Laser applications on the upswing

Perhaps the most exciting new laser is the Fraxel SR (Reliant Technologies), which recently became commercially available. It uses fractional photothermolysis, which is said to provide results on par with those of ablative resurfacing but with no downtime and less discomfort.

"It doesn't ablate skin over a broad or diffuse area like laser resurfacing would," according to Roy G. Geronemus, M.D., director of the Laser and Skin Surgery Center of New York and clinical professor of dermatology, New York University Medical Center. "It treats a fraction - about 17 percent - of the skin surface per laser pass. This creates not a wound, but zones of microthermal injury measuring 30 to 40 microns in diameter."

Safe, effective "What this means is you're able to safely and effectively treat photodamaged skin in terms of fine lines, moderate lines and some deeper lines, as well as changes in pigmentation, while improving overall skin tone and quality without downtime," he says. "This technology is quite unique in the sense that one is able to achieve a relatively quick clinical response."

A typical course of treatment requires four to six sessions of 10 or 15 minutes each. But patients start to see results after the first treatment.

"We begin to see improvement in a week or so. But the improvement continues for several months after the last treatment session," Dr. Geronemus says.

"The other major advantage is that you can treat other parts of the body that previously didn't respond particularly well to resurfacing procedures. That includes the neck, chest and hands," he says.

A recent study has shown the device to be safe and effective, although more research is needed. In the study, researchers analyzed the impact of the treatment on 15 patients' forearms and found enhanced undulating rete ridges and increased mucin deposition within the superficial dermis three months after treatment (Manstein D et al. Lasers Surg Med. 2004;34(5):426-438.). The same study included 30 additional patients treated for periorbital wrinkles. In this regard, wrinkle scores improved 18 percent (p < 0.001) at the same interval.

Patients tolerant Patients tend to tolerate the procedure very well. Side effects can include mild swelling and slight bronzing of the skin, as well as minor dryness. Patients can apply make-up and resume routine activities immediately after treatment. According to Fraxel's manufacturer, no oozing or crusting has been observed to date, and the device carries limited, if any, risk of scarring.

"With more clinical experience and longer follow-up," Dr. Geronemus adds, "there may be other side effects that are seen over time."

Cost of the treatment varies according to the patient's condition and number of required treatments.

"In many ways," he says, "it's probably somewhat comparable to laser resurfacing once one accounts for the multiple treatment sessions."

The need for multiple sessions represents probably the main drawback of the treatment, which also causes mild discomfort. Dr. Geronemus minimizes this with topical anesthetic and an air cooling device used during treatment.

"It's something dermatologists should keep their eye on," he says of the product. "As we have longer-term follow-up, we'll have a better sense for how beneficial it will be over the long run."

Nonablative lasers Also worth watching is the progress of newer nonablative lasers in treating acne scars.