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Lasers - The Cutting Edge in Cosmetic Surgery - Part 2

Lois W. Stern*

We need a way to distinguish the earlier CO2 and Yag Erbium methods described in Part 1 of this laser series from the fractional ones that that have since begun to emerge. Dr. Lawrence Bass explains further:

"We need to rename these older resurfacing treatments 'field resurfacing', meaning that the entire field in which the wrinkles are contained is resurfaced. In contrast, 'fractional ablative resurfacing' and 'fractional non-ablative resurfacing' are the newer options in which only individual non-confluent spots of skin are exposed within the same field."  

Understanding the Anatomy of Our Skin

Stratum Corneum (the outermost surface of the Epidermis)


New lasers are appearing on the market, claiming to produce the results of older ablative "field" lasers, but with minimal downtime. First on the scene were nonablative fractional lasers. During treatment, the fractional laser penetrates the non-living protective barrier of the skin, the stratum corneum, as if it were a window, leaving it completely intact. It then creates microscopic “wounds” within the targeted areas well beneath the outermost epidermal layer of skin. Both epidermal and dermal tissue are removed. In so doing, it triggers the body’s natural healing process to accelerate the production of collagen and new, healthier skin cells.  

To best understand how fractional lasers work, you need to think of your skin as a digital photograph in need of restoration or touch up. Just as you can alter a photographic image pixel by pixel, fractional lasers treat your skin with thousands of tiny microscopic laser spots. During treatment, these thousands of columns penetrate deeply into the dermis. What distinguishes fractional lasers is their ability to leave untouched specific skin areas while treating others. By creating microscopic treatment zones, the laser affects only a fraction of your skin at a time.  

For every microscopic zone the laser targets and treats intensively, it leaves the surrounding tissue unaffected and intact. This “fractional” treatment allows the skin to heal much faster than if the entire area were treated at once. Like other laser treatments, it wounds the skin and then uses the body’s natural healing process to create new, healthier, tighter tissue to replace the imperfections of the older skin. Because nonablative fractional treatments spare healthy tissue, they are effective even on delicate skin areas, such as the neck, chest and hands. Nonetheless, results are still less effective than those achieved through ablative laser resurfacing. Fraxel;Restore, one popular nonablative fractional treatment should not be confused with Fraxel Re:Pair, an ablative fractional system described below.  

This system yields more predictable tissue removal with better results than the earlier non-ablative treatments such as Cooltouch. There is minimal risk of pigment problems, no raw wound, and minimal recovery time, but multiple treatments are required (4 sessions on average normally spaced about 2 to 4 weeks apart). Although results are immediate and progressive, with optimal improvement usually visible in about 2 to 3 months, the results obtained by fractional non-ablative treatments are generally less dramatic than those obtained by ablative laser resurfacing techniques.  

What to Expect During Treatment:
As a first step, the treatment area is thoroughly washed. This is followed by a topical anesthetic ointment applied approximately 60 minutes prior to treatment in order to give the anesthetic time to take full effect. The actual treatment for a full face takes between 20 to 25 minutes. Most patients describe the treatment sensation as having a “prickling” feel. An air cooling system and topical anesthetic ointment alleviates most discomfort.
After treatment, the anesthetic ointment is washed off and a deep hydration mask applied to your skin, possibly followed by other topical skin products as antioxidants and moisturizer.  

What to Expect Post-treatment:
A mild sunburn sensation normally is experienced for about an hour after treatment, with minimal discomfort thereafter. The skin will have a pinkish tone for about 3 to 5 days, a normal sign that the skin is healing. Just like a natural sunburn, the skin will bronze over the next week or two and will flake and exfoliate normally. Using a moisturizer will help reduce the appearance of dry flakes. Swelling is minimal and generally resolves in 2 to 3 days. You may apply make-up or shave soon after treatment. Some patients return to routine activities, including work and social obligations, the same day. Others require a little more time, depending upon their skin condition and treatment. New epidermal skin develops within 24 hours. The process of skin repair involves:
·Bronzing: Your skin might have a bronze appearance that lasts anywhere from 3 to 14 days, depending on your treatment level.
·Flaking: Your skin will naturally and vigorously exfoliate as new skin replaces dead tissue. Flaking is similar to that of minor sunburn, but without the associated pain. Use of a moisturizer will mask the appearance of flaking.
Over the following weeks and months, the body continues to repair the deeper dermal tissues that have been affected by treatment, with increasingly beneficial results.
Dr. Bass adds his personal oobservations based on his extensive experiences with Fraxel:
"Some patients experience almost no bronzing or flaking or only for 3 days or so. Others will notice a more pronounced presence of these findings. Necks in particular and very aggressive treatments may take 1-2 weeks to clear off."
Post Treatment Precautions: Apply a moisturizing sun block with an SPF of 30 or higher twice a day without fail. Avoid direct sun exposure during the healing process and for at least 3 months after treatment. Wear wide brimmed hats outside for further shielding from the outdoor elements and especially when in direct sunlight.

"While it is generally recommended to wear sunscreen and minimize sun exposure, there doesn't seem to be any great sensitivity to the sun or need for special precautions. For example, I routinely perform Fraxel Re;store all summer long, (except for the hyperpigmentation prone patient),  I suspend certain other laser treatments like Er:Yag for the summer months," explains Dr. Bass.

In part three I will be talking about Fractional Ablative Laser Treatments.
Tune in for more.

You have my permission to reprint this article in part or full as long as it contains the following attribution:

© 2008 by Lois W. Stern

 Lois W. Stern is the author of the book, Sex, Lies and Cosmetic Surgery, (Infinity, 2006), soon to be republished in a revised edition with a CD enclosure. Lois invites prospective cosmetic surgery patients, physicians, and media to visit her website to read other articles and/or sign up for her monthly newsletter at: [Link Removed]

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