Fractional photothermolysis has been a significant breakthrough in clinical laser science. Fractional lasers employ technology which splits the laser beam into hundreds of microbeams, creating patterns of thermal microscopic wounds that reach deep dermal depths. These small wounds allow a rapid healing response. This method of fractional skin resurfacing has led to clinical efficacy in aesthetic and scar treatments with high physician and patient satisfaction. Fractional lasers have a superior safety profile when compared with traditional resurfacing techniques.
Fractional laser devices may be either non-ablative or ablative. Non-ablative fractional resurfacing (NAFR) heats up the dermis from 50 to 100 °C; which induces collagen to undergo irreversible coagulation of proteins. Ablative fractional resurfacing (AFR) heats up the dermis to greater than 100 °C; causing vaporization of tissue within the immediate area surrounded by a thermal coagulation zone.
NAFR devices were introduced in 2004 with a better safety profile but decreased efficacy versus traditional resurfacing devices (Manstein et al., Lasers Surg Med 34:426–438, 2004). NAFR has become a popular worldwide procedure due to its effective epidermal and dermal rejuvenation, increased safety profile, decreased post-operative downtime, use on all anatomical areas, and wide spectrum of medical and aesthetic indications. NAFR can be used for mild-moderate rhytids, leukoderma, atrophic and hypertrophic scars and many other indications.
Despite the success of non-ablative fractional lasers there remained a need for more aggressive tissue ablation for the purposes of rejuvenation of severely photodamaged skin, deeper rhytids and severe scars. AFR devices entered the market in 2007 with improved efficacy over NAFR.
There are many fractional devices currently on the market. Many of these devices have distinct technological characteristics that maximize safety and efficacy. This chapter reviews and discusses fractional devices and fractional treatment pearls.
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Manstein DD, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426–38.PubMedCrossRefGoogle Scholar
Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drugs Dermatol. 2009;8:294–7.PubMedGoogle Scholar
Behroozan DS, Goldberg LH, Dai T, et al. Non-ablative fractional laser for the treatment of surgical scars: a case report. J Cosmet Laser Ther. 2006;8:35–8.PubMedCrossRefGoogle Scholar
Hantash BM, Bedi VP, Kapadia B, et al. In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med. 2007;39(2):96–107.PubMedCrossRefGoogle Scholar
Kunishige JH, Katz TM, Goldberg LH, Friedman PM. Fractional photothermolysis for the treatment of surgical scars. Dermatol Surg. 2010;36:538–41.PubMedCrossRefGoogle Scholar
Orringer JS. Molecular effects of fractionated carbon dioxide laser resurfacing: a quantitative comparison with traditional ablative laser resurfacing. Presented at: American Society for Dermatologic Surgery/American Society of Cosmetic Dermatology & Aesthetic Surgery Joint Annual Meeting, Chicago, 22 Oct 2010.Google Scholar
Chapas AM, Brightman L, Sukal S, et al. Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med. 2008;40(6):381–6.PubMedCrossRefGoogle Scholar
Kim HS, Lee JH, Park YM, Lee JY. Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: a pilot study. J Cosmet Laser Ther. 2012;14:89–93.PubMedCrossRefGoogle Scholar
Fife DJ, Fitzpatrick RE, Zachary CB. Complications of fractional CO2 laser resurfacing: four cases. Lasers Surg Med. 2009;41:179–84.PubMedCrossRefGoogle Scholar
Avram MM, Tope WD, Yu T, Szachowicz E, Nelson JS. Hypertrophic scarring of the neck following ablative fractional carbon dioxide resurfacing. Lasers Surg Med. 2009;41:185–8.PubMedCentralPubMedCrossRefGoogle Scholar
Mamelak AJ, et al. Eruptive keratoacanthomas on the legs after fractional photothermolysis: report of two cases. Dermatol Surg. 2009;35:513–8.PubMedCrossRefGoogle Scholar
Waibel JS, Ozog D, Mi Q. Laser assisted delivery of vitamin C, vitamin E and ferulic acid formula serum decreases fractional laser post-operative recovery by increased bFGF expression. In press.Google Scholar
Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45(3):135–40.PubMedCrossRefGoogle Scholar