The Development of Skin Resurfacing Lasers: Ablative, Non Ablative and Fractional Lasers
Laser skin resurfacing is a procedure performed to reduce the appearance of age spots on face, scars caused by adult acne or other injuries, rough skin texture and wrinkles of various severities. The procedure, also known as lasabrasion, laser peel or laser vaporization, basically involves removing layers of skin using concentrated light energy. Since the introduction of laser skin resurfacing in the 1980s, the technology and methods used in practice have been continuously improved to reduce risks to patients and decrease the time necessary for recovery. Nonetheless, any skin treatment involving lasers can still be dangerous in the hands of inexperienced physicians, or those professionals who are easily swayed by patients who want aggressive treatments for faster results. Even newer technologies like fractional laser skin resurfacing still pose risks to patients who have unrealistic expectations about results or who do not receive honest information from their physician.
Ablative Laser Resurfacing
Ablative laser skin resurfacing uses powerful lasers to destroy the upper epidermis, or the outer layer or skin. This was one of the original uses for photo-energy technology, as the earlier lasers were very much focused on being an alternative to chemical peels and Dermabrasion. One of the first machines for skin laser resurfacing was the continuous wave Co2 lasers, which were very powerful and magnified infrared light waves to deliver destructive beams of energy to surface skin cells. However, although Co2 laser skin resurfacing procedures have been known to produce noticeable results, the earlier devices have also been notorious for their frequent side effects. For example, when the industry was just developing, it was not uncommon for patients to experience, painful skin inflammation, skin discoloration, scarring, and in some cases even infection. One of the biggest causes of problems with early generation ablative laser resurfacing was that it destroyed cells in the epidermis indiscriminately. The entire upper layer in the treatment area would be removed, and the body would scramble to heal skin damage which was in some cases similar to first degree burns. Over the years, laser skin resurfacing techniques would be improved in ablative technologies to mitigate this problem, and reduce healing times by shrinking the treatment area. This technology would come to be known as fractional skin resurfacing. Nonetheless, to this day, ablative laser skin resurfacing remains one of the most aggressive and effective type of photo-energy treatment, and carries the greatest risks of skin damage and painful recovery time.
Non-Ablative Skin Laser Resurfacing
Non-ablative, or non-wounding, laser skin resurfacing utilizes technology that will penetrate the dermis or underlying skin, but will not actually burn off cells from the surface. This type of treatment aims to heat up collagen fibers in the deeper layers, this stimulating protein development to tighten skin over the long term. If the ablative laser aims to simply remove skin imperfections, this weaker laser technology attempts to get rid of wrinkles from beneath. Compared to ablative laser skin resurfacing, these treatments are less effective but are safer and require less recovery time. Non-ablative laser skin resurfacing is usually performed on thinner skin areas, where the energy has fewer obstacles on its way to the dermis. This helps deliver treatment more efficiently and avoid damage to the epidermis. Such non-ablative laser technology is classified into three main groups namely: mid-infrared lasers, visible lasers and intense pulsed light.
Fractional Skin Resurfacing
Fractional laser skin resurfacing seeks to combine ablative and non-ablative techniques. It targets both the outer layer and the underlying skin by breaking the laser beam into smaller bursts of energy. Fractional laser skin resurfacing is used to treat acne scarring, skin pigmentation and wrinkles. With fractional laser resurfacing, it’s important to realize that it is not the laser itself that makes the difference, but how it is applied to the skin. The fractional technique uses the idea that the entire treatment area should not be damaged, but only a fraction of it. During treatment, the laser beam is divided into smaller “packets” of energy that are selectively delivered to parts of the treatment area, leaving healthy tissues in between. This fractional laser resurfacing idea has been used with ablative and non-ablative devices because it causes less damage, thereby decreasing side effects. The Fraxel laser device was the pioneer in fractional laser skin resurfacing. Now, many companies have developed their own versions, with various additions like suctioning technologies to increase light penetration into the skin, thereby decreasing the amount of energy needed; and specialized filters to better target specific skin problems.
Fractional Laser Resurfacing Side Effects
Although fractional laser skin resurfacing is less effective compared to ablative skin resurfacing, it is becoming a more popular choice because of the lower instance of side effects. However, this does not mean that fractional skin resurfacing is the best skin treatment. Side effects from aggressive treatments with this technique can include swelling, inflammation, hypersensitivity, and even skin peeling and crusting, which could last for up to a week after the procedure. Also, patients with darker skin tones, or those with a history of melasma, are prone to post-inflammatory pigmentation issues. Therefore, it’s important not to fall into the advertising trap for such procedures, which often make the side effects seem less serious, and to understand that fractional laser skin resurfacing has its own set of problems and potential health hazards for patients.