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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.

See larger chart

fractional-ablative-laser-treatment

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…)

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  • Filed under: Device Review, LT | fractional
  • The Basics of the Fractional Technology

    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.

    How fractional laser works

    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.”

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  • Filed under: LT | fractional
  • laser-resurfacing

    Still horrified by laser blasting of facial wrinkles followed by months of redness? This is so 90s!

    New generation of aesthetic lasers is safer and more selective in treating just what the doctors says you need: wrinkles, age spots, broken capillaries, saggy skin, etc. The result? Faster healing, so you can get back in makeup and return to work with smoother skin in as little as 24-48 hours. Well… it depends. Here is a brief guide to different laser treatments so you can better understand your options.

    Ablative Carbon Dioxide (CO2) Resurfacing

    This is the skin-wounding original 1990s procedure.

    Used for: hard-core lines and acne scars; can also tighten loose skin but is safe only for fair skin types only.

    How it works: By blasting and burning away the skin’s top layer, this aggressive single treatment bulldozes wrinkles and everything else in it path.

    How it feels: you should not feel anything during the procedure since it is performed under general anesthesia. Recovery time: you are a burn victim for several days with open wounds, which ooze and bleed, followed by 7-10 days of rawness while your obliterated epidermis regenerates, and pinkness for 4-5 months.

    Price: $4,000 to $8,000

    Efficacy/Results: Excellent (if done right) but in a few months after the treatment.

    Ablative  Erbium Laser Resurfacing

    Used for: fine to deep wrinkles and acne scars; can also tighten loose skin, doctor must be cautious with darker skin types.

    How it works: By evaporizing layers of epidermis (the skin’s top layer).

    How it feels: This proceudre is performed under a topical or local anesthesia and you may experience some burning discomfort. Recovery time: depending on the depth of resurfacing, you will feel from slight to mild oozing for 2-5 days, followed by 7-20 days of pinkness, which can be covered by make-up.

    Price: $1,500 to $3,000

    Efficacy/Results: Good to excellent depending on the depth of resurfacing.

    Ablative Fractional Resurfacing

    Types of lasers used: either CO2 or Erbium (Er:YAG).

    Used for: Smoothing fine-to-deep lines and evening out brown spots in a single treatment. Can also help tighten lax skin and remove some small spider veins.

    How it works: The laser beam strikes the skin in thousands of tiny spots, destroying tissue a millimeter deep in those microscopic spots only (think perforated paper). Surrounding skin remains intact, allowing for faster recovery than the original ablative devices but more intense results than the nonablative fractional laser. The hole-punching fires up the body’s wound-healing response, which generates collagen and smooths wrinkles. It’s ablative and therefore riskier for patients of color, but can be executed successfully at a doctor’s office.

    How it feels: Typicaly performed with local anesthesia similar to what you’d get in a dentist’s office. After 15 minutes of post-treatment discomfort and an application of ice packs, pain is minimal. For 24 to 36 hours, skin oozes, bleeds and peels, followed by five days of crustiness. Once crust peels, new, pink skin emerges and makeup can be worn; complete healing within two weeks.

    Price: $1,500 to $5,000

    Efficacy/Results: Average to good.

    Nonablative Fractional Resurfacing

    Non-ablative simply means that your skin will not actually be resurfaced, i.e. top layer of the skin, aka epidermis, will remain intact.

    Used for: Smoothing fine-to-moderate lines, evening out brown/age spots, and improving overall texture and glow.

    Downtime: typically none, but the skin may be red for a couple of days.

    How it works: The laser penetrates deep into the skin, heats and provides controlled thermal injury to the connective tissue, which stimulates collagen production. No oozing no raw skin. It’s typically performed over a course of three to five 25-minute treatments, one to two months apart. This procedure is safe for darker skin types.

    How it feels: like the heat is building up in your skin, but no pins and needles. May feel like a bad sunburn for a few minutes after the procedure is over; afterward, skin is pink and sandpapery for three to five days but can be camouflaged with concealer.

    Price: $600 to $1200 per treatment depending on the actual laser modality and doctor.

    Efficacy/Results: Average to good depending on a number of treatments.

    Intense Pulsed Light (IPL)

    Used for: Eliminating brown spots and other sun-induced discoloration and spot-treating broken capillaries. No effect on wrinkles.

    How it works: IPL devices are not lasers, unlike lasers they emit a broad spectrum of light. Short pulses of bright white light pinpoint brown pigment cells and redness, which are damaged when they absorb the light and the heat it creates. Safe for most skin types, but a doctor may dial down intensity for darker skin tones to avoid slim risk of de-pigmentation.

    How it feels: Like a sunburn. Patients experience slight swelling and pinkness the day of the procedure, but there’s no downtime, which is why it’s often categorized as a “lunchtime” treatment.

    Price: $400 to $600 per treatment.

    Efficacy/Results: Average and multiple treatments are required.

    What is Fractional Eyelift

    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.

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  • Filed under: LT | fractional
  • Fraxel Laser for Dark Skin Resurfacing

    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:

    • Plumping of acne scars and surgical scars
    • Smoother skin texture
    • Reduced wrinkles and fine lines
    • Improved skin tone
    • Softening of deep frown lines

    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.

    Comments, anybody?



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  • Filed under: LT | fractional
  • How Much Does Fraxel Laser Cost?

    Fraxel laser treatments are very popular due to the glitzy marketing by the manufacturer. Patients satisfaction with results and physicians opinion on efficacy and their return on investment are mixed. Very mixed.

    Here is a good source of opinions shared by actual patients who have had Fraxel:

    Interactive map of Fraxel costs


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  • Filed under: LT | fractional
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