Lasers - The Cutting Edge in Cosmetic Surgery - Part 3
By
Lois W. Stern

Fractional Ablative Laser Treatments

Fractional ablative laser treatments, the newest set of options, are available from several manufacturers, including the new fractional CO2 lasers (Fraxel Re:pair by Reliant and Deep Fx by Lumenis) and the Erbium:YAG lasers (LUX2940 and Profactional). The Erbium:YAG  has the advantage of  more precisely controlled thermal effect. Both types of ablative fractional treatments (CO2 and Erbium), like Fraxel Re:store, their nonablative fractional resurfacing laser, go up to 1300 microns deep into the skin as compared with the older laser resurfacing depths of up to 300 microns.

Through tissue ablation, removal of tissue from the epidermis and dermis, these treatments produce an open wound. But because the wounds are tiny (fractional), they heal rapidly, with much less risk of complications than with field ablative treatments. Some further input from Dr. Lawrence Bass:  

"All of the major systems out there (Fraxel Re:Pair, Lumenis Deep FX, Palomar Lux 2940, Sciton Profractional) are showing excellent skin smoothing and wrinkle reduction results, so it’s not clear that the longer recovery of the  fractional CO2 is worth it."  

He further notes that these treatments normally provide good wrinkle improvement and some skin tightening. Although Reliant claims that it is equivalent to CO2 resurfacing, the jury is still out on this claim. He also believes that acne scars may do better with non-ablative fractional treatments, which go deeper in the skin than most ablatives, but cautions that it is too early to know for sure.

CO2 fractional ablative laser treatments take about 5-7 days to heal, whereas Er:YAG systems seem to take about 3-5 days to heal. Following healing of the open wound, each treatment is associated with about 5-7 days of redness, easily concealed with makeup. On average, the patient should expect to have 2 treatments, separated by 1-2 months. The exception is Fraxel Re:Pair which has been widely touted in the media. Redness after one of these treatments can last as long as 3-4 weeks.  

What about results? "They generally yield less dramatic results than ablative field treatments but moderately better results than with nonablative fractional treatments," says Dr. Bass.  He further explains that Fraxel has been tinkering with parameters to cut down this period of redness, but it is unclear if the good results of wrinkle improvement exist at these kinder, gentler parameters.  

What to Expect During Treatment:
These treatments progress similarly to the fractional nonablative treatments described in Part 2, with a thorough cleansing of the skin, application of a numbing gel, and the laser application, which last for 20-30 minutes for a full facial treatment  

What to Expect Post-treatment:
Open wounds with local wound care required, usually for 3-5 days
5-7 days of redness that can be concealed with makeup
2 treatments separated by 1-2 months
Less results than ablative field treatments, but moderately more results than following nonablative fractional treatments
Best for wrinkles - (acne scars may do better with non-ablative fractional treatments which go deeper in the skin than most ablatives but too early to know for sure)
Incidences of hyperpigmentation and hypopigmentation are still unknown, but one might expect them to be less than following field ablative resurfacing.

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.
There is definitely a little more sun exposure risk with fractional ablatives than with fractional nonablatives.  

The good news is that we have entered an exciting new era in skin care and rejuvenation, with a number of options that were unavailable even less than a decade ago. The cautions surrounding these latest options are best expressed by Dr. Bass: "I should emphasize that these systems are very new so there is not a lot of long term follow-up, careful quantification of degree or durability of improvement or comparative data between the systems."

(c) 2008 by Lois W. Stern

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Lois W. Stern is the author of 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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