LAS VEGAS—Ablative fractional resurfacing shows promise for skin resurfacing and tightening, according to the first studies conducted on use of the technology.
Considered a more intense treatment than nonablative fractional devices, the ablative fractional laser could hypothetically mitigate the risks that are traditionally associated with ablative laser resurfacing.
"Will this ablative resurfacing really be the middle ground?" Dr. Zakia Rahman asked at an international symposium on cosmetic and laser surgery.
Nonablative fractional resurfacing devices such as Fraxel were developed to produce results similar to those of ablative laser resurfacing with less downtime for patients. With ablative fractional resurfacing, there is more downtime, although it is still less than with ablative laser treatments, noted Dr. Rahman, who is with Stanford (Calif.) University.
Initial ex vivo studies of ablative fractional resurfacing on human skin revealed the degree of skin tightening possible at different energy settings: 20 mJ produced 10% area shrinkage, 32 mJ produced 18% shrinkage, and 40 mJ yielded 23% shrinkage.
"This is really significant to me," Dr. Rahman said. At a high energy setting, 90 mJ, there was a reproducible 37% area shrinkage in the excised human tissue, she added.
Compared with nonablative devices, ablative fractional resurfacing devices increase depth of penetration. The width of the thermal treatment zones increases as the energy of the laser treatment increases. Histologic slides show annular coagulation of dermal collagen and treatment zones that get smaller as they go deeper, Dr. Rahman said.
Results might be comparable to ablative laser outcomes. "At 19 mJ you definitely get immediate tightening, similar to what you would have with a CO2 laser," Dr. Rahman said.
Dr. Rahman also treated the forearms of 24 patients with an ablative fractional laser at settings that varied from 5 mJ per microablative zone (MAZ) to 40 mJ per MAZ. Two investigators assessed results at 1 week, 1 month, and 3 months after treatment to gauge safety and efficacy.
Further assessment consisted of full face and neck treatments at settings from 5 mJ per MAZ to 20 mJ per MAZ in 30 participants. Ten of these patients were studied at Stanford as part of this multicenter investigation.
All participants in the forearm, face, and neck assessments had subjective and objective improvement of rhytides, pigmentation, and tissue laxity, Dr. Rahman said. Another patient showed significant improvement of the perioral area.
Improvements were sustained at a follow-up assessment at 3 months. Erythema resolved by this time and no adverse effects were reported. Most participants have been followed out to 6 months in this ongoing study.
The wound-healing response that was seen represents a significant improvement over traditional ablative resurfacing, said Dr. Rahman, who is a consultant for Reliant Technologies Inc., developer of the device.
In response to a meeting attendee's question about the next step in development, Dr. Rahman said, "We are going to [a] higher energy setting now, 30 mJ, to see if we can get sustained and greater results."