Living up to the hype: Fractional resurfacing makes good on promises

Key Points

Fractional resurfacing is touted as a method of removing wrinkles, reducing acne scarring, alleviating dark pigmentation and improving the overall look and feel of the skin - with rapid healing and without the downtime associated with other laser skin rejuvenation technologies. It's not surprising that people wonder whether to believe the hype about fractional resurfacing.

"This is the newest in laser technology and, obviously, has the attention of consumers," says Steven R. Cohen, M.D., a plastic surgeon in La Jolla, Calif., and clinical professor, University of California, San Diego.

Having gained significant experience using a variety of fractional devices over the years, Dr. Cohen says sharing some of his anecdotal observations could benefit his colleagues who have remained on the sidelines. "With fractional devices now on the market for five years, we can begin to draw some conclusions about who they work best on and what the limitations of the devices are," he says.

Realistic expectations

"If your patient is Asian with a Fitzpatrick skin type IV, conventional ablative lasers are not safe for resurfacing, and hence, the fractional technology may be not only the most effective treatment here, but also the only type of laser that would be safe to use," Dr. Cohen says.

For other patients who, for instance, have deep wrinkles around the mouth, he points out that CO₂ fractional lasers will help, but they may not be as successful in improving those deeper lines as conventional CO₂ or erbium, both of which, of course, are ablative lasers.

"It behooves the physician to explain the trade-offs, which may be prolonged redness and, ultimately, loss of pigment and texture.

"If that is acceptable to the patient, then an ablative laser may be a perfect choice in this circumstance," Dr. Cohen says.

When debating the relative merits and disadvantages of any technique or technology, Dr. Cohen stresses the importance of acknowledging that "Nothing we do treats all conditions and circumstances." Keeping this in mind, he adds, "Patient expectations should always be set realistically."

Dr. Cohen's experience has taught him to be especially careful when treating melasma. He recommends treating melasma at lower levels, primarily with the erbium glass (Fraxel re:pair, Solta Medical) laser, and he points out that acne also responds nicely to the er:glass laser.

He uses fractional CO₂ lasers for the neck and chest and other "off-face" areas and suggests that these areas need to be managed carefully, with lower energy settings, because they can scar or have prolonged dryness.