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[F558]Fractional Laser Skin Resurfacing

by Dr. Franziska Ringpfeil MD., Dr.

Abstract
Are you confused by all the different options you hear about making your skin look younger? Non-surgical skin rejuvenation, laser skin resurfacing, wrinkle treatment, fillers, face lift, and skin tightening are common approaches for improving the look of your skin. Among these options, laser skin resurfacing is the most effective, non or semi-invasive surgical approach to achieve drastic results. A multitude of technologies for skin resurfacing is currently available. They include carbon dioxide lasers, erbium lasers, plasma and radiofrequency devices delivering their results in a fractional, ablative or non-ablative manner. This review will help you understand the different skin resurfacing options and determine which one fits you best. You will learn about the different treatments, looking side by side at each attribute of skin resurfacing - expected results, social downtime, number of treatments needed, time results last, and cost.

Skin Resurfacing - Introduction

Maintaining beauty and a youthful appearance date back several thousand years to the ancient Egyptian. However, the advances in technology have never before awarded such a choice of modalities. Non-surgical skin rejuvenation, laser skin resurfacing, wrinkle treatment, fillers, face lift, and skin tightening are common approaches for improving the look of your skin. Particularly, the introduction of a multitude of skin resurfacing devices has caused a lot of confusion amongst consumers. Among these options, laser skin resurfacing is the most effective non or semi-invasive surgical approach to achieve drastic results.

First of all you must know that every new resurfacing laser or device is measured against the industry's most powerful machine for the past 40 years, the carbon dioxide (CO2) laser. It was invented in 1964 and has been the most widely used laser in medicine. In the area of dermatology, its use has been predominantly for facial resurfacing. It often achieves desired results in a single treatment, works on fine and intermediate lines and acne scars, maximally tightens the skin and delivers results that last a number of years. Its drawback is a long, 10-14 day social downtime, making it less desirable for any working person. To overcome this handicap and minimize healing time, many devices that do not injure the uppermost layers of the skin (non-ablative) have recently been developed by the aesthetic industry. The single most important advance was the creation of fractional technology. Leaving small islands of normal skin behind, the skin regenerates much faster than with the traditional full ablation of skin.

You will learn about the current industry recognized ablative and non-ablative strategies that rejuvenate your skin and about the benefits and downsides of each of these techniques.

Fractionated Ablative Lasers

CO2 Laser

As an ablative laser, it vaporizes the tissue and is able to eradicate fine and intermediate lines, smoothes overall skin texture and acne scars, eradicates uneven pigmentation as well as tightens the skin. It lets you appear about 10 years younger and often replaces the need for a face lift unless skin sagging is severe. Preparation and postoperative care most closely resembles a full fletched surgical procedure, however, CO2 laser resurfacing can be performed under local anesthesia. The price you pay for the results is one to two weeks of social downtime while the skin reepithelializes. In addition, the resurfaced skin may appear pinkish for several months thereafter.

Fractional CO2 Laser - ActiveFX(TM), DeepFX(TM), Fraxel re;pair(TM), Mosaic eCO2

Since the beginning of 2007, refined systems with partial degrees of ablation that leave small islands of normal skin from which the skin can regenerate much faster, have revolutionized the resurfacing market. Amongst these, the combination of DeepFx and ActiveFx, manufactured by the leader in CO2 technology (Lumenis) give results that most closely compare to the traditional laser resurfacing. This new technology offers faster healing times with still excellent results. In the meantime, a number of laser companies have now developed their own permutations of a fractionated CO2 laser and names include Fraxel re:Pair, Slim MIxto/SX, Exelo 2, Mosaic.

Erbium YAG Lasers

The traditional erbium laser has produced results that were absolutely comparable to the CO2 laser yet it fell out of favor because of significant post operative bleeding. As with the fractional method developed for the CO2 laser, today's erbium laser treatments are almost exclusively fractionated and may also be called pixelated. Names that you may read about are Pearl, Pixel, ProFractional and Starlux 2940. However, with the exception of the Pearl, these do not deliver results that mirror the original. While downtime is typically limited to 1-4 days, the downfall of most of the fractionated erbium technology is the very superficial nature of the resurfacing results, being excellent at improving sun damage, and skin texture, but will target only the finest lines. They are considered more like an aggressive peel. Several treatments are often necessary to achieve such results. These fractionated lasers do not significantly contribute to skin tightening, removal of wrinkles, let alone acne scars.

Non Ablative Fractional Lasers

Protecting the epidermis, the upper most layer of our skin, and thereby minimizing social downtime, non-ablative lasers deliver energy in the lower layers of skin, ideally only causing swelling which is socially much more tolerable than oozing. Amongst the non-ablative lasers, FRAXEL is the most marketed. Other brands include Affirm, StarLux-Lux, Mosaic.

Using a wave length lower than that of a CO2 laser, these lasers drive energy into the skin, stimulating collagen production and thereby tightening skin. Results after a single treatment are minimal and it can easily take 4-8 treatments to observe an effect. While its effects on wrinkles and lines after 4-8 treatments is fairly close to the results of a single CO2 laser treatment, it does not seem to deliver on scars as well. In addition, the Fraxel has been FDA approved for the treatment of melasma, also known as the mask of pregnancy, which shows as symmetric pigmentation on the face as a result of sun exposure with increased estrogen levels.

