What Is Fractional Laser Skin Resurfacing?-Understanding Non-ablative and Ablative Fractional Skin Rejuvenation

CO2 ablative laser resurfacing has been the “Gold Standard” for non surgical facial rejuvenation and removal of facial skin wrinkles and photo aging since 1995. CO2 ablative laser resurfacing can achieve very significant facial rejuvenation including wrinkle removal, skin tightening and removal of pigment and photo aging skin changes. (See Photo Below Before and After Ablative CO2 Laser Resurfacing).

However, the superb results of CO2 laser resurfacing have several limitations including a prolonged and difficult recovery period, often lasting two to three weeks, facial redness that can last three to four months, hypo pigmentation or lightening of skin color, and the potential for infection.

During the past several years new technology called fractional laser resurfacing has been developed which has dramatically shortened recovery time and lessened the occurrence of complications.

With fractional CO2 laser resurfacing the laser beam is broken up or fractionated into many small micro beams which are separated so that when they strike the skin surface small areas of the skin between the beams are not hit by the laser and left intact. These small areas of untreated skin promote a much more rapid recovery and healing with less risk of complications. The small areas treated by the fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production and resultant facial skin rejuvenation. (See Diagram Below)

In the above skin diagram, the first red area on the left represents traditional non-fractional ablative CO2 and Erbium laser resurfacing. To ablate means to surgically remove and the skin tissue is removed by the heat of the CO2 or Erbium laser. Since these lasers were not fractional, all of the skin in the treated area is removed creating an open wound that takes a long time to heal.

The second drawing is the fractional CO2 laser which fractionally ablated the surface of the skin down to a depth of 70-100 microns. This laser is fractional and the skin heals much quicker, but depth of penetration is not deep enough to produce substantial wrinkle removal, skin tightening and skin rejuvenation.

The third red areas represent the non ablative fractional laser technologies which heat but do not ablate the skin. These lasers use an Erbium laser to heat small columns of the deep skin layers to promote new collagen production and plump the skin and skin wrinkles. Recovery time is much less than with traditional ablative CO2 and Erbium lasers. Example of the non ablative fractional lasers is the Fraxel® non-ablative laser. This laser is excellent for improving skin texture, plumping wrinkles and acne scars, and shrinking pores, but multiple treatments are required.

More recently the new CO2 fractional ablative lasers (ablate means to surgically remove-see last column on right in diagram below) have been developed which actually remove the heated column of skin tissue and provide more substantial wrinkle removal and superficial skin tightening than the non- ablative fractional lasers (See Last Figure on Right in Above Diagram). These new ablative fractional CO2 lasers have the advantage of producing better wrinkle removal and skin rejuvenation than the non-ablative fractional lasers,  with less down time than the traditional non-fractional ablative CO2 and Erbium lasers.

These fractional ablative CO2 lasers reach much deeper into the skin, 600 to 1000 microns, and can produce much more effective wrinkle removal and skin rejuvenation with significantly less down time and recovery than traditional CO2 and Erbium non fractional ablative laser resurfacing.

WHAT IS THE FRACTIONAL CO2 LASER PROCEDURE?

The Fractional CO2 laser is a modified CO2 laser device which can treat:

* Fine Lines and Wrinkles
* Acne Scarring
* Aging Skin
* Stretch Marks
* Brown Age Spots
* Post Surgical Scars
* Large Pores
* Heavy Eyelids

The Fractional CO2 laser uses a pixilated CO2 laser to deliver very precise bursts of light using a “dot in a matrix pattern”, leaving untreated regions in-between to ensure a rapid recovery. Traditional full-surface CO2 laser treatments are performed using a beam of intense laser energy that is passed over the skin surface to vaporize the entire top layer of skin. The damage to the tissue is extensive and takes at least two weeks to heal and regrow a new top layer of skin (i.e., re-epithelialize the entire top layer of skin).

Fractional skin treatments deliver laser or high-powered light energy in a pattern. The fractional pattern leaves untreated areas of skin between the treated areas of skin. As these treated areas are much smaller than the surrounding healthy tissue, the healing time is significantly shortened.  Most fractional CO2 laser patients heal in less than one week for facial treatments.

