As I continue to review the Medline English literature and recent international conferences regarding Fractional photothermolysis (FP) technology, applications, and indications, it becomes more obvious that this relatively new modality is one of the most significant milestones in laser technology and skin resurfacing.
Successful conditions treated with non-ablative fractional lasers reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis.
An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. There is no doubt that AFP has demonstrated significantly greater improvement than non-ablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging.
Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders.
Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP will continue and bring additional data to use in determining treatment parameters and identifying new apppliations.
The concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, skin resurfacing techniques. Unlike conventional ablative (CO2 and Erbium) and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair.
Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. Many practitioners would agree that this first wave of fractional lasers has delivered very limited clinical efficacy.
In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide (CO2) laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. (more…)
Why the newer fractional technologies are so popular?
The latest fractional laser technologies offer a better balance of efficacy, patient tolerance and lack of side effects compared to older lasers.
For better results the depth of the laser beam penetration and the depth of skin resurfacing are important. But even more important is an optimal combination of depth, microspot size, density, as well as the ratio of ablation to coagulation.
Depth is a simple term that indicates how deep the thermal damage extends into the skin tissue. It is the depth of the microcrater or hot cylinder.
Microspot size is the diameter of the microscopic wound.
Density is the percent coverage over the skin surface, e.g. 20 percent density means 20 percent of the skin surface is damaged.
The “ratio of ablation to coagulation” can be explained as follows: one pulse of laser beam produces a crater (coagulation area), which is 100 µm wide, and the lateral thermal damage (area of ablation) of 50 µm in radius (100 µm in diameter) ; therefore in this case, the total width of coagulation is 100 µm, and the total width of ablation is 100 µm, therefore 1:1. This ratio is an indication of the downtime. Coagulation is a type of thermal damage, which greatly influences wound healing.
The problem is that no one knows the precise best recipe among all of these variables to achieve the best ratio of cosmetic enhancement to days of “downtime.”
Fractional Eyelift Procedure is used to reduce eyelid drooping and wrinkles without having to go under the knife and arguably with minimal downtime. In good hands the right type of fractional laser offers excellent results that are similar to a surgical eye lift without incisions.
Fractional Eyelift represents one of the latest advancements in fractional laser resurfacing technology and is used by many cosmetic surgeons as a safe and effective alternative to surgery.
“The Fractional Eyelift dramatically reduces the appearance of dark circles and eye wrinkles, tightens upper and lower eyelid skin and helps to elevate drooping eyebrows,” says Bruce E. Katz, M.D., board certified dermatologist and director of the Juva Skin & Laser Center in New York City. “It has a number of the benefits of a surgical eyelift without the risks and downtime. The only problem it doesn’t address is bulging fat pads.”
Metal eye shields are used during treatment to protect a patient’s eyes from injury. The only anesthesia needed for the procedure is a numbing cream that is applied to the eyelids. In a recent study of Fractional Eyelift involving more than 300 participants, patients showed dramatic and consistent results, Katz said.
The fractional laser resurfacing procedure works by breaking up the laser light beam into columns that target the area intended for treatment and leave surrounding skin tissues intact. The laser beam ablates damage elastic and collagen fibers in the skin, allowing new tissue to grow back in their place. Healing occurs quickly and is virtually painless. The end results are fewer wrinkles, a reduction in dark skin pigmentation and tighter skin in the treated areas.
In order to achieve the best results from the Fractional Eyelift, surgeons typically recommend three to five sessions delivered at two to three-week intervals.
I have just made a comment to an article named “Looking Younger Without Surgery” published by Hudson Valley Press in Newburgh, New York. Read full text.
Dr. Ran Rubinstein, board-certified facial plastic surgeon and founding physician of Laser & Cosmetic Surgery Specialists PC, is among the first in the tri-state region offering two new aesthetic solutions to turn back the clock on aging and sun-damaged skin.
Dr. Rubinstein has Fraxel re:store and re:pair, and provide the benefits of traditional skin resurfacing techniques without significant downtime and risks. “The results we are achieving with both the Fraxel re:store and re:pair laser systems are remarkable,” said Dr. Rubinstein. “Fraxel treatments represent new-generation laser resurfacing with predictable results. They allow me to rebuild damaged skin like digital photo modification – spot by spot.”
With the new Fraxel re:store and re:pair laser treatments, patients receive:
Fraxel restore and repair offer two levels of laser treatment according to Dr. Rubinstein. “While both reduce the appearance of acne scars, surgical scars, wrinkles, age and sun spots, I recommend re:store for anyone who wants more vibrant, younger looking skin with little to no downtime,” said Dr. Rubinstein. Three to five re:store treatment sessions are recommended at two to four week intervals.
“Fraxel re:pair is the more intensive treatment – best for more damaged skin,” explained the doctor. The fractionated laser technology in Fraxel re:pair has reduced downtime to as little as five days, in most cases. Usually only a single treatment is required. The added safety of both Fraxel technologies has made laser resurfacing safe for the face, as well as the neck, chest and hands Dr. Rubinstein added.
I wonder if Dr. Rubenstein is familiar with Nd:YAG/Erbium modalities used in a combination in one seating, sometimes referred to as Bi-Modal Facial Rejuvenation.
The Hudson Valley Press is the “first and only minority newspaper that gives coverage to Orange, Dutchess, Westchester, Rockland, and Ulster Counties. While primarily targeting the African American and Latino community, the weekly Hudson Valley Press promotes unification among all races and celebrates diversity.”
We have not seen any reputable studies on using ablative fractional lasers, so Dr. Rubenstein’s input would be very appreciated. The picture used in the article as “Wrinkles before/after Fraxel laser procedure” is showing a skin type II-III woman.
Aesthetic practitioners know that Fraxel is an expensive laser, treatments are expensive also, and they are not so well tolerated by patients with darker skin types. The first generation (non-ablative) did not live up to physicians’ expectations. The newer Fraxel (and many other fractional lasers that have been rolled out on the market by all major laser manufacturers) is ablative. Neither CO2 nor Erbium work well on skin types V-VI and require caution.
This is our most recent (constantly updated) collection of video materials demonstrating Fraxel laser skin rejuvenation, Fraxel and fractional laser skin resurfacing technology, fraxel CO2 laser acne scars, Fraxel laser skin tightening, and Fraxel laser wrinkles.
I have always been sceptical about marketing hypes created by laser manufacturers. It has taken me years of watching thermages and fraxels of the laser industry to come up with a solid body of research that would confirm the real efficacy and worthwile benefits to the patient. There is no doubt that laser technologies are advancing. Does the pace of marketing advances reflect the technological advances that would deliver improved results for the customer? No. Marketing is getting better faster than results for the cash paying patient.
Here is a link to a strong opinion by an experienced doctor who questions the efficacy of the fractionated lasers.