Ablative Fractional and Field Lasers


Lois W. Stern

A Short History of Ablative Resurfacing Field Lasers:

Unlike the fractional lasers detailed in Lasers - Part 1, the ablative resurfacing field lasers treat the entire field in which wrinkles or damaged skin is contained.

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 the pros and cons of these devices:

These field ablative lasers are used less frequently than even a decade ago, but still are a useful option for patients with pronounced wrinkling or in need of skin tightening, which I believe does not occur in a sigmificant degree with the fractional treatments.

The era of ablative resurfacing lasers began with Carbon Dioxide lasers (CO2), which worked by vaporizing wrinkles and/or acne scars, while evening out hills and valleys on the surface of the skin. Old, damaged tissue was removed while new tissue remodeled. In other words, as these laser wounds began to heal, they stimulated the growth of new collagen. Clinical studies were excellent and surgeons found that these CO2 lasers provided more precision in depth control than the earlier method of chemical peels.

The down side to these lasers is their lengthy recovery for the patient, who is left with a raw surface that heals slowly over a period of 10-14 days. Additionally, the skin remains red for 3-6 months or longer. The CO2 is normally not recommended for darker skinned people or suntanned complexions as these people are at high risk for pigment disturbances
, (lightened or darkened patches on the skin).

There are two other ablative field lasers that you might hear about: the Erbium YAG and the Pearl, which generally are a bit less aggressive than the Carbon Dioxide lasers (CO2), with a somewhat shorter healing time, with a trade off of generally a little less improvement. Surgeons sometimes resurface the skin with one of these systems while doing a facelift or eyelift, as the patient can heal from the resurfacing while recovering from surgery. But today, stand alone treatments with field ablatives have largely been replaced by fractional lasers.

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 in PART 1 of A NEW BREED OF LASERS IN COSMETIC SURGERY.

Understanding the Anatomy of Our Skin:

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.

What About Results?
Dr. Bass explains further:

All of the major Fractional Ablative Lasers systems out there (Fraxel Re:Pair, Lumenis Deep FX, Palomar Lux 2940, Sciton Profractional) are showing excellent skin smoothing and wrinkle reduction results, with some skin tightening. Yet generally results are less dramatic than with ablative field treatments, but moderately better than with nonablative fractional treatments.

Conversely, Dr. Bass further notes that acne scars may do better with non-ablative fractional treatments which go deeper in the skin than most ablatives.

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
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.

Summing It Up

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. Yet because these systems are still quite new, there is not a lot of long term follow-up, careful quantification of degree or durability of improvement or comparative data between the systems. My best advice remains the same as that which I expressed at the end of Lasers- Part 1:

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. When considering any laser resurfacing, focus on the skill of the person administering the treatment. Know that a skilled practitioner with lots of laser experience can produce excellent results with many different systems.

(c) 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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