Rejuvenation: Ablative, nonablative fractional options expanding

March 1, 2008

Key developments in facial rejuvenation techniques that promote new collagen induction include the introduction of fractional ablative lasers, as well as the advent of adjunctive treatments including LEDs, fillers and topical agents, an expert says.

Key Points

At the same time, recent research has shown that adjunctive treatments, including light-emitting diode (LED) modalities, dermal fillers and topically applied growth factors, also can promote collagen growth.

Laser and light source rejuvenation began 15 years ago with CO2 lasers, followed by erbium lasers.

Therefore, erbium and CO2 lasers have given way to fractional resurfacing.

Dr. Goldberg says, "This modality removes fractional components of the skin, which leaves zones of healthy tissue between treated areas and leads to less downtime."

Today, both nonablative and ablative fractional resurfacing technologies exist.

Nonablative technology

The nonablative category includes two lasers operating at 1,540 to 1,550 nm - the Fraxel (Reliant Technologies) and the StarLux (Palomar) - as well as the Affirm (Cynosure), which operates at both 1,440 and 1,320 nm, Dr. Goldberg tells Dermatology Times.

Because they're nonablative, they don't destroy the skin's outer layers, and selectively penetrate the deeper layers.

"The strength of this approach is that these lasers are able to treat patients with minimal to no downtime. And their safety profile is far superior to that of the older ablative lasers,"Dr. Goldberg says.

These systems also allow physicians to treat both facial and off-face areas, such as the neck, chest and hands.

"The downside of nonablative fractional technology is that patients require anywhere from four to six treatments," Dr. Goldberg says.

To address this shortcoming, he says manufacturers have begun creating lasers that can deliver results somewhat akin to those of CO2 and erbium lasers without significant downtime and in fewer than four to six sessions.

Ablative technology

Ablative fractional resurfacing essentially delivers erbium or CO2 energy in a fractional mode -hitting some areas and skipping others, but using significantly more successful wavelengths than are seen with nonablative fractional treatments, Dr. Goldberg says.

"Using these older wavelengths in a fractional manner," he says, "we can create results in one to two treatments," followed by a weekend of downtime.

"This leaves both the patient and physician with a choice of either the fractional lasers, such as Fraxel or Affirm, which work and are very safe but require multiple treatments, or a slightly more aggressive approach."

Thus far, two lasers of this type are available - the TotalFX (fractional CO2 laser, Lumenis) and Fraxel re:pair (erbium, Reliant).

Along with a fractional mode that's well-suited to removing brown spots from the skin's surface, the TotalFX offers a drill mode that provides tightening of deeper skin, Dr. Goldberg says.

Fractional CO2 lasers available from other manufacturers, such as Reliant, also can drill deep into the dermis, he says.