Versatile fractional laser shows promising results

Chicago - The buzz continues to build surrounding fractional photothermolysis - a new approach to laser technology that can treat a number of conditions with minimal downtime.

Paul M. Friedman, M.D., director of the DermSurgery Laser Center in Houston, calls it "breakthrough technology with multiple potential indications."

He explained this newer modality at the American Academy of Dermatology's Academy '05, held here.

"This is a very intelligent way of approaching photo-damaged skin. Instead of resurfacing the entire face, you are delivering very small laser treatment zones," Dr. Friedman tells Dermatology Times.

Excellent results for photodamaged skin

Dr. Friedman has been using the 1550 nm Fraxel laser since last fall and says the device provides excellent results for the treatment of photo-damaged skin and can even be used to treat skin on the neck, chest, arms, legs and hands, as well as the face. The risk of scarring with fractional photothermolysis is much less than it is with traditional ablative techniques when used off the face.

In addition to treating photo-damaged skin, Dr. Friedman has extensively used the device to treat acne scars, melasma, rhytids, dyschromia, and poikiloderma of Civatte. He considers this modality to be an "excellent treatment option" for dermal melasma because it targets areas of dermal melanophages and controls the condition much better than bleaching creams.

"This laser has been embraced by a majority of top laser surgeons in the country, and they have all been excited with the results to date and the safety of the device," Dr. Friedman says.

He says it has potential application for the treatment of surgical scars, post-inflammatory erythema, striae, actinic keratosis, and disseminated superficial actinic porokeratosis (DSAP).

Multiple micro treatment zones

Fractional photothermolysis works in the skin via multiple microthermal treatment zones (MTZ). One MTZ is 50 microns to 70 microns in diameter and is surrounded by a zone of untreated tissue, which is the unique feature of this modality. Each treatment session targets just 17 percent to 20 percent of the skin.

With each pass of the robotic handpiece over the treatment area, the fractionated laser's Intelligent Optical Tracking System randomly creates multiple treatment zones in a consistent pattern that is laid down evenly, regardless of velocity. Laser passes are repeated horizontally and vertically. An average of 2,000 MTZs are created per square centimeter of treatment area.

With untreated tissue surrounding each MTZ, wound healing is expedited and re-epithelialization is rapid. Tissue in the epidermis is coagulated, and collagen is denatured between 400 microns and 700 microns.

"Necrotic debris and melanin are eliminated by keratinoctye migration and rapid expulsion," Dr. Friedman explains.

He says transient side effects can include mild erythema that lasts one to three days, and mild edema that resolves within three days in most patients. Temporary bronzing of the treated area can persist for two weeks. Discomfort during the procedure may be eased with topical anesthesia and cooling provided by the Zimmer air cooling device.

Full-face treatments for photodamage require 20 minutes to 30 minutes, while neck and hands can be done in 10 minutes. Because the laser targets only a fraction of skin tissue with each pass, multiple treatment sessions are required, usually consisting of three to five office visits with a two- to four-week wait between each session.

Although fractional photothermolysis achieves superior results for treatment of fine wrinkles, texture and overall photodamage, Dr. Friedman says it has not yet attained the same quality of results to treat deeper lines that traditional resurfacing procedures have.

He also says the laser technique and treatment parameters may be tailored to the particular patient indication. These parameters need to be standardized through further study.

"Additional controlled studies are needed to determine optimum treatment parameters, intervals and future applications. As we optimize treatment parameters, the potential is even greater than what we have already seen."