Nonablative Cosmetic Laser: Fractional photothermolysis 1520-1560 nm (Fraxel)

Generic name: Fractional photothermolysis with 1520-1560 nm laser

Brand(s): Fraxel

Function / Purpose:
Treatment of fine lines, small wrinkles, possibly medium wrinkles, pigmentation; improvement of skin texture.

Details:
As far as wrinkles and skin texture are concerned, the benefits of typical nonablative lasers are rarely dramatic but there is minimal down time and few side effects. The results of classic ablative resurfacing (e.g. with a CO2 laser) are often dramatic but there are at least two weeks of down time, risk of infection, loss of pigmentation and other side effects. Fractional photothermolysis is the attempt to combine the key benefits of the two approaches but avoid most of the side effects.

Fractional photothermolysis works by producing microscopic zones of heat-induced injury surrounded by healthy tissue whereas classic ablative resurfacing creates contiguous lesions. Fractional photothermolysis usually involves two or more 10-30 min sessions, with about 1-2 weeks in between. No more than 20 percent of the skin surface is treated (non-contiguously) at any one session. Since thermal wounds are microscopic and surrounded by uninjured cell, healing is quick, with minimal risk of scarring or infection.

The results of fractional photothermolysis depend on the density of microburns, the number of passes, and total number of treatments. Skin texture may improve after just one or two treatments. Fine lines, wrinkles and hyperpigmentation generally take 2-4 treatments to improve. It appears that for best results, treatments should not be more than 1-2 weeks apart.

There is some debate whether fractional photothermolysis is indeed superior to older nonablative infrared lasers. Some experts feel that the benefits are similar, while others believe that fractional photothermolysis has clear advantages and will replace many nonablative lasers even though it tends to be more expensive. The jury is still out. Ideally, clinical studies with head-to-head comparisons are required. Also, considering that fractional photothermolysis is relatively new, the best practices for its use may still be somewhat immature and leave room for further improvement.

On the other hand, the view that fractional photothermolysis may fully replace ablative lasers is unjustified. Skin resurfacing with ablative lasers can improve wrinkles, scars and texture irregularities to the degree fractional photothermolysis is unlikely to ever achieve. But fractional photothermolysis does not directly compete with ablative resurfacing because the latter is a far more invasive, disruptive and risky.

Overall, fractional photothermolysis is a promising and possibly somewhat more effective cousin of infrared nonablative laser treatments. As it matures, it may (or may not) replace its currently more commonly used relatives.