Fractional Laser Resurfacing

The use of lasers to treat facial problems is a relatively new procedure. Many different lasers have been, and are being developed to treat specific conditions. They can be roughly grouped into two categories depending on their wavelength, i.e. ones that target specific types of cells, like hemoglobin in blood vessels (pulse dye laser) and those that are ablative, that just vaporize everything they are focused at, like the erbium and carbon dioxide lasers (CO2).

The latter are the type primarily used in facial rejuvenation. The depth and extent of vaporization is controlled by various modalities, like the length of time that the laser is focused on an area, the size of the spot that comes out of the laser machine as well as the laser’s power setting and frequency of the pulses emitted. The smaller the spot size, the lower the power output and the longer it is focused on an area as well as how many times it is passed over the same area determines the amount of surface tissue it will remove and damage to the surrounding tissues it will cause.

Essentially, a burn is produced which may be superficial (1st degree) down to a deep or 3rd degree. The depth of the burn will determine how long it will take to heal. A superficial ablation or burn of the skin surface by the laser will produce some redness or inflammation and take a few days to go away. The deeper 2nd degree level will cause some blistering, scabbing as well as redness (inflammation), which should still heal within a two-week period. The latter though may persist for several months until it heals. If the depth of penetration of the laser causes a 3rd degree burn, then scarring would result.

Facial resurfacing with the CO2 laser became extremely popular because it was very effective in rejuvenating the skin, helping to reverse primarily the textural changes associated with aging, sun damage, and smoking. This laser almost totally replaced dermabrasion in the treatment of acne scarring. When properly used, the complications were minimal, but used incorrectly could be disastrous creating extensive scarring. The side effects, such as prolonged redness (average of four months with limited sun-exposure) and difference in coloring from treated and non-treated areas became more troublesome.

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