Fractional resurfacing and CO2

January 1, 2007

Omaha, Neb. - As laser resurfacing evolves, the persistent challenge remains how to somehow incorporate the dramatic benefits of ablative, CO2 resurfacing with the user-friendliness and higher safety profile of nonablative measures.

Fractional resurfacing, though only offering about 25 percent of the results of CO2, has enough pluses over other modalities to have gained a very strong following. The innovative system offers skin tightening and improvement through deep, microthermal zones - without the significant downtime or potential for complications that come with CO2.

"There is no doubt that fractionated resurfacing is gaining traction over time," Joel Schlessinger, M.D., tells Dermatology Times.

Fractional advantages

Unlike CO2, fractional resurfacing does not leave significant hypopigmentation and allows for a smoother transition at the edge of the treatment area, instead of a line of demarcation at the stopping point.

Because of that advantage, fractional resurfacing is useful for the décolleté area, where CO2 was very risky, says Dr. Schlessinger, an Omaha, Neb.-based, board certified dermatologist and general cosmetic surgeon, and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

"CO2 had a tendency to scar and even keloid on the neck, whereas (fractional resurfacing) doesn't. It typically doesn't use high enough energies to cause scarring or keloidal formation," he says.

But hope springs eternal that a technology can come even closer to the gold standard in skin rejuvenation set by CO2.

Fractional CO2 lasers, such as Lumenis' ActiveFX, in fact, borrow from the fractional resurfacing model, creating "tiny columns of thermal damage that penetrate deep down into the dermis and stimulate the growth of new collagen," according to a Lumenis press release.

Unlike other fractional methods, however, the columns of thermal damage are created by CO2 itself, offering the promise of CO2-like improvements in treatment of photodamage and wrinkles.

Not without its dangers

But will the aggressive introduction of CO2 have the effect of flying just a little too close to the sun?

"Although this will provide a more significant tightening, it will also come with more potential complications as with the previous CO2 lasers," Dr. Schlessinger says.

He notes that there have been many attempts to make "kinder, gentler" versions of the CO2 laser.

"Unfortunately, most have either lacked the punch of CO2 or had the punch, but also had the problems," he says.

"Time will tell if (fractional CO2 lasers) will live up to the hype without causing complications such as the older CO2 lasers."

But while the pursuit of the optimal laser continues, the idea of using resurfacing, alone, is, in fact, rapidly becoming obsolete.

"Resurfacing alone is almost extinct at this point because there are so many alternatives available that make sense to use along with resurfacing," Dr. Schlessinger says.

Mixing and matching

With an ever-expanding array of fillers, skin care products and Botox (Allergan Medical) to work with, dermatologists are increasingly able to mix and match their favorite tools with specific indications.