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.

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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…)

Doctors Arielle N. B. Kauvar from New York Laser & Skin Care and E. Victor Ross, M.D., director of laser and cosmetic dermatology, Scripps Clinic, San Diego, provided a quick overview of different aesthetic lasers for medical practice in this article published by Modern Medicine yesterday.

The overview is a good basic briefing on most of the laser modalities, applications and what different types of lasers have to offer. Dr. Ross is one of the veterans of the laser medicine and I like his comment on his personal favorite lasers: ”If my clinic were burning and I only had time to save two lasers, I’d save my KTP laser and my CO₂ laser. They do very different things, but they’re the yin and yang that allow me to cover the widest range of indications with the fewest lasers”.

There is, however, a tremendous shift towards non-invasive and affordable treatments in the last few years. The trend is also fueled by bad economy, which caused a significant drop in more expensive invasive procedures. These days most of aesthetic physicians should consider rushing in to save their YAGs if the practice were burning.