What is fractional? To be treatment?
Fractional laser treatment is a noinvader Treatment using a device to deliver a laser beam divided into thousands of microscopic treatment areas that target a fraction of the skin at a time, analogous to a pixel-by-pixel enhanced or altered photographic image.
Fractional laser treatment has narrowed the gap between ablative and non-ablative laser techniques used to treat sun damaged and aging skin. While ablative laser treatments work primarily on epidermis (superficial skin cells) and non-ablative treatments work only on dermal collagen (middle layer of skin) only, fractional laser treatment works on both epidermal and dermal layers of the skin.
The first commercially available fractional laser was the Fraxel® [Reliant Technologies now Solta] device, which emits a non-ablative wavelength of 1550 nm. There are now a few machines available that use fractional, erbium-based technology: YAG lasers for surface treatments and CO2 lasers for deeper ablative treatments (eg Fraxel repair [Solta Medical], active and deep FX [Lumenis], Quadralase [Candela] and fractional pearl [Cutera])
What is fractional laser treatment used for?
Fractional laser treatment is used to treat:
Facial lines and wrinkles (rhytids)
- sun damage
Skin pigmentation associate with photoaging
- Surgical and acne scars.
Although fractional laser treatment has been recommended in the treatment of pigmentation disorders such as melasma, the treatment itself can lead to post-inflammatory pigmentation.
Fractional laser treatment can be used anywhere on the body, but is particularly useful on the neck, chest, and hands compared to traditional ablative modalities.
Fractional laser treatment may also be beneficial for poikiloderma Civatte and stretch marks.
Fractional laser treatment can be used on all skin types and patients, but the techniques vary depending on the patient's age, skin type, sun exposure, and body location. Fractional laser treatment can be combined with surgery and other skin treatments.
How does fractional laser treatment work?
Understanding how fractional laser treatment works requires a basic understanding of the skin's structure. In summary, the skin consists of 3 layers, the epidermis (upper layer), dermis (middle layer) and subcutis (lower layer of fat). The epidermis contains pigmentthey produce cells called melanocytes, which are responsible for the coloration of the skin. The dermis is made of collagen and elastin fibers that provide the skin with strength, toughness, elasticity and flexibility (click here for detailed information on skin structure).
As the body ages, the appearance and characteristics of the skin change. The epidermis becomes thinner, so blemishes become more visible and collagen in the dermis is gradually lost, contributing to the formation of facial lines, sagging skin, and wrinkles.
Fractional laser treatment works by targeting both the epidermis and the dermis. It does this by delivering a laser beam that splits into thousands of small but deep treatment columns on the skin. These are called microthermal treatment zones (MTZ). Inside every ancient epidermal MTZ pigmented the cells are expelled and the penetration of collagen into the dermis causes a reaction that leads to the remodeling of the collagen and the formation of new collagen. When using MTZ, the laser is targeted and intensively treated within the area, while the surrounding healthy tissue remains intact and unaffected and helps the wound heal. This fractional treatment results in a faster healing process than if all the tissue in the treatment area were exposed to the laser.
What does fractional laser treatment involve?
The following is a summary of the Fraxel® procedure:
Evaluation / pre-treatment preparation
- Define problem areas and adapt a treatment pattern to focus the areas for correction.
- Take pretreatment pictures.
- Pretreatment with whitening cream (eg, hydroquinone) or chemical peel may be necessary for patients with dark skin or pigmentation problems.
- Consider acyclovir or valacyclovir prophylaxis against herpes simplex infections (cold sores)
- The patient needs to remove all jewelry and makeup. Wash your face with soap and water before treatment.
- A anesthetic the cream is applied to the treatment area. The anesthetic takes between 45 and 60 minutes to take effect.
- Anesthetic cream is removed and glides gel it is then applied to the treatment area, which helps the laser establish a uniform MTZ dot pattern.
Fractional laser application
- The sliding gel acts as a contact lubricant for the robotic handpiece that glides across the surface of the skin.
- The treatment time will depend on the areas to be treated, but a full face will take around 30 minutes.
- The pain associated with the procedure is dependent in the energy delivered to the treatment site. It is essential that the strong anesthetic cream provided with the Fraxel laser is used.
- A cooling device, called the Zimmer ™ machine, is used to reduce discomfort during the procedure.
Post-treatment and recovery
- The sliding gel is washed after treatment.
- Patients may experience a slight sensation of sunburn for about an hour after the procedure.
- Swelling is usually minimal and should resolve in 2 to 3 days.
- The skin will be pink for 3 to 5 days.
- Within 24 hours a new epidermal skin develops and the skin will have a bronze appearance that can last from 3 to 14 days. Skin peeling can also occur as new skin replaces dead skin tissue, which can be treated with a moisturizer.
- Skin exfoliation can be pronounced after ablative therapy when the skin should be gently removed with running water, petroleum jelly, and gauze once or twice a day.
- During the healing phase and for several months after treatment, it is recommended to protect the treatment area with a moisturizing sunscreen with an SPF of at least 50+. Protective clothing and wide-brimmed hats should also be worn to protect the skin from sun exposure.
Four to five treatments with Fraxel® are required, depending on the energy level used and the condition of the treated skin. These are spaced a month apart. Results are not immediate and are slow. progressive, with an optimal improvement visible over a period of three to four months. This time frame and treatment regimen allows for complete healing and replacement of damaged tissue with new collagen and elastin, and healthy and viable growth of skin cells.
Ablative fractional rejuvenation lasers are more aggressive than non-ablative devices, so recovery takes a little longer.
What are the side effects and complications of fractional laser treatment?
Fractional laser treatment appears to be well tolerated by most patients. Shaving or applying mineral makeup can be done soon after treatment. In most cases, patients can return to work directly after treatments or the next day, depending on the condition and skin treatment.
Some of the side effects and complications that can occur after aggressive or ablative fractional laser treatments, particularly on the skin of the neck, include:
- Excessive peeling (climbing, peeling) and some crust
- Swelling for up to a week after treatment: This can be helped by applying an ice pack at 10 minute intervals for the first 24 hours.
Post-inflammatory pigmentation: occurs more frequently in patients with a history of melasma or post-inflammatory. hyperpigmentation (more common in dark skinned patients)
- Acneform rashesHerpes Simplex bacterial and candida infections
- Contact dermatitis