Fractionated laser treatments
A lot of excitement has been generated by the introduction of the ‘fractionated’ laser treatment. There are a few different varieties of fractionated laser, such as PIXEL and FRAXEL. The reason for the excitement is that these lasers offer the opportunity for reduced ‘downtime’ after treatment.
The idea (simplified here) is that with each laser pass, the quantity of skin actually ‘hit’ with the laser is only a ‘fraction’ of the area covered. That is, a single pass with the laser may only actually ‘hit’ 25% of the skin. The benefit is that the surrounding, unaffected skin can more quickly heal over the affected areas. This is in distinction to standard ‘resurfacing’ laser techniques, whereby the entire surface of the skin is affected.The earliest fractionated lasers are non-CO2 (e.g., Erbium-based). These fractionated lasers typically require several treatments to see results. At the Mid-Winter meeting in Vail, Colorado in January 2007, some of these results were presented (though not by me). While these early fractionated lasers show some results, treatment of rhytids (wrinkles) is not as effective as one may like. Interestingly, more than one speaker mentioned that we are ‘going back’ to CO2 laser treatments.A new laser has been introduced which combines fractionation technology with CO2.

I alalert have begun using this laser in a handful of patients (I had previously used the standard CO2 extensively). I can say that these patients are seeing some nice results. The recovery is typically a few days (versus weeks or months with standard CO2 laser). While I cannot compare this to the non-CO2 fractionated lasers, all indications are that fractionated CO2 lasers may be more effective at reducing wrinkles than their fractionated, non-CO2 brethren. However, it is perhaps not as effective as a standard CO2 laser or deep chemical peel. In time, the answers to these questions will become more clear.

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