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 With the ability to treat an impressive variety of cosmetic and dermatologic concerns, the advent of fractional laser technology has proven to be an invaluable addition to the aesthetic practitioner's toolbox.
Laser resurfacing has become a staple in the array of modern non-surgical rejuvenation techniques, offering patients an option to correct sun damage, skin conditions and numerous signs of the ageing process by inducing the skin's healing processes. But with the growing number of laser resurfacing techniques, it's hard to believe that one of the most influential advances in aesthetic laser technology only became available for commercial use five years ago. Click here for your exclusive invitation to join us for an evening of champagne, canapes and a live demonstration of what fractional laser can do for you. Fractionated laser resurfacing was initially developed as a way for laser surgeons to achieve the significant results of traditional laser resurfacing with less severe patient downtime and fewer overall adverse events, but it has since proved to be even more versatile. Instead of affecting the actual laser, the technology affects how the laser is delivered to the skin. It works by breaking up the laser beam to create microscopic thermal injuries in the form of tiny holes, or ‘dots', in the skin's surface, penetrating deep into the dermis. The unaffected tissues surrounding each dot lesion heal the injuries, stimulating cell renewal and the production of new collagen and elastin. Unlike traditional ‘flat-beam' laser resurfacing, these tiny column-like injuries reach deep below the dermis without causing extreme inflammation, swelling, post-treatment hyperpigmentation and other excessive adverse effects.The advent of the first commercial non-ablative fractionated laser device in 2006 was a catalyst for the wide range of fractional laser devices that exist today. The Fraxel SR was initially approved for skin resurfacing to treat periorbital rhytids (wrinkles around the eyes), pigmented lesions, melasma, acne scars and surgical scars, and involved an injection of blue dye into thew skin to guide the path of the laser. Five years on, this blue dye is no longer needed and the versatility associated with fractional laser technology has given rise to many devices on the aesthetic market that are approved to treat a wide variety of indications.
Laser classificationA fractionated delivery system can be applied to almost all types of aesthetic lasers, allowing doctors to utilise higher strength wavelengths with significantly less downtime than previous modalities. Having said this, the aggressiveness and ultimate results of any fractional laser treatment depend on the strength of the laser itself, achieving levels of dermal remodelling ranging from minimal coagulation to severe ablation. Because of this, the myriad of fractional laser devices on the market are separated into ‘non-ablative' and ‘ablative' categories, which indicates whether or not the device removes, or ‘ablates', the outermost layer of the skin during treatment. Various criticisms towards this somewhat simplified way of categorising fractional laser treatments note that different types of lasers are suitable for different concerns, and therefore should be classified according to their type instead of the degree to which they ablate the skin. This is particularly pertinent for ablative fractional lasers as different devices emit light in different ways, consequently causing different depths of penetration into the skin. Some say this calls for a need for a further classification of ‘micro-ablative' and ‘deep dermal ablative' fractional laser treatments. Non-ablativeNon-ablative fractional lasers are lower strength lasers and not as aggressive on the skin as ablative treatments. There is less recovery time post-treatment because of this, however most patients require four to six treatments to achieve their desired results - which can often be achieved with one to three ablative treatments. While the premise behind all laser resurfacing techniques is to rejuvenate layers of skin tissue by inducing the skin's healing mechanisms, non-ablative fractional laser treatments achieve this without removing the outermost layer of the skin during treatment. Instead, non-ablative fractional lasers coagulate the skin in tiny columns reaching down to the dermis, leaving the surrounding tissues to heal the microscopic injury and rejuvenate the appearance. Despite being non-ablative, patients experience peeling and flaking as part of the skin's recovery process post-treatment, the degree of which depends on the type and strength of laser used. Typically, non-ablative fractional laser treatments are used to treat less severe levels of skin damage and concerns such as superficial wrinkles, larger sized pores and skin texture for overall tightening and rejuvenation. A recent take on the use of fractional technology is the use of bipolar radiofrequency (known as RF), which causes deep dermal heating in the under layers of the skin and has been tentatively classified as ‘sublative'. AblativeAblative fractional laser resurfacing is typically employed for more severe skin conditions such as deep pigmentation and sun damage, deep-set wrinkles, acne scars, birthmarks and rough skin texture. Often quipped as the ‘gold standard' in laser resurfacing, the most aggressive form of ablative fractional laser resurfacing involves the CO2 laser. Non-fractional or ‘flat-beam' CO2 laser resurfacing has been around since the 1980s but generally fell out of favour with doctors and patients because of the risk of extremely adverse effects post-treatment - including cases of hyperpigmentation and severe blistering and swelling lasting for a number of weeks. While a longer and more uncomfortable recovery process, the results of traditional CO2 laser resurfacing are still held in high regard. Some doctors have been able to achieve similar results with fractional CO2 laser resurfacing, with significantly less adverse effects. The target tissue of any laser treatment is a key indicator of the kind of laser used, however CO2 and Er:YAG lasers are the most common kinds for ablative treatments. References:"Update on Fractional Laser Technology", The Journal of Clinical and Aesthetic Dermatology, January 2010. Michael H Gold MD. "Fractional photothermolysis: current and future applications", Lasers in Surgery and Medicine, 2006; 38:169-176. R Geronemus MD. "In Vivo Histological Evaluation of a Novel Ablative Fractional Resurfacing Device", Lasers in Surgery and Medicine, 2007; 39:96-107. Basil M. Hantash MD PhD et al. "Novel Use of Erbium:YAG (2,940-nm) Laser for Fractional Ablative Photothermolysis in the Treatment of Photodamaged Facial Skin: A Pilot Study", Dermatologic Surg 2008; 34:1-6. Moshe Lapidoth MD et al. "Fractionated CO2 laser skin rejuvenation", Dermatologic Therapy, 2011; 24:41-53. Emily P. Tierney et al. "Fractional Photothermolysis: A New Concept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury", Lasers in Surgery and Medicine, 2004; 34:426-438. Dieter Manstein, MD et al. Fractional laser resurfacing devicesNon-ablative fractional resurfacing devicesFraxel re:store 1550nm - Solta Medical Ablative fractional resurfacing Erbium:YAG lasersPixel - Alma Lasers Ablative fractional resurfacing CO2 lasersActive FX/Deep FX - Lumenis Other ablative fractional resurfacing devicesPearl Fractional 2790nm fractional YSGG - Cutera Microablative fractional resurfacing devices <750μmActive FX - Lumenis Deep dermal fractional resurfacing devices >750μmDeep FX - Lumenis |
