Laser Resurfacing: Below the Surface

Nonablative fractional devices are an effective tool for acne scars, skin of color and younger patients seeking minor rejuvenation.
Below the Surface

Fractional laser devices, which pixelate the laser beam, dividing it into thousands of microscopic treatment zones to target a fraction of the skin at a time, have become key tools for dermatologists and plastic surgeons. Reliant Technologies introduced the first commercial fractional laser in 2004 under the brand Fraxel. The original 1550nm nonablative Fraxel device led to a proliferation of platforms, including several fractional ablative systems.

While the introduction of ablative fractional technologies that offer comparable benefits to traditional—or full-field—laser resurfacing have generated a lot of excitement, physicians are finding that nonablative devices continue to offer unique benefits to patients seeking rejuvenation, a reduction in acne scarring and relief from stubborn pigmentation problems.

Jill Waibel, MD, a Miami-based dermatologist, notes that nonablative fractional devices have become widely accepted as effective for reversing signs of photodamage, acne scarring and pigment irregularities. Among the benefits of nonablative vs. ablative technologies is the ability to treat darker skin types and off-the-face areas, including the hands, chest and neck. “Nonablative fractional resurfacing has become a popular worldwide procedure due to its effective epidermal and dermal rejuvenation, increased safety profile, decreased postoperative downtime, use on all anatomical areas, and wide spectrum of medical and aesthetic indications,” she says. “It can be used for mild to moderate rhytids, leukoderma, atrophic and hypertrophic scars.”

Today, nonablative devices include a range of wavelengths, including Solta Medical’s original 1550nm Fraxel, combined 1550nm and 1927nm Fraxel Dual, and 1440nm Clear + Brilliant; radiofrequency (RF)-based devices, such as Syneron’s eMatrix and Eclipse Aesthetics Skinfinity; and Sciton’s Halo Hybrid, which includes both the nonablative 1470nm wavelength and ablative Er:YAG energy.

Nonablative Advantages

Two indications for which nonablative devices are considered primary treatment options include acne scars and facial rejuvenation in skin types IV-VI. “For conditions such as acne scarring, a series of nonablative treatments may be slightly superior to ablative resurfacing,” says New York City-based dermatologist Anne Chapas, MD. “This is because the nonablative treatment places a lot of heat in the dermis, which induces collagen and scar remodeling. Additionally, nonablative resurfacing is preferable in darker skin patients because it has a decreased risk of post-inflammatory hyperpigmentation.”

Acne scar treatments are typically performed at a high millijoule setting to reach the scar tissue, according to Dr. Chapas. “Depending on the skin color and area being treated, the density or treatment level should be adjusted to limit bulk heating and decrease the risk of PIH,” she says. “Typically, three to six sessions are recommended and conservative estimates of 30% to 50% improvement can reliably be achieved.”

When treating patients with acne scars, Dr. Chapas and Philadelphia-based dermatologist Eric Bernstein, MD, turn to the Fraxel Dual. “I love the Fraxel Dual for acne scarring, using mostly the 1550nm wavelength. Its efficacy and safety cannot be matched for that indication,” says Dr. Bernstein.

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