Patients return for multiple treatments until 100% of the skin's surface is treated.
At low fluences with high density, the laser's zone of thermal injury extends to the superficial papillary dermis, producing excellent improvement in the appearance of actinic dyschromia and photodamage.
"There's no question color- and texturewise, these patients can really do profoundly well. Although just 20% of the epidermis is being treated [at each session], they don't look 20% better; they look 40%50% better.
"I don't know why; it doesn't make sense. It obviously has to do with our ability to perceive changes in the skin," he said.
A greater challenge is the best and safest use of the device at high fluences with low density. In this scenario, a deep wound is created over a smaller total area of the skinabout 10% per treatment session. Associated edema and erythema may persist for some time, but the potential exists for improvement of deeper wrinkles, just as he was hoping for, Dr. Rubin said.
Fraxel Could Be Well Suited for Some
The Fraxel 1,550-nm erbium laser may fill a niche for certain patients desiring skin rejuvenation, Dr. Rubin said.
These include:
▸ Patients with dark skin prone to hyperpigmentation. Because the damage inflicted by the Fraxel laser is done with microscopic pinpoints, it does not create the persistent erythema that often leads to hyperpigmentation following ablative therapies. Used at low fluences, it may be an excellent option for these patients.
▸ Patients with melasma. Melasma is essentially a condition of "misbehaving melanocytes," according to Dr. Rubin.
"When melanocytes aren't functioning appropriately, we would love to kill them without killing the surrounding tissue and creating hypopigmentation."
The selective action of the Fraxel laser may be able to "gently" knock out enough melanocytes to control melasma without tipping the balance too far, he said.
Results in melasma patients at 12 months are "intriguing," he said, although 68 months of clearance would be necessary to prove that the therapy is a significant advance.
▸ Patients desiring significant rejuvenation of nonfacial skin. Ablative CO2 laser treatments are risky in areas of the body with few pilosebaceous units to assist in reepithelialization. Because the Fraxel laser does not produce a widespread wound, it may be better at safely treating the skin of the neck, chest, hands, and arms.
Dr. Rubin has no financial interest in the Fraxel laser and receives no funding from its manufacturer, Reliant Technologies.