CO2 ablative laser resurfacing has been the “Gold Standard” for non surgical facial rejuvenation, skin rejuvenation and removal of facial skin wrinkles and photo aging since 1995. CO2 ablative laser resurfacing using the Ultrapulse CO2 laser can achieve very significant facial rejuvenation including wrinkle removal, skin tightening and removal of pigment and photo aging skin changes.
However CO2 laser resurfacing has several limitations including a prolonged and difficult recovery period, often lasting three weeks, prolonged facial redness that can last three months, hypo pigmentation or lightening of skin color, and the potential for infection which can lead to scarring.
During the past three years new technology called fractional laser resurfacing or fractional skin rejuvenation has been developed which has dramatically shortened recovery time and lessened the occurrence of complications.
With Fractional Skin Rejuvenation 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.
The first fractional laser made by Reliant the Fraxel laser and subsequently Palomar Medical’s Lux1540 have produced excellent results treating acne scars and facial pigmentation and have improved skin texture and facial rejuvenation. They have not however achieved the same degree of wrinkle removal and skin tightening as the traditional ablative CO2 laser resurfacing technique.
Above Before and After Lux1540 Non-ablative Fractional Laser Resurfacing (Photo Courtesy of Palomar and Dr. Dwight Scarborough)
To ablate means to “surgically remove”. The Fraxel and Lux1540 are non ablative lasers which mean that when the laser beam strikes the skin the skin is not removed immediately, rather the laser beam heats the skin to cause inflammation and new collagen production. The benefits of non ablative laser skin treatments are dramatically reduced recovery time, but the results in terms of wrinkle removal and skin tightening are much less dramatic.
The results achieved by ablative CO2 resurfacing are more significant because ablation removes damaged, aged skin as well as heating the deeper skin layers to promote new collagen production.
Recently several new micro fractional ablative lasers have been developed which have the benefits of fractional treatments, less down time and complications, as well as the benefits of ablative skin resurfacing, better wrinkle removal and facial rejuvenation. The diagram below shows how this new technology works in comparison to previous laser methods.
The first on the left is traditional CO2 and Erbium laser resurfacing. Next is the Lumenis CO2 ActiveFX which fractionally ablated the surface of the skin down to a depth of 70-100 microns. Next are the non ablative fractional technologies which heated but did not ablate the skin. More recently the Palomar Lux2940, the Sciton Profractional, the new Lumenis Bridge Therapy and Reliant’s FDDA or Repair lasers have all developed new ablative or microablative fractional laser systems that reach much deeper into the skin, 200 to 1000 microns, and can produce much more effective wrinkle removal, new collagen production and skin rejuvenation with significantly less down time and recovery than traditional CO2 ablative laser resurfacing.
The photo below shows the wrinkle removal results achieved with Palomar’s new Lux2940 micro fractional ablative laser with 4-6 days of down time and a week of redness as compared to 3 weeks of down time and 3 months of redness with a traditional CO2 laser resurfacing.
The new Fractional Skin Rejuvenation lasers are a very exciting advance 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.
Another very exciting aspect of Fractional Skin Rejuvenation is that unlike older ablative laser resurfacing techniques, the new Fractional Skin Rejuvenation lasers appear to be safe to use on darker skin for Asian Skin Rejuvenation and African American Skin Rejuvenation. This will make the latest skin rejuvenation techniques available to millions of people with dark skin who could not be safely treated with previous skin rejuvenation techniques.
The patient below was treated with the Lumenis ActiveFX fractional ablative CO2 laser by Dr Bosniak in NY:
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