Elsaie_subbed.qxp 19/5/09 12:32 pm Page 63
What Is New in Fractional Laser Resurfacing?
Table 1: Devices Using Non-ablative Fractional Technology
Laser Type Lux IR Fractional Lux 1540 IPL- Matrix IR (Diode + Bi-Polar Mosaic – Controlled Affirm
(IPL-powered Infrared) powered Laser Radio Frequency) Chaos Technology (CCT)
Wave length 850–1,350nm 1,540nm 915nm 1,550nm 1,320/1,440nm
Spot size 12x28 10 and 15mm 8x5mm 10x10mm/8x8mm/ 10mm
6x6mm/5x10mm
Fluence Up to 100J/cm
2
70mJ/microbeam Diode fluence up to 70J/cm
2
; 70mJ 1,440nm up to 8J/cm
2
;
RF fluence up to 100J/cm
3
1,320nm up to 14J/cm
2
IPL = intense pulsed light.
R1–3) that control the coverage area, ranging from 5 to 50% of the The Affirm CO
2
device utilises a CO
2
laser, which has been a
skin surface area.
6
cornerstone of laser resurfacing for decades, but uses a novel
microablative technique. By treating only minute segments of the
Fractionated delivery uses either a lens in the hand-piece to break up facial area at a time, the Affirm CO
2
laser is able to minimise
the light into fractionated beams and emit the light in an array of downtime and healing while still rejuvenating the whole area of the
fractionated beams, or a scanner to deliver treatment columns to the skin and the collagen beneath.
8
skin with sparing in between. In 2007, Reliant changed the name
of the SR1500 to Fraxel Re:store and introduced a more superficial Side effects of FR are typically mild and transient, including erythema,
version called the Fraxel Re:fine intended for obstetrics and periocular oedema, xerosis and slight darkening of the skin (bronzing)
gynaecology and family practitioners and the medi-spa market. during desquamation of the microscopic epidermal necrotic debris.
9
Completing their portfolio, in 2008 the more invasive Fraxel re:pair Erosions are uncommon and can be managed by liberal application of
(fractional CO
2
) was launched, intended for more serious users such a healing ointment or plain petrolatum with cool wet compresses
as experienced plastic surgeons and dermatologists. The Fraxel family every two to three hours. To date, permanent pigmentary alteration
of lasers requires use of a cooled-air blower for patient tolerance. and scarring have not been reported. However, when an aggressive
treatment protocol with a high density of MTZs is used, the risk of
The Lux 1540 Fractional Er:YAG (Palomar Medical Technologies Inc., visible epidermal ablation, along with the side effects associated with
Burlington, MA) contains a multilensed hand-piece that divides pulsed ablative laser procedures, is increased. Additional research is ongoing
light at 1,540nm into microbeams that heat the epidermis and upper to determine optimal treatment parameters and the long-term
dermis in a fractional fashion, penetrating up to 1mm. It is approved benefits and sequelae of FR.
by the US Food and Drug Administration (FDA) for soft-tissue
coagulation. The StarLux Fractional IR (Palomar Medical Technologies, The devices discussed above are all non-ablative fractional
Inc., Burlington, MA) takes a slightly different approach in that it uses mid-infrared systems. The ProFractional (Sciton, Inc., Palo Alto, CA) is
a fractional infrared hand-piece to deliver non-coherent light in the an ablative fractional erbium: yttrium–aluminium–garnet (Er:YAG)
825–1,350nm range as a regular array of small hyperthermic beams laser. It uses a scanner to deliver light at 2,940nm to create
with contact cooling to heat the deep dermis to induce collagen 250µm-wide microchannels in the skin at depths ranging from 20 to
change and skin tightening.
7
Another available device is the Matrix IR
fractional applicator (Syneron Medical Ltd, Yokneam, Israel), which is
a hand-piece compatible for use with the company’s eMax or eLaser
treatment systems. The technology heats the skin with its fractional
Controlled chaos technology is a novel
915nm diode optical energy followed by bipolar radiofrequency
technology that delivers an array of
pulses that result in collagen remodelling. Matrix IR creates
microthermal bands of heating while leaving the surrounding tissue
randomised erbium:glass microbeams to
intact, which acts as a ‘healing reservoir’ for the thermally damaged
the skin surface in a ‘spray-paint’ pattern.
tissue. The premise is that undamaged tissue works to promote
quicker healing while ensuring that there is limited or no patient
downtime. Table 1 shows different available devices that use
fractional non-ablative technology. 1,500µm. Treatments are performed in a single pass, and most
patients require one to two treatments. As one of the few 2,940nm
Controlled chaos technology (CCT) is a novel technology that delivers ablative fractional procedures, the Pro-Fractional instantly ablates the
an array of randomised erbium:glass microbeams to the skin surface hot debris from tissue, reducing pain and irritation and speeding
in a ‘spray-paint’ pattern. This is thought to minimise cross-thermal recovery. The ProFractional laser can selectively treat up to 60% of the
diffusion between adjacent wounds. The Mosaic (Lutronic Inc, Ilsan, skin area in a single pass. The Pixel (Alma Lasers, Buffalo Grove, IL) is
Korea) laser has been developed to use this technology and another ablative fractional Er:YAG laser that delivers light at 2,940nm
treatments can be delivered in two treatment modes: a dynamic mode and is a module of the Harmony platform. The Pixel has a penetration
with continuously delivered CCT beams or a static stamping mode. depth of 20–50µm. The operator can choose whether the treatment
Treatment columns are 100–200µm wide and are able to penetrate up energy is divided between 49 and 81 pixels within a given spot size
to 1.2mm. This offers a randomised non-linear and non-sequential (11x11cm
2
) using a micro-optic lens. At 49 pixels the depth of
scan, versus the sequential and linear scan of the competition. CCT penetration is higher, while at 81 pixels the net depth of penetration is
allows for tissue cooling between deliveries of adjacent microbeams, shallower. The field of fractional lasers is rapidly changing and many
resulting in much greater patient comfort, avoiding the bulk heating.
4
more devices will be available in the coming years.
EUROPEAN DERMATOLOGY 63
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99