Traditional full-surface CO2 laser treatments deliver effective results but require significant downtime – patients experience a much longer healing process, and the risk of complications, including infection, is greater.  Fractional CO2 treatments provide results almost as good as traditional full-surface CO2 laser with far less downtime and risk.

Another nice thing about the Fractional CO2 laser is that one can treat areas besides the face safely. Fractional CO2 laser can produce excellent results treating the neck, hands and back for conditions such as skin laxity, acne scars and wrinkles. One to two treatments is all that is needed to allow for up to an 85 % improvement in these conditions.

HOW LONG DOES TREATMENT TAKE?

Treatment with the Fractional CO2 laser takes anywhere from 30 minutes to 1.5 hours depending on the area(s) that are treated. If a repeat treatment is required, this is usually performed at least 2 months later.

WHAT IS THE PRE -CARE INSTRUCTIONS FOR THE FRACTIONAL CO2 LASER?

We request that patients with darker skin types (those that tend to tan easily or have a history of developing dark blotches after skin injury) apply a hydroquinone cream two times a day for one month before the procedure date which will decrease the risk of post-inflammatory hyperpigmentation or temporary darkening of the treated area.  You will be provided with a written prescription so that you can purchase this cream.

All patients will need to start a prescription pill antibiotic and a prescription pill anti-viral drug one day before the procedure and continue it twice a day until seven days after the procedure.  You will need to come in for a pre-treatment appointment for a facial (if face is being treated) and instruction appointment before the procedure. 

HOW MUCH DISCOMFORT CAN I EXPECT?

There is minimal discomfort with this treatment. A topical anesthetic cream will be applied to the treatment area at least one hour before the procedure. We will also ask you to take a generic Vicodin pill or Darvocet pill which we will give you about 30 minutes before the procedure. If you are anxious, we can prescribe anti-anxiety medication regimen which can be taken 1 to 2 hours before your procedure. Someone must drive you to and from the office. Post-treatment discomfort usually is described as moderate sunburn, which can easily be controlled with ice and medications such as Tylenol™ or Advil™.

HOW LONG WILL I STAY RED?

The advanced technology of the Fractional CO2 laser allows the skin to recover quickly. There can be some minor redness and peeling of the skin. This quickly disappears within a 3-7 days. Redness can persist for up to one to two weeks.

WHAT ABOUT POST OP CARE?

A layer of Aquaphor Healing Ointment will be applied to the treated area before you leave the office.  You will need to apply this ointment several times each day during the first week to keep the treated sites from drying out.  Dryness will slow the healing process and make the area more uncomfortable.  Cool compresses or ice packs may reduce swelling and the sunburn feeling if used every 2-4 hours during the first 2 days when you are awake.  It is important to stay out of intense sun for at least one week after your treatment. Our Institute staff can recommend additional elegant products to help the healing process. Concealing makeup can be used to minimize redness once you receive permission to apply makeup from the doctor at the first check-up appointment 3-4 days after the procedure. Again, the beauty of the Fractional CO2 laser is that one is pretty much healed by 7 days after the laser treatment is done.

HOW LONG WILL THE EFFECTS OF THE TREATMENT LAST?

Fractional CO2 laser’s effects can be seen for several years. Repeat treatments are sometimes required but this is determined on a case by case basis. In our experience, patient satisfaction has been extremely high for this procedure.

HOW CAN I SCHEDULE A CONSULTATION OR TREATMENT?

Feel free to one of our staff or patient advisers if you would like to schedule a consultation appointment at (530) 671-4182 or (800) 437-5273.

   

 

The new micro fractional ablative CO2 laser resurfacing techniques are very exciting advances in the field of non-surgical facial rejuvenation and wrinkle removal. Many new applications are being developed which will likely improve our ability to rejuvenate the skin and possibly improve scars, stretch marks, and remove pigment. Call us at (530) 671-4182 to set up a consultation.