What it means for a patient
- Ablative laser removes the outer skin and gives the largest change, with about 2 weeks of recovery and a small risk of complications.
- Nonablative laser heats the deeper skin and leaves the surface in place.
- Fractional laser treats tiny columns of skin and sits between the other two in both results and recovery time.
- The choice among them weighs the size of the result against recovery time and risk.
- This is a review. It reports no new patient results.
Why this paper matters
It set out the range of laser resurfacing types, nonablative, fractional and ablative, with the trade-off between result, recovery and risk for each.
Overview
Laser resurfacing began in the 1980s with continuous-wave carbon dioxide (CO2) lasers, which had a high rate of side effects, including scarring. Pulsed CO2 and erbium lasers followed and removed skin in a controlled way. Their 2-week recovery and small but real complication risk led to nonablative and then fractional lasers. The article is a continuing medical education review.
Findings
- Continuous-wave CO2 lasers (1980s) had a high rate of side effects, including scarring.
- Short-pulse, high-peak-power, rapidly scanned CO2 lasers and normal-mode erbium:YAG lasers were developed to remove skin in a precisely controlled way.
- Ablative resurfacing: about a 2-week recovery and a small but significant complication risk.
- Nonablative resurfacing heats the dermis to improve wrinkles and sun damage while keeping the outer skin layer intact.
- Fractional resurfacing ablates microscopic columns of skin in a regular pattern over a fraction of the skin surface.
- Fractional lasers are more effective than nonablative lasers and give faster recovery than ablative lasers.
- Neither nonablative nor fractional resurfacing gives results comparable to ablative resurfacing.
- Both have become much more popular than ablative resurfacing, because the risks are limited and the improvement acceptable.
- The abstract gives no patient data.
Terms
- Laser resurfacing: using a laser to remove or heat layers of skin so new skin forms.
- Ablative: removes the outer layers of skin.
- Nonablative: heats the deeper skin without removing the surface.
- Fractional: treats many tiny columns of skin and leaves the skin between them untouched.
- CO2 laser: a laser that uses carbon dioxide gas, used for ablative resurfacing.
- Erbium:YAG laser: a laser that removes thin layers of skin with less heat spread.
- Epidermis: the outer layer of the skin.
- Dermis: the deeper layer of the skin that holds collagen.
- Rhytides: wrinkles.
- Photodamage: skin damage from sun exposure.