Thanks to our expert, Dr Gavin Chan, Melbourne Cosmetic Surgeon, for being my blog guest on the topic of fractional laser vs needling vs dermapen.
An industry problem that I see for patients, is that many clinics, with their varying investment levels in equipment, may give biased advice on what treatment is suitable for the patient’s problem. i.e. the doctor/ nurse / therapist will only advise the patient to have the treatments that they are capable of offering, even though those treatments may not be the gold standard or even suitable to address the problem.
The reason I chose Dr Chan for this topic is because he is a cosmetic medical device-lover, and at his clinics, he has invested so much into gold-standard level equipment, that limitations on his number of medical tools is not an issue. Dr Chan can choose the best treatment for the indication because he has all of the options available.
Dr N: Dr Chan, please tell us a little about the differences between Fractional laser, and Needling devices?
Dr G: Both fractional lasers and needling devices create micro-injuries that promote skin healing and repair which in turn generates new collagen. This can be useful for the treatment conditions such as acne scars, or simply to improve wrinkles. Fractional lasers use light energy to produce this injury, and skin needling utilises a more mechanical method instead.
Dr N: What is the difference between ablative fractional laser and non-ablative fractional laser? How can you help a patient determine which one is preferable for them?
Dr G: Basically, the term ablative means that skin is ‘vapourised’ by the laser, that is, the skin is removed. Non-ablative implies that the skin is still intact. Examples of ablative fractional lasers include the fractional carbon dioxide or erbium lasers, and an example of a non-ablative fractional laser is the Fraxel laser. Generally speaking, ablative lasers tend to be more aggressive than non-ablative lasers, which usually means greater downtime, and that fewer sessions are required to achieve a certain result, but the risks may be higher as a result. When choosing a laser for a particular patient or condition being ablative or non-ablative or fractional or non-fractional are only two of the many factors involved. In many ways, picking the right laser is like picking the right pair of shoes for a certain occasion or situation. A clinic with a variety of lasers can allow the patient more choice and possibly a better choice for their skin concerns. Otherwise, if you only have one laser option, it’s like having to wear your runners everywhere, whether you are going to the park or a formal black tie event.
Dr N: For which cosmetic issues are ablative fractional laser best?
Dr G: I find ablative fractional lasers significantly superior to non-ablative lasers for the treatment of wrinkles and skin texture.
Dr N: For which cosmetic issues are non-ablative fractional laser best?
Dr G: Lasers such as the non-ablative Fraxel 1927nm wavelength are great for the treatment of sun-induced pigmentary problems such as freckles. They are able to treat the skin relatively gently, yet achieve excellent results for these skin concerns.
Dr N: For which cosmetic problems are needling devices best?
Dr G: Skin needling, as opposed to laser, produces no heat energy. In my experience, this reduces the risk of post-inflammatory hyperpigmentation (pigmentation that occurs after treatment or trauma to the skin). I use skin needling in my practice in particular for the treatment of acne scarring.
Dr N: What is the difference between needling, microneedling, dermaroller, dermapen and dermastamp?
Dr G: Skin needling is generally performed with a roller that has a cylindrical head with multiple needles attached to it. The length of the needles used in microneedling are very short , usually less than one millimetre, and can be used without the need for injected local anaesthetics. Therefore, they are often sold as home kits for people to use on a regular basis on their own. Dermapen and dermastamp are the newer versions of skin needling that are powered by a small motor which oscillates a small group of needles to go back and forth whist being moved over the skin.
Dr N: With Needle devices , how important is the length of the needles? To what extent does it effect the success of the treatment?
Dr G: We tend to use the deepest needles possible (3mm) for acne scarring. I find this stimulates the most amount of collagen to improve this condition. Although, the downtime on this treatment is 10 days and requires a significant amount of (injected) local anaesthetic, and sometimes intravenous sedation, to perform this procedure. Conversely, it is possible to use very short needles, as small as 0.1mm, as a home device that can be used more regularly and even daily to promote new collagen production. However, the results from frequent treatment with shorter needles, even when used regularly, do not usually reach the improvement achieved by longer needles.
Dr N: If a patient comes in with acne scarring, which treatment is your preference? Needling or fractional laser, or both? What is your treatment protocol for both options, including depth and type of laser, and size of needle, and also number of treatments? How do results compare between the 2 treatments?
Dr G: I tend to use fractional ablative carbon dioxide lasers for fair skinned patients who can afford the downtime. Fractional non-ablative lasers such as the 1550nm Fraxel laser I use when I don’t want the patient to experience as much downtime, so they will require more treatments, but the downtime will be more acceptable to the patient. I use skin needling with the 3mm roller for those with olive to dark skin and acne scarring, as the risk of pigmentation problems after is much less than laser. Each treatment is tailored to the individual patient – so I can’t make a general comment on the number of treatments required, as this will vary from person to person.
Dr N: Home needling devices, what can they be used for, and how do you rate them?
Dr G: I find these particularly effective for enhancing the effect of skin care products. Basically, you can roll the needling device over your skin and then put your products on top. It’s like putting holes in the lawn before you fertilise it. Penetration of the products is increased several fold.
Dr N: How effective are Needling devices and fractional laser for fine lines and wrinkles?
Dr G: I find fractional ablative laser the most effective for fine lines and wrinkles. However, for those with significant wrinkling, I still find that non-fractional (traditional) carbon dioxide lasers do the best. The downtime on this treatment is 10-14 days, but the results are superior to even having many fractional treatments.
Dr N: For skin rejuvenation on the neck or decolletage, which would you choose, fractional laser or needling?
Dr G: The neck and the body never heal as well as the face, so care must be taken whatever laser or treatment you choose. Generally, I double the downtime predicted for the face for all neck/body treatments. Fractional laser treatments bring a degree of safety to the treatment of necks, because not every part of the skin is treated. In the past, many patients have been scarred on the neck with (non-fractional) carbon dioxide lasers.
Dr N: How do complications compare between needling devices and fractional laser?
Dr G: As mentioned previously, I find that post-inflammatory hyperpigmentation is greater with laser than needling.
Dr N: Any other important tips you’d like to share on these topics?
Dr G: One of the important newer innovations that has been used in conjunction with fractional laser and needling is using them as drug-delivery devices. That is , it is possible to deliver any drug or topical treatment further into the skin without injecting it in. A good example of this is the use of topical cortisone after fractional carbon dioxide lasers on raised scars. This can help to settle the scars down as the cortisone penetrates deep into the scar and helps to slow scar formation.
Thanks again for being my blog guest, Dr G:)
Dr Gavin Chan, founder of:
1300 863 824
Manningham Medical Centre
Level 6, 200 High Street
Lower Templestowe 3107
Level 1, Suite 2,18-24 Clyde Rd
42 Ross Street