Lois W. Stern

I know exactly what you want, because I want it too: skin treatments that are less invasive, with little downtime, minimal risk and excellent, long lasting results! But this is not just a consumer ‘Wish List’. Plastic surgeons and dermatologists want to deliver skin treatments that meet those very same criteria. Popular interest in these magical ‘quick fixes’ is so huge that when Fraxel Re:pair recently debuted on the Today Show, the parent company, Reliant, had 20,000 hits on its website in 90 minutes, causing it to shut down. Given such strong public interest, Reliant was invited back on the Today Show a week later to further demonstrate its Fraxel lasers, and again their website was besieged by a deluge of visitors.

Will this new breed of lasers take the place of surgical facelifts? Not really, but they can help postpone the need for a surgical facelift for some time. Will they ultimately give us similar, yet kinder, gentler results than the ablative resurfacing techniques more popular a decade ago? Probably not as dramatic a result, but still effective for treating acne scars and some of those earlier signs of aging.

What Are Fractional Lasers?

To understand how fractional lasers work, think of your skin as a digital photograph in need of restoration or touch up. Just as you can alter a photograph pixel by pixel, these lasers treat your skin with thousands of tiny microscopic laser spots. If you are more of an outdoor type than into digital photography, think in terms of aerating your lawn. When you aerate your lawn, you have a bunch of holes in it, with undisturbed lawn in between. Although these holes exist, but are not noticeable after the lawn treatment is completed. Fractional lasers work on the same principle, creating microscopic channels in your skin while leaving normal skin between these channels untouched. By bridging the gap between the laser-induced injured skin and the untreated skin, Fractional lasers allows for more rapid healing.

During fractional laser treatment, these thousands of columns penetrate deeply into the dermis. What distinguishes fractional lasers is their ability to leave untouched specific skin areas while treating others. By creating microscopic treatment zones, the laser affects only a fraction of your skin at a time.

Skin Remodeling

Dr. Lawrence Bass, Clinical Assistant Professor of Plastic Surgery and Director of the Minimally Invasive Plastic Surgery Program at New York University Medical Center, has generously given of his time and expertise, to educate me about the field of modern laser technologies. In this article, Lasers - Part 1, I will share what I have learned about Fractional Lasers, reserving information about field lasers for Lasers - Part 2. But know that the basic concept behind all laser technologies is the same: wound and heal. One must wound the skin to remove old surface tissue, which in turn stimulates the growth of new collagen.

Remodeling is one of our twenty-first century buzzwords. We are all familair with this term in reference to home remodeling. Skin remodeling has a similar connotation, but works to rejuvenate the skin covering our bodies, rather than to alter interior or exterior features of our homes.

When we speak of remodeling for wrinkle treatments, we are targeting treatment within the mid-dermis. For skin-tightening devices (Titan, Thermage), we are targeting the deep dermis at the dermal/subcutaneous junction, explains Dr. Bass.

Understanding the Anatomy of Our Skin

Stratum Corneum (the outermost surface of the Epidermis)

The outer layer of our skin is called the epidermis, with the stratum corneum its outermost surface. Beneath the epidermis lies the dermis. Fat cells lie beneath the dermis, within the subcutaneous layer. When one loses volume in the face, it is due to loss of fat in the subcutaneous layer.

What to Expect During Treatment:

As a first step, the treatment area is thoroughly washed. This is followed by a topical anesthetic ointment applied approximately 60 minutes prior to treatment in order to give the anesthetic time to take full effect. The actual treatment for a full face takes between 20 to 25 minutes. Most patients describe the treatment sensation as having a "prickling" feel. An air cooling system and topical anesthetic ointment alleviates most discomfort. After treatment, the anesthetic ointment is washed off and a deep hydration mask applied to your skin, possibly followed by other topical skin products as antioxidants and moisturizer.

What to Expect Post-Treatment:

A mild sunburn sensation normally is experienced for about an hour after treatment, with minimal discomfort thereafter. The skin will have a pinkish tone for about 3 to 5 days, a normal sign that the skin is healing. Just like a natural sunburn, the skin will bronze over the next week or two and will flake and exfoliate normally. Using a moisturizer will help reduce the appearance of dry flakes. Swelling is minimal and generally resolves in 2 to 3 days. You may apply make-up or shave soon after treatment. Some patients return to routine activities, including work and social obligations, the same day. Others require a little more time, depending upon their skin condition and treatment. New epidermal skin develops within 24 hours. The process of skin repair involves:

· Bronzing: Your skin might have a bronze appearance that lasts anywhere from 3 to 14 days, depending on your treatment level.
· Flaking: Your skin will naturally and vigorously exfoliate as new skin replaces dead tissue. Flaking is similar to that of minor sunburn, but without the associated pain. Use of a moisturizer will mask the appearance of flaking.

Over the following weeks and months, the body continues to repair the deeper dermal tissues that have been affected by treatment, with increasingly beneficial results.

Dr. Bass adds his personal observations based on his extensive experiences with Fraxel:
Some patients experience almost no bronzing or flaking or only for 3 days or so. Others will notice a more pronounced presence of these findings. Necks in particular and very aggressive treatments may take 1-2 weeks to clear off.

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.

While it is generally recommended to wear sunscreen and minimize sun exposure, there doesn’t seem to be any great sensitivity to the sun or need for special precautions. For example, I routinely perform Fraxel Re;store all summer long, (except for the hyperpigmentation prone patient), whereas I suspend certain other laser treatments like Er:Yag for the summer months, explains Dr. Bass.

Summing It Up

I highly recommend that you educate yourself while considering a laser treatment. It will help you understand the terminology used during a consultation, enable you to ask more intelligent questions and partner with your doctor in a meaningful way. But my best advice, when considering any laser treatment is as follows:
Focus on the skill of the person administering the treatment. Know that a skilled doctor with lots of laser experience can produce excellent results with many different systems.

The fractional laser treatments we have been discussing above are non-ablative. To learn about the more aggressive fractional and field ablative laser treatments, and what you can expect from them in terms of downtime and results, click here.

I found an excellent video on the internet by NY Dermatologist Dr. Jarrod Frank, where he explains the difference between fractional non-ablative, fractional ablative and field ablative lasers (entire surface of a skin area), before going on to demonstrate treatment of stretch marks on one of his patients.
Watch this video.


To learn more about: Preparing for Laser Resurfacing, Benefits and Risks, Costs, and more, read this Web MD article.

© 2011, revised 2013 by Lois W. Stern

Lois W. Stern is the author of Sex, Lies and Cosmetic Surgery and Tick Tock, Stop the Clock ~ Getting Pretty on Your Lunch Hour as well as numerous magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients.

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