Introduction

Non-ablative fractional Fraxel laser (NAFL) requires effective post‑procedure care to reduce complications. Postoperative complications may develop as a result of inflammation and oxidative stress induced by thermal damage from the laser treatment. 

Antioxidants have demonstrated effectiveness in managing inflammation and mitigating postoperative oxidative stress by neutralizing oxygen radicals.

Aim

To evaluate the efficacy and patient satisfaction of a topical skincare regimen containing 15% vitamin C, 1% vitamin E, and 0.5% ferulic acid—CE Ferulic serum (CEF) following NAFL treatment. 

Patient Profile

Methods

• Randomized, investigator-blinded, split-face, controlled trial 
• 50 Photoaging patients suitable for Fraxel laser treatment were included.
• Patients were randomized to receive CEF treatment on one side of the face and 0.9% normal saline (NS) on the other side immediately after the NAFL procedure and daily during the 7-day follow-up.

Endpoints and Assessments

• Primary endpoint
  • Change in erythema score (0 = no erythema, 1 = mild erythema, 2 = moderate erythema, 3 = severe erythema) on Day 7.
• Secondary endpoints
  • Change from baseline in erythema score on days 1 and 3
  • Change from baseline in edema score and skin sebum content 
  • Percentage change from baseline in Erythema index (EI), Melanin index (MI), skin hydration, Transepidermal water loss (TEWL), 
  • Scab formation/detachment
  • Patient satisfaction

• Pain levels via VAS (score 0 representing “no pain” to score 10 representing “extreme pain” at 15 min, 30 min, and 1 h immediately after the NAFL treatment and on Day 1.
• Any adverse events (AEs) and serious adverse events (SAEs) starting from the screening process were recorded

Results

Primary Endpoint 

• Day 7 erythema improvement was significantly greater on CEF side 
  • CEF: 0.04 vs. NS: 0.18 (p = 0.011).
• Erythema scores remained consistently lower for CEF. (Table 1)

Table 1 :Change in erythema score from baseline on Days 1, 3, and 7

Follow-up time	CEF mean	NS mean	p-value
Day 1 (T2–T0)	1.18	1.38	0.008
Day 3 (T3–T0)	0.58	0.76	0.008
Day 7 (T4–T0)	0.04	0.18	0.011

Note: T0: baseline; T2: Day 1; T3: Day 3; T4: Day 7; T2–T0: the mean change from baseline on Day 1, T3–T0: the mean change from baseline on Day 3, T4–T0: the mean change from baseline on Day 7. Abbreviations: CEF, CE Ferulic serum; NS, normal saline.

Secondary Endpoints

Erythema Index (EI) and Melanin Index (MI)

• EI reduced significantly more on CEF side by Day 7. 

Figure 1: % Change in Erythema Index (CEF vs NS)

 

• MI improvement was significantly better on CEF vs NS by Day 3.

Figure 2: Melanin Index (MI) % Change: (CEF vs NS)

Skin Hydration, TEWL, Sebum 

 

Figure 3: Mean percentage change in skin hydration

 

Figure 4: Mean percentage change in TEWL 

• Sebum: no significant differences was observed between CEF vs NS

Figure 5: Mean percentage change in skin sebum content

Edema & Scabbing

• Edema reduced over time; no significant difference was observed in CEF vs. NS 
• Scabbing stage showed no significant differences.

Patient Satisfaction

• Patients reported greater comfort and overall satisfaction with the CEF‑treated side.
• Satisfaction included improvements in texture, radiance, pores, fine lines, and overall skin appearance.

• 59.2% of patients were “very satisfied” with CEF vs. 46.9% for NS.
• Comfort: CEF 53.1% vs NS 38.8%; Exceeded expectations: 49% vs 4.1%

Pain and Safety Outcomes

• Pain significantly lowered on CEF side at 30 min and 1 hour post‑NAFL.
• Pain score by VAS (CEF vs NS)
  • 15 min: 5.60 vs 5.76 (p=0.218)
  • 30 min: 3.62 vs 4.02 (p=0.036)
  • 1 hour: 1.84 vs 2.22 (p=0.022)
• No product‑related adverse events reported.

Conclusion

Combining Vitamin c, e and ferulic acid serum with Fraxel laser led to improved erythema score, erythema index, melanin index , and skin hydration within 1 week following the Fraxel laser treatment, as well as a higher level of patient satisfaction and less pain.

Reference 

J. Cosmet. Dermatol., 2025; 24: e70251