Fractional photothermolysis is a new skin resurfacing laser technology for treating wrinkles, melanocytic pigmentation, scars, and photodamaged skin. Treatment with the Fraxel laser (Reliant Technologies, Inc.) creates microzones of injury in the skin that are surrounded by normal intervening skin that rapidly heals the injured tissue. From June to November of 2005, 70 patients underwent 2 to 6 treatments with the Fraxel laser (Reliant Technologies, Inc.) on the face and/or extremities for abnormal pigmentation, wrinkles, and scars. Treatments were 1 to 3 weeks apart. Clinically, the patient experienced little downtime other than erythema and edema for a few days followed by light skin exfoliation for a few days. After treatment, skin color and texture were more homogeneous with a decrease in the unwanted melanocytic pigmentation. The skin showed a decrease in rhytids. In summary, fractional photothermolysis improved skin color and texture and decreased fine wrinkles and melanocytic pigmentation with minimal downtime for the patient. © 2007 Lippincott Williams & Wilkins, Inc.