by Lois W. Stern  Fractional Ablative Lasers Fractional ablative lasers are the newest set of treatment options, now available from several manufacturers. In order to understand how they work, let's refer back to the diagram you already saw last month in PART 1 of A NEW BREED OF LASERS IN COSMETIC SURGERY. Stratum Corneum (the outermost surface of the Epidermis)  Remember that the outer layer of our skin is called the epidermis, with the stratum corneum its outermost surface. Beneath the epidermis lies the dermis. Tissue ablation refers to the 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. Dr. Lawrence Bass, Clinical Assistant Professor of Plastic Surgery and Director of the Minimally Invasive Plastic Surgery Program at New York University Medical Center, explains further: “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 field 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. New fractional CO2 lasers (Fraxel Re:pair by Reliant and Deep Fx by Lumenis) and the Erbium:YAG lasers (LUX2940 and Profactional)are being produced by a number of different companies. 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. 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 1, 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 with ablative field treatments, but moderately more results than following nonablative fractional treatments Best for wrinkles - (Dr. Bass notes that acne scars may do better with non-ablative fractional treatments which go deeper in the skin than most ablatives but it's 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.” © 2008 by Lois W. Stern Lois W. Stern is the author Sex, Lies and Cosmetic Surgery (Infinity, 2006, 2010), a book based on the experiences of over one hundred women, which explores many of the emotional undercurrents for those undergoing cosmetic procedures. Learn more. She also has developed an interactive CD and a Medical Support Tool multimedia DVD for professional office use - both in part based on content from this book. Her second book, Tick Tock, Stop the Clock, (Infinity, 2006, 2010), is written with contributing chapters from eleven highly renowned experts in diverse fields of beauty enhancement. Get details. Along with Patty Kovacs, host of the Health and Beauty Revolution Show, Lois has developed a newsletter and website dedicated to serving women seeking a trusted resource for cutting edge health and beauty news. You can find valued information or sign up for their FREE newsletter - only 10 issues per year - from the Sign-up tab: Click here. To send Lois a message, click here. |