Fractional Laser Resurfacing
 Fractional
resurfacing is an exciting new technology that fills a
unique niche in any skin care rejuvenation protocol. The
technology is similar to other technologies in the fact that
it heats the dermis and initiates a cause and response;
however, it has several unique features that offer distinct
advantages over other technologies.
It is best to conceptualize the methodology of this laser by
visualizing the pixels on a computer screen. Now consider
only a 1 cm2 section. In each square cm there is a defined
number of “microthermal heating zones”. The size and depth
of these cones are dependent on the energy utilized;
however, they are usually between 70 and 120 microns wide
with 100 to 200 microns between these zones. Again,
depending on the energy utilized, anywhere from 13 to 20% of
any area is treated, leaving 80-87% of the tissue untreated,
which is one of the very unique characteristics of this
treatment, and hence the name “fractional resurfacing”, as
only a fraction of the skin is resurfaced at any one time.
This allows rapid wound healing and a low chance of
complications. Most patients can return to work within 24
hours of the time of treatment. There is no break in these
microthermal zones, just pure heating, but there is a
central coagulant of epidermis called a MEND “micro
epidermal necrotic debris” that is shed over the next 2 to 3
weeks. The treated area is easily covered with makeup. On
males, the treated area may be a dusky brown appearance, but
the individual microthermal zones are so small that they
cannot be seen with the naked eye. Again, imagine a computer
screen, and they are only seen when zoomed in to extremely
high power. (See Fig.1)
EXPECTATIONS:
The
technology is designed for fine-to-moderate wrinkling, brown
dyspigmentation (dyschromia), and may even yield a mild
improvement in redness, although that is not its original
design.
INDICATIONS:
The main
advantage of this treatment is that it usually gives 20 to
40% of the improvement in wrinkle reduction of a CO2 or
Erbium laser resurfacing with much more limited down side
and no open wound. It has a theoretical, but unproven, lower
incidence of complication, such as hypopigmentation and
scarring. Although post inflammatory hyperpigmentation still
would be a distinct possibility, we have not seen it in our
practice to date.
The target is
water, so skin type is not a significant factor, and
therefore can be used on all skin colors. Therefore, the
indications are for anyone who does not want the down time
of standard laser resurfacing and will accept mild
improvement in wrinkle reduction and significant improvement
of dyschromia and texture on the face.
It cannot be
overemphasized that Fraxel offers patients a unique
treatment for neck and chest, arms and hand aging. Standard
laser resurfacing which is an excellent treatment for
wrinkling and aging on the face is not an option on the
neck, chest, arms, and hands due to the high morbidity and
high risk of scarring in these areas. These complications
are extremely rare with fractional resurfacing due to its
unique, advanced technology. Other modalities, such as
intense pulse light can be used in these areas to help and
aid with brown spots and red discoloration; however,
fractional resurfacing holds the unique place of being able
to more adequately treat the fine wrinkling and crepiness
that so many women complain about. The risk with any thermal
injury is blistering, hyper and hypopigmentation and
scarring. We have noticed blistering in only one patient in
our series. This was on the back of the hands and it healed
uneventfully, although with some prolonged erythema lasting
as long as a week. This was under normal setting and the
patient was known to have very sensitive skin. No long-term
sequelea or complication has occurred in this patient. All
of these risks are discussed with our patients. We simply
state that they are expected to be lower, but no long-term
studies have been done with this device as yet, and the
patients enters into this therapy with a clear understanding
of this issue early on in the process.
Another
unique role of fractional resurfacing is in patients who
desire treatment for wrinkles in areas previously treated by
electrolysis. Electrolysis destroys the hair follicles and
glands, which are critical to rapid uneventful healing in
cases of standard laser resurfacing. (This is the reason the
neck, chest, arms, and hands are danger zones for standard
resurfacing due to a natural paucity of glands in theses
areas). However, with fractional resurfacing at least 80% of
the skin is untouched; therefore, the areas treated can be
healed from the remaining normal skin and as a result, does
not need this glandular and follicular healing.
TREATMENT:
 Treatment
consists of skin preparation of exfoliation with either
cleanser provided by the company or a gentle
microdermabrasion. A blue dye is then applied to the skin.
This blue dye is a key safety feature in that an optical
mouse in the hand piece will not allow the laser to fire
unless seen in contrast with the blue dye. This blue due is
placed over the areas to be treated and the laser will not
fire in areas where the blue dye is not present.
After the dye
is applied, 23%Tetracaine combined with 7% lidocaine is
utilized in our office. This is left in place for 1-1/4
hours. Use of Valium and/or Vicodin is rarely necessary now
that the treatment is performed under air cooling and the
very effective topical anesthetic mixture. In patients that
require any oral sedation, they must be driven home. The
patient is treated in our office by a trained, delegated
assistant (R.N., P.A., N.P.). Meticulous technique with 50%
overlap is utilized to create adequate coverage. We choose
to delegate this treatment to two highly trained personnel
that dedicate the majority of their day to these treatments.
The device can test for accuracy of treatment and our RN’s
tested as accurate as anyone in the country and are utilized
in teaching the technique to new users. We are very proud of
this fact and we feel it shows our commitment to the fine
details so necessary to offer the best and safest of care to
our patients.
Post
operatively the blue dye is washed off the face. This is
slightly more difficult in patients with acne and those with
beards. The dye is water-based and will come off with soap
and water, although a prolonged scrub is sometimes
necessary. Post treatment the patient feels as though they
have experienced a moderate to severe sunburn. This is
greatly alleviated by Solarcaine Aloe Gel and ice. Most of
our patients can go out that evening; however, there is some
swelling and some erythema that varies from 1 to as long as
4 to 5 days in some rare instances. However, all of our
patients, even with swelling, have been able to go through
most of their normal daily routines, which is the advantage
of this particular therapy. Treatments are usually repeated
every two week, but we feel must be repeated 4 to 5 times
for optimal results. One can certainly wait longer between
treatments if needed. Although our patients can see results
early in the first few weeks, the final results are not
appreciated for 6 months after the last treatment since
collagen remodeling is underway.
SUMMARY:
The
advantages of this technology is that it opens up a new
option for patients who want the neck, chest, arms, and
hands treated, and for those who would like something more
aggressive than intense pulse light or chromophore
treatment, but they do not want the down time of aggressive
laser resurfacing. The best candidates are those who prefer
the more minimal down time and accept a less aggressive
result than laser resurfacing. The downside is that although
it does not require general anesthesia, in some patients for
those requiring sedation, it does require someone to drive
them home, and they are at our office several hours with pre
and post treatment regimens described above. Also, there is
some variable discomfort with the treatments. We have found
them to be very well tolerated with the regimen described
above, especially with the use of air cooling. The use of
cooling now makes the use of Valium or Vicodin almost non
existent.
Our patients
have received this treatment very enthusiastically and are
quite satisfied with the results. This treatment has frankly
“sold itself”. Patients and their friends can clearly see
the improvements and the success spreads quickly by word of
mouth. We are very pleased to offer this unique, new, and
exciting treatment to our patients.
COST:
Face - $1000 per treatment x 3 - subsequent $500
Partial Area - $350 each area
Neck - $1000 x 3 - to subsequent $500
Chest - $1000 per treatment x 3 - subsequent $500
Neck/Chest - $1500 x 3-subsequent $750
Hands - $500 x 3
Forearms - $1300 x 3 - $650 subsequent
Forearms and Hands - $1600 x 3 - $800 subsequent
This skin care
treatment, as well as other highly effective treatments are
available at the Dallas Medical Skin Care Center. Let us
make an appointment to evaluate you and advise you on the most
effective solution available. |
