Has anybody had experience adding 1-2 passes with the Fraxel Refine (on 4 pass setting) at 20 J, 20% density (maximum level or density on the Refine) to essentially obtain a 25-30% density during a single treatment? In other words, setting for 4 passes and then administering 5 or 6 passes. Any reason this is not feasible?

This is very feasible, and you can not argue with the math. The problem with the re:fine is depth. The increase in surface area coverage will only improve superficial texture on younger pts. It does not have the ability to improve deeper pathology like, rhytids, scars (all types), stretch marks, ....etc. I have personally seen pts with improvement to texture without any improvement on other areas mentioned with 4-5 treatments. In fact with melasma this technique may make it worse due to too many "insults " to the DEJ. Take home message, in younger pts this will improve texture with less treatments, but will do no good with deeper dermal issues. The limiting factor being depth of MTZ. This Fraxel was designed to be a starter laser for inexperienced users to give a limited sub-group of pts a cleaner fresher appearence.

Makes sense Florida PA - thanks for the input