Fractional Photothermolysis: A Novel Aesthetic Laser Surgery Modality

Abstract

The ubiquity of increased sun exposure, oral contraceptives, and phototoxic drugs has led to an increased prevalence of conditions such as dyschromia, melasma, rhytides, and other signs of photoaging over the past few decades. Through the application of selective photothermolysis, laser surgery has attempted to create therapeutic options for these medically recalcitrant conditions. To date, however, this technology has been met with limited success, due to a high incidence of posttreatment side effects, inability to treat off the face, and a safety profile tailored to Fitzpatrick skin types I to III. More recently, a novel approach coined "fractional photothermolysis" was developed in an attempt to overcome these limitations. This new laser treatment modality has allowed for effective treatment of a diverse array of dermatologic conditions on and off the face with a wider therapeutic index and improved safety profile independent of Fitzpatrick skin type. This review sheds light on the technical aspects, biologic mechanisms, and clinical effects of fractional photothermolysis that help set it apart from previous modes of laser surgery.

Histological comparison of two different fractional photothermolysis devices operating at 1,550 nm

“…Non-ablative fractional resurfacing was recently introduced as a new treatment modality which has been demonstrated to be effective for treatment of periorbital rhytides, acne scars, surgical scars, melasma, and photodamaged skin [14][15][16][17]. Fractional photothermolysis employs multiple zones of small thermal injury, so called microscopic treatment zones (MTZs), which are generated by focusing a mid-infrared laser device emitting at 1.55 mm wavelength within the skin.…”

Monitoring of wound healing process of human skin after fractional laser treatments with optical coherence tomography

“…In the stark contrast, the epidermis has already reepithelialized with partial restoration of the basement membrane after 72 hours of NAFL treatment. By 7 days after treatment, the MEND has been exfoliated whereas complete replacement of MTZs with new collagen occurs by 3 months [40]. Consequently, although collagen regeneration can last for three months after NAFL treatment, the epidermis can be reepithelialized in 7 days, which is an indicator to evaluate the wound healing.…”

Immunohistochemical evaluation of the heat shock response to nonablative fractional resurfacing

“…3 Currently, this method has been used successfully to treat numerous dermatological conditions including melasma, poikiloderma, acne scars, and rhytides. 4 While the mechanism underlying FP's clinical efficacy is uniformly thought to involve dermal collagen coagulation in combination with induction of rapid epidermal turnover, the variety of clinical indications just noted often requires unique treatment regimens, each potentially targeting different depths of thermal injury.…”

“…FP has demonstrated clinical efficacy for a wide array of clinical indications and was recently reviewed. 4 In particular, several reports suggest a significant benefit in improving the clinical appearance of scars. [5][6][7][8] Indeed, previous studies showed significant improvement in the appearance of post-operative scars after laser assisted skin closure.…”