Fractional resurfacing beyond the face

Dr. Shamban

The versatility of a dual-wavelength fractional laser allows one to treat non-facial body areas with precision and safety. That’s according to Beverly Hills, Calif.-based dermatologist Ava Shamban, M.D.

"We've added a Fraxel Dual device (Solta Medical) in all of our offices because you can do so much with it - on the face, off the face, pretty much the whole body," says Dr. Shamban.
Increasing pulse energy allows one to increase the depth and diameter of microthermal zones (MTZs). "And the delivery system is continually scanned, so as you're scanning it across the chest or face, you don't run into the striping that can happen with an intense pulsed light (IPL) device," she says.

The Fraxel Dual's 1550 nm wavelength addresses deeper resurfacing needs, such as severe skin damage and, to an extent, wrinkles. "It's not like the gold standard of the old CO2. But my patients don't necessarily have the tolerance for that anymore."

On the arms and chest, Dr. Shamban’s patients frequently complain of crepiness, brown spots and laxity. She typically treats these patients with eight passes total, first with the 1550 nm wavelength, then the 1927 nm wavelength, using treatment level 3 at 20 mJ/cm2. Applying topical platelet-rich plasma (PRP) and hyperdilute poly-L-lactic acid immediately post-laser can deliver more dramatic improvements.

On the legs, Dr. Shamban's patients frequently complain of flat seborrheic keratoses mixed with lentigines and actinic purpura. "By doing a series of treatments using both the 1550 nm and the 1927 nm wavelengths on the leg, it's remarkable how you can improve that texture." Settings vary depending on skin type, and are similar to settings used on the arms.

The 1927 nm wavelength is FDA-approved for actinic keratoses. For patients who have many thick AKs, she suggests briefly applying Levulan (aminolevulinic acid, DUSA/Sun Dermatology) pre-laser to improve results.

The biggest drawback of AK treatment with the 1927 nm laser, she says, is swelling. "People need to know that they're going to be swollen for a couple days." However, she adds, applying PRP or Alastin Regenerating Skin Nectar (Alastin Skincare) post-treatment appears to help.

The Fraxel Dual can also address all types of scars, including burn scars, says Dr. Shamban. "It even helps a little with the redness, probably because the tissue healing resolves some of the telangiectasia."

When evaluating a fractionated laser, says Dr. Shamban, it's important to know how consistently the energy is delivered, the safety level of all manufacturer-recommended treatments and how the company supports its product with education.

Lasers represent a substantial capital investment, she adds, in purchase price and ongoing maintenance costs. "So it's important to know that the company you're dealing with is going to give you the right service, and that the machine itself is sturdy and not prone to breaking down."

Buying lasers is a bit like shopping for jewelry, says Dr. Shamban. "You have to really bargain."

But by researching the product and manufacturer, she says, one can choose a quality device.

Disclosures:

Dr. Shamban is a consultant, researcher and shareholder for Allergan; a consultant and researcher for Galderma, Merz and Revance; and has received grants/research support from Endo, Brickell Biotech, b10 and Teoxane Laboratories.

References:

Ava Shamban MD. "Not Just for the Face: Fractional Resurfacing for Optimal Treatment of the Chest, Arms and Legs." The Cosmetic Bootcamp. June 21, 2019.