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Fractional Laser

Author: Dr Naomi / 31 Oct 2015

Before and after 5 treatments of ablative fractional laser and dermal filler

Before and after 5 treatments of ablative fractional laser and dermal filler

There are 2 types of fractional laser: Non ablative and ablative

Both of these  types of fractional laser create channels in the skin, covering only a fraction of the skin’s surface area. The difference between the non-ablative and the ablative fractional laser is that the ablative fractional laser vaporises the tissue in the column.

This page is about ablative fractional laser. Non ablative fractional laser is less invasive, has less downtime and is less painful.

What is fractional ablative laser?

Fractional ablative laser is differs from full field resurfacing. Full field resurfacing removes the whole surface area of the treatment site (eg in a Microlaser Peel). Fractional laser ablates (vaporises) narrow channels into the skin covering only a fraction of the surface area of the treatment site. This action activates the body’s wound healing mechanisms, but leaves the surrounding skin intact, so that rapid healing is possible.

Who should have fractional laser?

Anyone who would like to rejuvenate their skin

Those with acne scarring

Those with melasma should have profractional laser ( a type of fractional laser with less tissue damage around the laser path

How does fractional ablative laser work?

The fractional laser creates clean micro ablated channels in the skin, by vaporising the tissue. This causes fibroblast and collagen production. This leads to increased skin turgor and thickness.

Can fractional laser be combined with other procedures?

Definitely, results can be maximised by combineing procedures. At our clinic, two of my favourite procedures in terms of skin results, are combination procedures.

1. Fractional laser and microlaser peel.

What I love about this combination is that with the microlaser peel, I am removing 100% of the surface area of the skin to a level of between 10-30 microns with the Microlaser Peel, but I am also getting the depth with the fractional laser which is going to depths of around 150-200 microns and covering 11% of the surface area of the skin. So the results are really great, probably due to the fact that we are getting the coverage and also the depth. This procedure has 5 days downtime.

OR

2. Fractional ablative laser and BBL

What I LOVE about this combination is that I’m getting 100% coverage of the skin with the BBL, and this is targeting the pigmentation and sun damage, and also I am getting the depth and the ablation with the fractional laser.

The amazing thing about this combination is the great results patients can get with such minimal downtime.

This combination has 3 days downtime

What are the side effects/risks of Fractional Laser?

Hyperpigmentation / PIH (Post inflammatory hyperpigmentation) Increased skin pigmentationThis tends to occur in patients with darker skin tones. If a patient is predisposed to PIH, then they should be on a lightening agent prior to and after treatment to reduce the likelihood of PIH occurring. Topical steroid may also be prescribed by the doctor after the treatment to reduce the likelihood of PIH

Hypopigmentation (decreased skin pigmentation) This is possible after Erbium laser. The deeper the treatment, the greater the likelihood of this occurring. This is uncommon in full facial resurfacing at mild to moderate depths. Hypopigmentation in a very small area is likely when removing a deep benign mole/naevus.

Scarring: Very uncommon

Infection: Cold sore (herpes virus) and bacterial infections are possible. Antivirals may be prescribed preventatively. Antibiotics may be required if a bacterial infection occurs

Acne erruption: This can occur after the procedure possibly due to the greasy ointment which is required for healing. It usually resolves quite quickly

The procedure for fractional ablative laser

Consultation:

Consultation is required before erbium laser resurfacing treatment.

A history will need to be taken, including history of other treatments, complications, skin type and history of cold sores. The amount of downtime available will need to be discussed and also other treatment options

Examination of your skin and what needs to be required.

Photographs of your skin will be taken.

Consent form will be read and signed, with opportunity for further discussion

If the patient is predisposed to PIH, a lightening agent would be prescribed. Sometimes this is required for up to 8 weeks prior to procedure. In this case, test patching may also be required

The patient may be prescribed a retinoid to prepare the skin for resurfacing.

Appointment will be made for the procedure. Prepayment is required

Patients should buy vaseline ointment and white vinegar in preparation for the treatment

The Fractional Ablative Laser Procedure

The patient arrives 1 hour before the procedure and may be given some Valium prior to the procedure if required

Local anaesthetic may be injected to block the nerves

A topical anaesthetic will be applied for 1 hour prior to the procedure with glad wrap.

The patient’s face will be cleaned twice with medical grade acetone.

The ablative  fractional  laser will be used on the face with 1-2  passes over the face.

An ointment will be applied to the face eg Vaseline /paw paw ointment

The patient’s face will be bleeding (depending on depth treated) and covered in a layer of ointment

The patient will go to a recovery room where their face is cleaned and ointment is reapplied.

The patient will be given post treatment instructions

The patient should sleep on a clean dark towel in case of bleeding post procedure

How will I look after ablative fractional laser?

Day 1 after fractional ablative laser

Day 1 after fractional ablative laser

Day 2 after fractional ablative laser

Day 2 after fractional ablative laser

Day 2 after fractional ablative laser

Day 2 after fractional ablative laser

How many treatments of ablative fractional laser will I need?

For acne scarring, we recommend a minimum of 5 treatments

For melasma, typically we recommend 2-3 treatments of profractional laser

For rejuvenation, patients can typically be satisfied after between 1 and 5 treatments.

The important thing to consider when having fractional laser, is that fractional laser, by definition, is not covering the full surface area of the skin, so the results are limited by that fact, hence the fact that multiple treatments will be required. My most typical coverage when I’m using my fractional laser on the face is 11%. Which means that I am only ablating 11% of the patient’s skin, so there is really only potential for around 11% improvement at best.

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