While fractional lasers appear to be offering some of the best results currently in treating signs of aging in the skin and reducing the downtime associated with the procedures, work is continuing on ways to optimize the results that can be obtained. Varying wavelengths and depths as well as combining the laser treatments with retinoids are providing doctors better answers for their patients.
Dr. Tanghetti says that cosmetic dermatologists are looking at new ways to wound the skin, and in the wounding, to create the opportunity for skin to repair and rejuvenate itself.
"The advantage of the fractional-type devices is that they can wound the skin in a way that is not as ablative, and which allow much less downtime associated with the treatments," Dr. Tanghetti tells Dermatology Times.
"They do a little bit of ablation, a little bit of damage, if you will, and as the damage is repaired, it leads to new collagen development and replaces some of the damaged tissue," he says.
Dr. Tanghetti, manager of the Center for Dermatology and Laser Surgery, says retinoids complement that process.
"I use the retinoids all the time with the fractional lasers, because the retinoids enhance repair, in my opinion. They even enhanced repair for more ablative lasers such as the CO2 laser, whether it's used with hydroquinone for melasma or for photo-aging," he says.
Before the development of the fractionated lasers, Dr. Tanghetti says the CO2 laser was a primary laser of choice for anti-aging treatments.
"The issues with the CO2 laser included longer downtime, and, probably the most troubling, were side effects which included the potential for prominently mottled pigmentation which is difficult to deal with. Researchers are trying to use the CO2 now in a fractional manner to see if those problems are mitigated. That data is still forthcoming, however, so it's really premature to speculate."
Research and testing are also continuing on the fractional lasers.
"We are still tweaking the fractional devices to optimize the results. We are going deeper and are using other wavelengths. For instance, we are doing a study right now using a fractional 1440, which is the Affirm (Cynosure) laser with Multiplex, which means we put 1320 in there in a fractional way.
"We are developing new ways to deliver the light and new wavelengths to use with it," he says.
Dr. Tanghetti, a clinical professor at the University of California, Davis, says current research brings a number of contributors to the table.
"First of all, industry is developing the new, innovative technologies. Secondly, investigators and doctors in the field are working on finding new techniques and optimizing existing techniques. It's an interesting partnership," he says.
Add to that the pharmacological agents.
"It's naïve to think that any one of them is going to be the Holy Grail in treating photoaging. My guess is that the answer will include a little bit of everything."
Dr. Tanghetti finds that using multiple wavelengths works well.
"We also have to optimize our cooling. That would be helpful. The cooling with all of these devices is critical, and physicians need to be very cognizant of that.
"Also, it's important to be aware of using different energy levels with different skin types. We recommend that doctors test the devices on a nonfacial area to determine where they are optimized and where problems occur, before using the device on a cosmetically sensitive area. Those parameters are usually developed by early users of new devices," he says.
Even though fractional machines may be similar in nature, each requires its own acclimatization.