for collagen production, it's that inclusion of radio frequency that makes the difference here. It's what increases collagen and elastin production to a more significant degree than professional microneedling would on its own. And it's far more effective than at-home devices, which many dermatologists don't recommend. At-home tools create a small amount of damage and don't reach deep into the dermis. They aren't ablative — i.e. removing skin — so they can't replicate that same level of collagen production. That's why microneedling is not nearly as effective for someone with significant scarring and not at all effective on active acne.
After deeming me an appropriate candidate for Fractora, Dr. Ahn invited me to his practice, located in Westborough, MA, to experience the treatment for myself and try and make me a believer. Here's how it all went down.
Prior to my visit, I was instructed to switch to gentle products without active ingredients — so no anti-aging products and no anti-acne products. I was also given a prescription for Valtrex to help prevent cold sores. (When you're creating any type of trauma to the skin, there is a chance it can cause the herpes simplex virus to surface and cause a sore. Fun.)
After arriving at the clinic and filling out the standard "you probably won't, but if you do die, you can't sue" paperwork that doctors insist you sign before treatments like this, I was ushered into Dr. Ahn's office to chat. I was fortunate enough to not have any deep scarring, so the good doctor told me my main concerns were staining (aka post-acne redness) and the actual pimples. We then headed to have photos of my skin taken so we could see my baseline and make it easy to judge my progress when I returned for my followup.
I was led to a room where I had numbing gel applied to my skin and I was given a Xanax to help calm me down. Oh, did I mention I'm terrified of needles? Yeah, like panic-attack-and-faint-when-I-get-blood-drawn terrified. So that made things extra interesting. I then waited patiently for an hour as the gel did its thing and the drugs kicked in.
The treatment itself was administered by the very lovely and patient Rebecca Hoffey, RN, RNFA. She gave me the rundown of what was about to happen: "We have a device that blows cold air on the face to distract you and take the focus away from what I'm doing," she said. What she was doing was taking a headset with 24 microscopic needles and "stamping" (read: pressing it firmly into my skin) while releasing a pulse of radio frequency below the surface.
It is — as you would expect when getting poked repeatedly with needles —not pleasant. Xanax or no, I was in a good amount of pain. After she finished the first pass, Hoffey told me I'd done great, but then broke the news she had to do the whole thing again. I'm pretty sure I called her a few unflattering names in some very colorful language.
The reason for this double pass, Dr. Ahn told me after, was to cover the most surface area possible. On the second pass, she was getting different parts of the skin, meaning she was removing more columns in different areas, increasing the amount of scarring or sebaceous glands being removed.
The Day After
When my torture was finished, I was given a saline-and-gauze soak and had moisturizer gently applied to my skin. I then was escorted back to my hotel room, where I promptly collapsed into bed and slept for 14 blissful hours.
When I finally woke up, I went to the mirror to see the damage. My skin was puffy and my face looked like it had been sunburned, but there was really no pain. It was just itchy. Very, very itchy. I headed to Dr. Ahn's office for an evaluation and to make sure everything looked on the up and up. I was told to wash my skin twice a day with a gentle cleanser (I used Cetaphil), do my saline soak, then coat my skin in moisturizer (Cetaphil again) every two hours.
Hoffey also warned me not to use any sort of ice compress. "Part of the way this treatment works is that it relies on your body's inflammatory response, so we want that inflammation," she noted. "We know it's going to create collagen and it's going give you a better result. If you're applying ice you're reducing that inflammation." This also went for Advil — if I had an pain or discomfort, I was instructed to take Tylenol. And, of course, copious amounts of sunscreen were required whenever I so much as looked in the general direction of the outdoors.
Then it was back to NYC to heal and wait for my skin to be magically transformed.
Unfortunately, it didn't quite go like that. The first few days my face looked like it was covered in blackheads. These were the areas where the needle had punctured and visibly wounded my skin. My complexion felt a bit rough and bumpy. Things went permanently downhill from there, as my skin began to break out with a renewed vengeance, almost as if to punish me for the trauma I had put it through. The next month brought the five stages of I Just Can't Even With This. One week in, I told myself it was my skin purging. Two weeks and I tried to convince myself it was still a purge. Three weeks and disappointment set in. Week four brought a feeling of betrayal. By week five I decided it was time to ask my nurse what the hell was going on.
