How do Fractional Laser Treatments work?

There seems to be a million kinds of fractional lasers out there,  how do they work?

Doctor Answers 2

Fractional resurfaing comparison

Fractional resurfacing uses the same concept of partial skin treatment to induce complete skin remodelling, but the systems can be very different. Most people describe fractional resurfacing (FR) like aerating a lawn, where vertical channels are punched into the skin. As the skin heals from that treatment, adjacent non treated skin still improves but also speeds recovery. this analogy gives you an idea of the variables. The channels can be wider, deeper, more dense, or be ringed by a zone of controlled damage that influences healing. Plus the energy source used to create the microchannels also vary, from erbium lasers to CO2 lasers to radiofrequency units to others. It's an area of active research, so the best system is debatable. What is clear is that FR is less painful, easier to recover, safer, and can be applied to the same regions as conventional resurfacing.

My unit is Sciton's erbium laser (profractional), which is a few generations of improvement from the first "fraxel" units. It's precise in it's treatment, and allows a great deal of option to the surgeon. The company has made one of the gold standard erbium lasers for years. But it is just one solid unit among many.

The catch is you need to know that each laser company (and therefore the doc that has the respective laser) will tell you theirs is the best. Not true. And unfortunately the treatment numbers one laser requires for a treatment don't always compare to another laser, so it's almost impossible to compare lasers apples to apples. So when you consult with your physician (please find a core physician in derm, facial plastics, plastics, or oculoplastics), realize that more aggressive treatments are required for more significant results. And that we are still giving up something for total correction because we are trying to make the treatments easier to tolerate.

Two last things worth mentioning. You have to be on a solid skin care regimen to get reasonable results from FR. We use retin-A and obagi, but others will do. Both before and after treatment. And two, you need to expect multiple treatments. I have tried to push the power settings up to keep the treatment to one, but it still seems to require more.

Madison Facial Plastic Surgeon
4.5 out of 5 stars 10 reviews

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Fractionated lasers

Good question. The answer is no, they are not all the same. The main differences lie in the results and surrounding thermal injury. The perfect laser does not yet exist. CO2 gives a dramatic result but causes more thermal injury. Erbium gives a less dramatic result (which is why I like to do multiple passes depending on the area) but also causes less thermal damage.

Your plastic surgeon can discuss all of the treatments during an examination.

Good luck!

Jacob Freiman, MD, FACS
Miami Beach Plastic Surgeon
4.5 out of 5 stars 147 reviews
