Laser Resurfacing Treatments - fully ablative vs. fractional

Laser resurfacing treatments which ablate or remove skin are of two main types: fully or fractionally ablative (fractional). Fully ablative treatments are easy to visualize: the laser is used to treat the entire area of the face, often called "full-field" resurfacing. The more energy the laser light contains, the deeper into the skin it penetrates. Since the effect is top-down, there is no way to effect change in the deep layers without going through the superficial cells. As an extreme example, treating damage in the dermis requires removing the entire epidermal layer. A deep treatment like this can require the patient to spend 10-14 days under dressings or ointment and up to months of redness as the skin settles back down.

Newer treatments are based on the realization that a laser beam can be split (fractionated) into many tiny columns which can penetrate through the epidermis into the dermis, while leaving the majority of the surface intact. This allows healing to happen in days, rather than weeks or months. It also allows powerful treatment results to be achieved through several moderate treatment sessions instead of in one large procedure.

In fully ablative mode, resurfacing lasers allow the physician to change the depth of the treatment; in fractional mode, the physician can adjust both depth of each column, but also the density, or percentage of skin treated in each session.

A common point of confusion is the difference between fractional ablative or resurfacing treatments, the topic of this article, and a treatment called Fraxel. The two treatments are very different. Fraxel is a brand name for a non-ablative fractional laser treatment. That is, it stimulated columns of deeper skin but did not ablate or remove them. As a result, the improvement seen with these treatments was modest at best. Unfortunately many patients invested time, money and discomfort in a series of Fraxel treatments when this modality was first introduced. The majority of these patients were disappointed and now distrust anything that sounds like Fraxel, which simply didn't deliver. At Tahoe Medical Spa, we offer fractional ablative treatments NOT non-ablative Fraxel.

For most people, lasers are used for two main reasons: reduction of skin discoloration (age spots and sun damage), and tightening the skin.

Color irregularities are almost always located in the superficial layers of the skin, so the laser doesn't need to penetrate deeply. A shallow fully ablative treatment often gives wonderful results with minimal downtime. Fractional treatments will also remove pigment, but only in the percentage of skin which is treated - typically 5.5-22%, so that percentage of pigment will be removed in each session.

Tightening the skin requires penetrating deep into the skin, down into the dermal layer. Fractional laser treatments offer a way to treat down into the deeper layers without requiring too much downtime. This is especially valuable for problems such as scars (particularly acne scars) which often only affect a small percentage of the total surface area of the skin, but may be quite deep - sometimes over a millimeter (1000 microns). To reach these depths with full field resurfacing or a chemical peel would require a dangerously aggressive procedure - one with unacceptable risks and recovery. A series of fractional laser resurfacing treatments has been proven to be the safest and most effective way to treat acne scars.

Each treatment has its role and advantages. They can even be combined in one session: a superficial fully ablative treatment to remove brown spots and superficial lines and then fractional therapy which goes deeper around areas to treat deeper wrinkles or scars. The more modalities your physician has and is comfortable with, the easier to customize a unique treatment for you which will address your concerns and gain you an optimal result in the amount of downtime that fits into your schedule.