Laser: Fractional

What is fractional laser treatment?

Fractional resurfacing is just as it sounds, affecting only a small portion of the total surface (ranging anywhere from 15 to 25%) of the treated skin with any one treatment. Fractional resurfacing is used to improve overall skin color, tone and texture, and is especially useful for people who have brown discoloration from sun-induced freckling and who also wish to improve texture at the same time. The Fraxel laser employs fractional resurfacing, and is also one of the best treatment options available for acne scars.

Before fractional laser treatmentAfter fractional laser treatment

            Before                             After

Patients require between four to six treatments to attain desired results. Treatments are performed no more often than once every 7-10 days, but in most cases they are done 4 to 6 weeks apart. After arriving for the procedure, a topical anesthetic gel is applied to the treatment area and allowed to sit for an hour. After the topical anesthesia has had time to work, a blue dye is applied to the treatment area. More anesthetic gel is then applied, and the laser treatment is performed.

In addition to the anesthetic gel, we also use a device called the Zimmer Cooler (a hand-held cool air device), which chills the skin and makes the procedure even more comfortable.

After the procedure, the blue dye is washed off. There may be some slight stinging of the skin for about one hour following the procedure. Ice can be applied to reduce any discomfort. There is some redness and swelling following the procedure, which lasts an average of two to four days, and can be covered with makeup within a day or two. The entire visit lasts about 2 hours.

What is it used to treat?

Fractional photothermolysis is used for the treatment known as skin rejuvenation/resurfacing, which includes; the reduction and possible removal of fine lines and wrinkles, improvement of deeper wrinkles, repair of sun damaged skin on the face, neck, shoulders and hands, the reduction of age spots and blemishes, acne scars and hyperpigmentation (areas of darker pigment or brown patches in the skin).

The Fraxel™ SR Laser, for example, has been awarded clearance by the American Food and Drug Administration (FDA) for dermatological procedures requiring soft tissue coagulation; for the correction of peri-orbital wrinkles (crow’s feet), acne scarring and pigmented lesions, including age spots, sun spots and skin discolouration; for skin resurfacing and for the treatment of melasma, (dark skin colouration which forms on sun exposed skin – often affects women during pregnancy).

What happens before the procedure?

Careful discussions regarding your reasons for wanting treatment are very important before you begin the treatment. You must also make sure that this treatment can deliver what you want and how you would like to look afterwards. Your practitioner should be able to answer all these questions.

A medical history should also be taken to make sure that there are no reasons why you shouldn’t undertake treatment. You may be asked to read detailed information and sign a consent form which means that you have understood the potential benefits and risks associated with the procedure.

Photographs may also be taken by the practitioner for a "before and after" comparison at a later date.

What happens during the procedure?

The way that the procedure is performed and the preparations involved will depend on the specific device that the practitioner is using. The type of device used will have a bearing on the need for contact gels, cooling systems, optical dyes, topical anaesthetics etc. As an illustration we will describe the process involved with treatment using the Fraxel™ SR laser.

The skin is first cleansed and then a blue tinted solution is applied to the treatment area. Topical local anaesthesia may also be applied to increase patient comfort during the procedure, and a chilled air device may also be available.

The blue tint, available under the brand name OptiGuide™ Blue is water soluble, and when applied to the skin highlights the contours of the skin’s surface, allowing the machine to precisely read the discreet contours of the treatment area and adjust its output accordingly.

The laser treatment head is then passed over the surface of the treatment area in a series of horizontal and vertical overlapping passes, until an erythema or mild redness is noted in the skin by the practitioner.

The blue tint and anaesthetic are washed off immediately after treatment. You may find you still retain a blue tinge in some pores and blemishes for a few days, although this can be covered with make-up.

A typical treatment of the face will take approximately 20-25 minutes.

How many treatments are needed?

Unlike with ablative laser resurfacing, where one treatment is usually enough; multiple treatment sessions are required with fractional resurfacing to obtain optimal results.

According to the manufacturers of the Fraxel™ machine, clinical studies suggest that in general 3 - 5 treatments spaced about 5 to 7 days apart produce a gradual remodelling of the skin, until complete healing occurs; when old tissue is replaced with fresh collagen and elastin filled tissue.

The number of treatment sessions required depends upon the individual patient and the condition undergoing treatment; your practitioner will be able to create an appropriate treatment regime for you.

How much recovery time is needed?

Most patients will be able to return to work immediately following this type of procedure.

Due to the way the laser treats the skin, it remains relatively strong, therefore any redness can be camouflaged with make-up straight away without any ill effects; and men are also able to shave almost immediately after the treatment.

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Images courtesy of Gerald Goldberg, M.D.

© 2010 Vivacare.
Last updated February 12, 2009

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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