Fractional Resurfacing: New and Improved Laser Skin Resurfacing?
A new, less invasive process may deliver quicker healing.

Because of the high risk-benefit ratio of laser skin resurfacing, less invasive approaches for treating photoaging have been desirable. Nonablative rejuvenation has become very popular, as it involves little or no downtime, but the resulting improvement has been modest at best. Now, with the manufacturer's support, researchers have introduced fractional photothermolysis, a new concept in skin rejuvenation. These researchers used a 1.5-µm laser, at pulse durations of 1.5 to 5.0 msec and fluences of 1.5 to 3.0 J/cm2, to lay down arrays of very small spots with spacing of 250 µm, at densities of up to 6400 spots/cm2 in what the authors term microscopic treatment zones (MTZs). The researchers made as many as five passes over the forearms and periocular skin of 45 subjects and repeated the treatment three more times over 2 to 3 weeks.

Typical MTZs were 100 µm in diameter and penetrated 300 µm into skin. Re-epithelialization was complete within one day. Immediate histologic analysis revealed intact stratum corneum overlying a column of necrotic debris adjacent to a column of completely uninterrupted, untreated skin. Three months after treatment ended, rete ridges were enhanced; there was increased dermal mucin and measurable skin tightening. Clinically, wrinkling was modestly reduced.

Comment: Unlike CO2 laser skin resurfacing, in which ablated epidermis and high dermis and a semi- to full-thickness wound cause crusting, swelling, oozing, and erythema that last for 1 to 2 weeks, fractional resurfacing involves only some brawny erythema, and healing is a matter of days rather than weeks. The isolated, noncontiguous microthermal wounds are surrounded by zones of viable untreated tissue, which facilitates the quicker healing. The process requires topical anesthesia; the degree of pain is directly proportional to the density of the pulses and the number of passes. Considerable work remains to be done to determine efficacy, ideal candidates, and the optimal settings, number of passes, number of treatments, and intervals between treatments.

— Jeffrey S. Dover, MD, FRCPC
Published in Journal Watch Dermatology

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