When describing fractional laser resurfacing, we like to use the analogy of your skin as a lawn. Fully ablative laser resurfacing can be thought of as pulling off the sod, whereas fractional laser resurfacing is thought of as aerating the lawn. When you leave areas of the lawn untreated, the holes will close up quickly resulting in a full patch of lawn that is healthier than before due to rejuvenated areas of fresh grass.
Fractional laser resurfacing is ideal for those patients that would like improvement in fine lines, texture, and tone and do not mind having about one to two weeks of easy downtime. It is also a good option for those that have more substantial, deeper wrinkles and skin laxity that they want improved, but cannot or will not tolerate the two week downtime of fully ablative laser resurfacing. The quality of downtime associated with full ablation is much more substantial than fractional resurfacing, as it involves around the clock care of the skin in the first week until new skin begins to cover the surface. With fractional resurfacing, hydration of the skin is still important, but it is mainly “social downtime” until the small columns of treated skin heal in.
Fractional laser resurfacing is actually the laser of choice for treatment of scarring. Studies looking at the treatment of acne scars have shown that fractional laser resurfacing gives better results that fully ablative laser resurfacing. In fact, fully ablative laser resurfacing of acne scars can actually result in a WORSE result. World experts in scar treatment of all types, including surgical scars and burn wounds now unanimously agree that fractional laser resurfacing is a first line treatment of scarring, being supported by a plethora of clinical studies.
The number of fractional laser resurfacing treatments required will really depend on the indication. If you are looking for a treatment to invigorate your skin, remove signs of sun damage, and improve fine lines, one or two treatments may be all you need. If scarring is the issue, the number of treatments depends on the depth of the scar. Very superficial scars may be improved with only one treatment, whereas deeper scars, such as those produced by acne, will involve at least 4 treatments. Similarly, patients with deeper wrinkles will require several treatments to see substantial improvement. It is important to remember that it takes new collagen 6 months to fully mature and to see the final result, thus the treatments are ideally spaced at least 2 – 6 months apart.
There are a large number of laser companies that produce fractional lasers devices. There are two main types of lasers that produce instant evaporation of the treated skin – CO2 lasers and erbium lasers. CO2 lasers are effective at drilling holes into the skin but treatment is associated with considerable heat and produces significant collateral damage around the treated skin columns. This results in greater and prolonged side effects seen as swelling and redness. The erbium laser does not require as much energy to evaporate skin cells, and thus produces almost no collateral damage. Healing is faster and side effects are much reduced compared to fractional CO2 resurfacing.
It has been observed that greater amounts of heat generated in the skin does affect the degree of tightness in the skin. If skin tightening is the desired effect, it would appear that CO2 laser would be the laser of choice, but this would be need to be balanced by the desire to avoid unwanted side effects. The perfect solution became evident when the engineers at Sciton created an erbium laser which had the option of adding incremental amounts of heat to the treatment, even as much heat as to mimic the CO2 laser. The Profractional laser treatment gives the physician ultimate flexibility and control to treat individual patients according to their needs, as well as individual areas of a patients face. This is the reason Restore Vein & Skin Centre invested in the Sciton platform, considered the Cadillac of laser systems.
For patients that want improvements that laser resurfacing achieves but want minimal downtime, there are a number of non-ablative fractional laser systems that can achieve this. Non-ablative lasers do not cause instant evaporation of the columns of treated skin. Rather, the skin is injured to the degree that will eventually be recognized by the body as non-functional and be removed. There is significantly reduced down time and no associated peeling of the skin compared to ablative fractional skin resurfacing as there are not any actual holes produced in the treatment. The downside of non-ablative resurfacing is that there will be much less immediate improvement in the appearance of brown sunspots and other blemishes.
While we do offer non-ablative laser resurfacing, we find that most patients in Kelowna and the Okanagan show at least some signs of sun damage. Our preferred treatment for those patients that want minimal downtime but more substantial improvement than non-ablative resurfacing provides, is Halo pro. This treatment combines ablative and non-ablative wavelengths and is a first of its kind.