Fractional CO2 laser ablation has become very popular among cosmetic dermatologists and plastic surgeons.

Below is a list of tips from our medical panel.

Cosmetic conditions

1. Vertical lip (smokers) lines, deep wrinkles and acne scars require deep penetration to stimulates more collagen and ablate more tissue for better skin tightening.
2. Superficial pigment and surface textural problems will require less penetration and a mild ablation.
3. For Stria (Stretch Marks): mild penetration of 80-100 mj, deeper penetration may cause adverse effect.
4. Melasma: medical experts are not sure it will work and do not recommend treating Malasma at this time.
5. For Tattoo Removal: deep penetration might be good for resistant tattoos, results will vary as always with tattoos.

Pre / post-treatment tips for fractional CO2 laser treatments:

1. Mild moisturizers to avoid acne flare-ups
2. No aquaphor or vasoline. Beware of the Lanolin in the Aquaphor. Mild moisturizers are good enough.
3. Aveeno Water Gel may get your patient one less day of downtime.
4. Frequent saline soaks are good.
5. Cold ice packs or chilled air cooler for 30-45 min after treatment are good.
6. Valtrex for all patients! Acyclovir (cheaper) will also work.
7. No pain medications after treatment! Prolonged pain suggests infection: bacterial, viral, fungal. Follow up with your patients!
8. Pliaglis can be mixed with Cetaphil cleanser or moisturizer. 90% Pliaglis and 10% cleanser or moisturizer in the mix.
9. Experts worry about possible Lidocaine toxicity so excercise care. Compounded Lidocaine works as well or better than Pliaglis. Pliaglis costs $60 per treatment. Compounded Lidocaine costs about $6 per treatment.
10. Do not routinely use oral antibiotics unless indicated for acne outbreak prevention: Keflex 500 mg TID, Doxycycline 100 mg BID, Erythromycin can be used to prevent acne outbreak.
11. Sunscreens: every day and stay out of sun until the skin is healed up completely, and use good UVA blockers for further protection.

Fractional C02 lasers are not perfect but can produce great results if used correctly. Especially in a combination of treatments.

Fractional photothermolysis, based on creating spatially precise microscopic thermal wounds, is performed using a 1550-nm erbium fiber laser that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones.

Fraxel resurfacing has been shown to be both safe and effective for facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. Because only a fraction of the skin is treated during a single session, a series (typically 3 to 6 treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement.

Many physicians have reported that a series of Fraxel treatments can achieve a similar clinical result for atrophic scars compared with traditional ablative laser skin resurfacing with either CO2 or Er:YAG 2940-nm lasers. However, the improvement seen after a series of Fraxel treatments for perioral laxity and rhytides often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.