Non-Laser Fractionated Resurfacing Devices

Plasma and radiofrequency devices belong to this category. Because of the more convincing results, plasma technology will be discussed here. The plasma device is not based on laser principle. Plasma is pushed into the skin to induce partial ablation of the epidermis and renewal of collagen beneath the surface of the skin. Treatments can be delivered in 1-2 aggressive sessions, results mimicking nearly those of fractionated CO2 laser resurfacing. When energy levels are minimized to allow for as a little as a few-hour lasting redness, several treatments will be needed for an effect. With the latter technique however, results tend to be much less dramatic. Having gained FDA approval in the second half of 2007, the technology is fairly new and long term results are not known yet.

Skin Resurfacing - Summary

In sum, many exciting technologies are available nowadays. The general rule of little downtime little results still applies. Non-ablative technology seldom achieves noticeable results in a single treatment and the overall outcome even after several treatments is often below expectations. Ablative devices appear to deliver best, require only a small number of treatments results and social downtime can effectively be lowered by the uses of fractional technology. Ultimately, your goals, your ability to tolerate social downtime and your wallet will steer you and your treating physician to a resurfacing plan that is tailored to you.

Lasers work by removing the outer layer of skin, which includes thickened and dead skin layers. Following this, the laser light causes restructuring of collagen in the dermis, or deeper layer of the skin. The overall effect is a tightening of the skin, with a smoothening out of fine wrinkles and other skin surface irregularities.

It is important to understand that each face is different with regard to skin color, texture, and degree of wrinkling, and choosing the best resurfacing option can make a difference. Laser resurfacing has not eliminated other methods such as chemical peels and dermabrasion, which continue to play a role in skin resurfacing, but in many cases the laser has proven to be a superior tool.

Patients with deep, static wrinkles, moderate to severe acne scars, or deep hyperpigmentation will generally require deep skin resurfacing. This procedure may involve intravenous sedation anesthesia for patient comfort, or infiltration of local anesthetic (numbing medicine) into the treatment areas. Recovery time for a deep laser peel is generally 7-10 days.

Laser resurfacing is generally less uncomfortable than a deep chemical peel, and patients usually have minimal pain after the first twenty-four hours.

Over the first week, it is normal to experience crusting and redness as the outer skin layers become separated and are replaced by new skin. Following this, the skin appears somewhat pink and sensitive for several weeks, however most patients can resume applying makeup at 7-10 days if desired

YAG laser uses light of a 2940 nm wavelength which is readily absorbed by water in our cells. It treats light-skinned to moderately dark or olive-skinned patients with little to no risk of hypopigmentation (permanent skin lightening) and very little risk of hyperpigmentation (darkening of skin) or scarring in experienced hands. This laser can achieve dramatic results which compare with CO2 laser in many cases.

CO2 laser resurfacing has long been considered a "gold standard" in deep laser resurfacing, due to the impressive nature of results obtained. It uses a 10,600nm infrared beam which is also well-absorbed by water in our cells. Newer CO2 laser "scanning" technology has significantly lowered the risks of adverse effects such as hypopigmentation, or skin lightening. The CO2 laser generally suits patients with fair to average complexions, although new "fractionated" technology allows the laser to be used for most skin types.

Active FX (utilizing CO2 technology) and Micro Laser Peel (utilizing Erbium: YAG technology) offer two options for effective superficial skin resurfacing. Superficial resurfacing is generally performed with only a topical numbing cream, and patients can drive themselves home. Recovery time is generally between one to seven days only, with no lingering "pinkness."

Chemical peels are a skin resurfacing option, and include light, medium, and deep peels. The peel works by removing the outer layer of skin, and causing changes in the deeper layer (including new collagen formation) that may actually tighten the skin. Medium and deep peels under local anesthesia or mild to deep sedation. Medium depth (TCA-Jessner) peels are excellent for fine wrinkles and splotchy skin changes, and deep peels (phenol) can produce dramatic improvement in deeper wrinkles. A new layer of skin develops in 5-7 days, and makeup can usually be applied in 10-14 days.

Article Source : Laser Surgery

About Author

Both Dr. Franziska Ringpfeil MD. & Dave Stringham are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Dr. Franziska Ringpfeil MD. has sinced written about articles on various topics from Beauty Procedure. Dr. Ringpfeil's medical career began in Germany where she graduated from medical school and started training in dermatology. In 1990, she was invited to join Thomas Jefferson University. After completing residency and receiving board certification,. Dr. Franziska Ringpfeil MD.'s top article generates over 1300 views. to your Favourites.

Dave Stringham has sinced written about articles on various topics from Tummy Tucks Before and After, Health and Breast Enlargements. LookingYourBest.com an online resource for . Learn more about and cosmetic surger. Dave Stringham's top article generates over 368000 views. to your Favourites.