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Aesthetic Dermatology Laser
What Is New in Fractional Laser Resurfacing?
Keyvan Nouri
1
and Mohamed L ElSaie
2
1. Professor of Dermatology and Otolaryngology, Director of MOHS, Dermatological and Laser Surgery, and Surgery Training, Department of Dermatology and
Cutaneous Surgery, University of Miami Miller School of Medicine; 2. Lecturer in Dermatology and Cutaneous Surgery, National Research Centre, Cairo, and
Clinical Fellow, Dermatology Lasers and Cutaneous Surgery, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine
Abstract
CO
2
ablative laser resurfacing has been the ‘gold standard’ in non-surgical facial rejuvenation and the removal of facial skin wrinkles and
photoageing damage since 1995. Recently, a new generation of fractional or microablative CO
2
lasers has been introduced. According to the
concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area.
An array of microscopic thermal wounds is created that ablates the epidermis and dermis within tiny zones; adjacent to these areas, the
epidermis and dermis are spared. This microablative process of laser skin resurfacing has proved to be safe and effective not only for facial
rejuvenation, but also for bodily rejuvenation. It is capable of improving wrinkles, acne scars and other types of atrophic scars and benign
pigmented lesions associated with elastotic, sun-damaged skin. As a result of the areas of spared epidermis and dermis, healing is more
rapid than with fully ablative CO
2
laser skin resurfacing and downtime is proportionately reduced. The drive to attain cosmetic enhancement
with minimal risk and rapid recovery has inspired the field of fractional resurfacing and newer developments remain under investigation.
Keywords
Fractional resurfacing, ablative, non-invasive, mid-infrared
Disclosure: The authors have no conflicts of interest to declare.
Received: 16 March 2009 Accepted: 29 April 2009
egydoc77@yahoo.com
Over the past few years a novel approach in skin resurfacing, termed microthermal zones (MTZs). In response to the many small injuries,
fractional photothermolysis, has been developed to address the the skin generates newer, healthier skin.
1
shortcomings associated with skin rejuvenation using ablative and
non-ablative lasers and light sources. Although dramatic clinical Mid-infrared Fractional Resurfacing Devices
improvement can be achieved with ablative lasers, patients are often The Fraxel SR750 uses a diode pumped erbium fibre laser emitting
hesitant to pursue this treatment option because of the extended light at 1,540nm to target water in the skin.
2
The beam is delivered
post-operative recovery period and inherent risks of the procedure. through an optically tracked, microprocessor-controlled hand-piece
Non-ablative lasers and light sources, on the other hand, have to produce an array of MTZs each about 100µm in diameter, or about
demonstrated modest efficacy in the non-invasive treatment of mild the size of a human hair. During each treatment, 125 or 250 columns
facial rhytides and atrophic scarring with minimal side effects, but of MTZs are created per cm
2
per pass, depending on operator
require multiple treatments with delayed and often inconsistent settings.
3
With this version of the Fraxel laser, a water-soluble dye is
clinical results. Due to the quick rise in the availability of laser applied to the treatment area to allow the laser’s optical tracking
procedures and new technologies, physicians now have a dazzling system to detect contact with the skin and adjust the laser repetition
array of options in their laser armamentarium, including innovations rate depending on hand velocity. When the hand-piece moves more
in laser fractional resurfacing (FR). Due to a need for more noticeable quickly, the laser repetition rate is greater, and when the hand-piece
clinical improvement than these latter non-ablative systems can moves more slowly, the laser repetition rate is lower. This ensures a
provide, fractional photothermolysis was introduced into the skin uniform, reproducible pattern of treatment columns.
4
resurfacing market to treat patients with rhytides, dyspigmentation
and atrophic scars. The full subject is beyond the scope of this The first-generation Fraxel was called Fraxel 750, and the second
article; however, the latest updates and upgrades are highlighted. Fraxel SR1500; both are now renamed Fraxel Re:store, erbium
fractionated non-ablative lasers.
5
The difference between the first-
The Basics and second-generation Re:store Fraxel lasers was a 2007 software
FR falls somewhere between ablative and non-ablative resurfacing. upgrade that adjusted the size of the laser spot along with changes
It essentially causes a fraction of the injury but also achieves a in depth. The software upgrade permitted a maximum energy of
fraction of the results. The first fractional device, introduced in 70mJ, allowing for a greater penetration depth – up to 1.4mm. The
2004, was the Fraxel SR750 (Reliant Technologies Inc., Mountain first-generation Fraxel SR750 laser had treatment energies up to
View, CA) laser using fractional photothermolysis, which is the 40mJ, with column depths ranging from 400 to 700µm. The Fraxel
concept of creating equidistant microthermal injuries called Re:Store has varying treatment levels (1–12 and advanced levels
62 © TOUCH BRIEFINGS 2009
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