Ablative treatments smooth roughened skin, periorbital rhytids, remove pigmented lesions and minimise acne scarring. Dr Peter Crouch discusses the latest advances and the tried-and-tested methods

Until the development of laser skin resurfacing in the 1980s, mechanical abrasion and chemical peeling agents were the mainstay of treatments targeting acne scarring, wrinkles and tired, aged skin. Controlled ablation promised the prospect of restoring a more youthful, radiant appearance. Non-ablative remodelling of existing tissue is only one method of stimulating positive change and is the key strategy with IPL and radiofrequency treatments and has been outlined in previous articles in this series. The approach with most non-ablative treatments is to provide a controlled thermal stimulus sufficient to denature and contract collagen while avoiding surrounding tissue damage. Most non-ablative procedures utilise thermal (heat) energy for immediate tissue contraction (short-lasting), followed over the next few months by collagen remodelling and regeneration (longer-lasting).

Ablation literally means destruction, and there are several approaches for removing unwanted tissue and to promote increased tissue turnover as part of healing. Depending on the depth of ablation, skin resurfacing, smoothing of periorbital rhytids, removal of pigmented lesions and minimisation of acne scarring are all possible outcomes of expertly delivered skin ablation. In the months following ablative treatment, the body’s natural healing processes produce new replacement tissue, resulting in healthier, more even, smoother skin and a more youthful appearance.

The ideal tissue-ablation device would cause little pain and discomfort, have little or no downtime, be affordable, show demonstrable results after each session and cause no unwanted side-effects. As tissue ablation can effectively remove unwanted targets and the ablation is more related to tissue water content and is relatively more indiscriminate, ablative techniques rely more on targeting precisely where the treatment beam ablates rather than using the wavelength of the treatment beam to discern one target from another based on pigmentation—that is, a specific chromophore, or the presence of, for example, haemoglobin. Because the wavelengths often used for ablation specifically target tissue water, the fluence often determines, fairly precisely, the exact depth of ablation.