Excellent results without significant adverse effects or downtime

Fractional photothermolysis, a new nonablative laser therapy for photodamage and other skin conditions, offers many benefits of ablative lasers while avoiding their drawbacks. Ablative lasers such as the CO2 and Erbium:YAG produce the greatest improvements in sun-damaged skin, but their use is limited by significant adverse effects, including posttreatment edema, burning, and erythema that can last for 4 to 5 months, says UAB cosmetic dermatologist Marian E. Northington, MD.

“Fractional photothermolysis delivered by the Fraxel™ laser is safe for nonfacial skin, including delicate areas such as the neck and chest, and for people with ethnic skin, who are at risk for hyperpigmentation and scarring with other modalities,” says Northington, who trained with the physician who helped develop the Fraxel laser.

Resurfacing the Skin
To induce collagen remodeling, ablative lasers strip away the epidermis and some layers of the dermis, leaving skin red and extremely vulnerable to sun. The Fraxel laser, which keeps the outermost layer of the epidermis intact, creates an array of microscopic thermal wounds, called microscopic treatment zones, at specific depths. Unlike other ablative and nonablative lasers, which produce layers of thermal heating, the Fraxel laser creates microscopic columns of thermal damage, sparing surrounding tissues and promoting more rapid healing.

The laser treats about 20% of the skin during each session. “To achieve optimal results, patients typically need 4 treatments, spaced 2 to 4 weeks apart. Collagen remodeling and subsequent improvements in skin texture and appearance continue for several months after the last treatment,” says Northington, who frequently follows laser treatments with Retin-A formulations that augment collagen remodeling and skin turnover. Results are excellent, she says, removing lentigines and other discolorations and producing fresher, tighter, and more youthful skin with little to no downtime.

Patients can apply makeup immediately after a session and while most experience redness equivalent to a sunburn, this typically fades within 4 days. Mild edema is normal and resolves within 2 to 3 days. Patients also may notice bronzing, which can last for several weeks, flaking, and superficial scratches, but individuals tolerate treatments well. Results are lasting and removal of precancerous lesions helps stave off development of skin malignancies.

The Fraxel laser is Food and Drug Administration-approved for treating pigmented lesions, periorbital rhytides, skin resurfacing, soft tissue coagulation, and melasma. The brown facial patches of melasma often affect people with darker skin, for whom other types of lasers are not appropriate.

“The laser is excellent for fine-to-moderate facial wrinkles, but is not as effective as ablative lasers for deeper lines, such as those that often develop around the mouth,” she says. In nonfacial areas the laser safely and effectively treats dyschromia and fine lines as well as mild laxity and minor atrophic and hypertrophic scars.

“Fractional photothermolysis resurfaces the skin with minimal risk and damage,” says Northington, who also performs sclerotherapy and liposculpture and offers Botox injections and an array of soft tissue fillers.

For more information
Dr. Marian Northington
1.800.UAB.MIST
mist@uabmc.edu