"It's normal," Hoffey assured me. "It has to get a little worse before it gets better." My skin, she continued, was bringing those impurities that were below the surface and pushing them up and out. Dr. Ahn added that it usually takes the skin four to six weeks to produce that collagen, hence my skin was just starting to begin the healing process. We made the command decision to come in for a second round.
Once More Into The Breach
The reality of a treatment like Fractora — actually, with most non-invasive procedures — is that multiple treatments are needed in order to see real results. "You're not going to have one treatment and say 'wow, this is the best thing ever,'" said Hoffey. We repeated the procedure, taking another set of photos before the treatment to show my progress after the first treatment. This time we switched up the drugs, hoping half a Xanax and a Vicodin would do the trick. Not so. This time I cried like a little baby and came up with some even more colorful expletives to hurl at my nurse. Lest you think this is normal, apparently I am a special little snowflake, as the medical team reports only having had very few people be in that much pain. Lucky me.
After my extended drug-induced nap, I met with Dr. Ahn and made plans to come back for an evaluation.
Is This The Real Life? Is This Just Fantasy?
Again came the breakouts — but then, at the end of week, something inexplicable happened: My acne slowly started to disappear. By week four, I was almost completely clear, with only a little bit of leftover redness. I was dumbfounded. Could this be happening? I went to Dr. Ahn on week six and we once again took photos of my skin.
I'm going to make this point very clear: I don't do photos in articles, especially before and afters. It makes me uncomfortable to be on display, especially the vulnerability that comes with having not-great skin. However, as someone who has been through hell and back with acne, I'm sharing these pics here — unretouched and makeup-free — for those of you out there who are suffering from this confidence-crushing disease.
It's that important to me to truly show how Fractora changed my skin. It is legitimately life-changing. For the first time in years, I don't feel like a fraud whenever I tell people I'm a beauty editor. And my skin is only getting better as time passes and that collagen continues to grow.
Now, everything isn't sunshine and rainbows here. There are some roadblocks to deal with. The first one is everyone's favorite: the cost. Fractora is not cheap. As part of my experience, Dr. Ahn was generous enough to comp my sessions, but typically, depending on where you go, you are looking at spending anywhere from $1,000 to $2,500 a treatment. And, since multiple treatments are most definitely needed, you're looking at a possible $5,000+ price tag. That can definitely be cost-prohibitive for the majority of us.
Additionally, the results themselves are dependent on the person and severity of their acne. And it may not permanent — maintenance may be required. For someone like me, Dr. Ahn recommended coming back in a year for a follow-up treatment to perk up collagen production. That's not to say I'll necessarily need it again, just that I may want to spur that healing process all over again. It's more of a personal preference, so I'll think it over depending on how my skin progresses in the next year.
Another hurdle? Finding doctors who offer it. When I asked Dr. Ahn why more people and publications weren't talking about this or providing it in their practice, he told me there were a variety of reasons. While there have been a few studies, Dr. Ahn explains that there aren't many scientific articles that look at the effects of fractionated microneedling on acne and oil production. But the most common reason, he speculates, is that the machine itself is expensive, clocking in at $70,000 for a doctor to purchase. "Most often acne is treated by a dermatologist and most medical dermatologists have no interest in purchasing a $70,000 machine that is primarily used for cosmetic purposes." And those who do purchase it are more interested in treating wrinkles with it than developing an acne clientele.
My takeaway? If you can find a doctor that offers it and are able to squirrel away the dough to afford it, Fractora is worth every penny. The amount of ultimately ineffective products and treatments I have received over the years easily adds up into the thousands of dollars, not to mention the emotional toll acne has taken on me for literally half my life. It's hard to put a price tag on being able to walk out of the house foundation-free and not feel like you need to keep your head down in embarrassment as you pass people on the street.
Main/homepage photo: Imaxtree