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With no randomized, objective studies comparing performance of fractional ablative resurfacing lasers, an expert recommends trying them for oneself before buying.
Perhaps the biggest controversy in the field of fractional ablative resurfacing is which product to choose, says Ashish C. Bhatia, M.D., F.A.A.D., assistant professor of clinical dermatology, Northwestern University Feinberg School of Medicine, Chicago.
"There's a lot of data available at this point," he says, "but most of it is histological data from each manufacturer."
Therefore, he says that during the selection process, it's crucial to bring products into one's office and try them to see their true downtime and clinical results. This will tell physicians everything they need to know about the lasers' effectiveness and ease of use, he says.
Along with pricing, Dr. Bhatia says, "Those are things the potential buyer should evaluate on his or her own, rather than falling into the marketing hype that's behind each of the lasers."
Manufacturers are usually open to lending lasers for evaluation, Dr. Bhatia says. If a company isn't, "I would strongly consider not buying their laser. These are substantial investments that cost anywhere from $80,000 to $145,000. And you don't necessarily get what you pay for."
Traditionally, he says most physicians performed skin resurfacing with CO2 or erbium lasers - ablative resurfacing, which involves removing 100 percent of the skin's outer layers, then letting the face heal.
"Ablative resurfacing did a wonderful job for wrinkles, fine lines, pigment problems and some acne scarring as well," Dr. Bhatia says.
However, he says ablative resurfacing created significant downtime. "For up to two weeks," he says, "patients experienced significant redness and swelling. Most people couldn't afford that much downtime."
Ablative resurfacing also carried substantial risks - particularly when performed by poorly trained providers. These risks include hyper- or hypopigmentation, prolonged erythema, ectropion and scarring.
Additionally, ablative resurfacing left some patients with an unnatural alabaster sheen, he tells Dermatology Times. Dermabrasion and deep chemical peels also carry these risks, he notes.
To address these shortcomings, laser manufacturers started introducing fractionated ablative lasers about a year ago, Dr. Bhatia says.
"Instead of removing 100 percent of the skin's surface," he says, "these lasers remove a small fraction of that."
One would think such an approach would yield only marginal effects, Dr. Bhatia says.
However, he says, "The effects of these lasers are actually very significant. The wound-healing process still occurs, but the normal skin between treated microspots acts as a good regenerative base." Accordingly, he says fractional ablative lasers require only four to six days' downtime.
Often, two treatments can deliver results as impressive as those achieved by one treatment with full-surface ablation, Dr. Bhatia says.