The Wembley Medispa


Pearl Fractional Laser Skin Resurfacing

Monday 11 June 2012

The use of light as a medical treatment has grown considerably over the past few decades. There are now many kinds of devices, which deliver various different types of light for an ever-increasing number of potential uses. This article provides descriptive insight into the history of laser treatments; various laser procedures and a description of the Pearl Fractional Laser Skin Resurfacing Treatment as offered by the MediSpa. If you do not wish to read the details, simply skip to the last paragraph (Summary of Advice for Fractional Laser Skin Resurfacing).

A Little Bit of History

The use of light from lasers for medical procedures was developed in the 1960s when they were first used as cutting tools in operations by some surgeons. Laser technology has developed over the last few decades to treat patients with a variety of different skin problems including the effects of sun damage, the removal of body hair and recently the treatment of psoriasis and acne.

Lasers are also commonly used by ophthalmologists (eye specialists) for the treatment of certain eye conditions, and there are also now numerous private clinics offering laser treatment as a solution to short sightedness.

Since the early 1990s, lasers have become the high tech equivalent of dermabrasion or deep chemical peels for skin resurfacing (removal of the outer layer of the skin). Laser skin resurfacing declined in popularity due to the development of less aggressive light treatments aimed at skin rejuvenation.

Figures from the American Society for Aesthetic Plastic Surgery (A.S.A.P.S.), which has just started to track statistics for fractional laser skin resurfacing treatments, specifically with the Fraxel™ device from 2007, indicate that in 2010 just over 102,000 treatments were performed.

If you are considering fractional laser skin resurfacing the following information will give you a basic understanding of the procedure. It can’t answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask your doctor about anything you don’t understand.

What are Ablative and Non-Ablative Lasers and how do they work?

A laser is a high-energy beam of light that can be directed into certain areas or tissues within the skin. These beams of light are produced in one wavelength or colour at a time, and can vary in terms of their strength and the type of tissue that they can target.

The process of directing a light source to target a selected area of the skin to damage it is technically known as “selective photothermolysis”; where “thermolysis” refers to ‘decomposition by heat’ and “photo” refers to ‘light’.
Ablative Lasers

So – called “ablative” or skin resurfacing lasers briefly direct an intense burst of laser energy onto the surface of the skin. This energy heats water within the surface layers of the skin, causing both the water and the tissue of the skin to turn to vapour. Every time the laser passes over the skin, some of the outermost layers of the skin are removed in a precise and controlled way to the appropriate depth.

The skin then heals over a period of time, as new layers of collagen are produced. The skin can literally resurface itself, causing an improvement in the appearance of sun damaged or acne scarred skin. After the treatment, the skin will look much healthier than it did previously.

This intensive treatment can significantly reduce the appearance of lines, wrinkles, and pigment (or skin colour) changes on the face, neck, and other parts of the body. They can be used in sensitive areas, such as lines around the lips, eyes and even eyelids, or over the whole of the face. Acne and other types of scars and certain stretch marks can also be improved.

There are two main types of ablative laser – the original machines used were carbon dioxide lasers, and more recently erbium:YAG, and YSGG laser systems have been introduced.

The so called Non-Ablative lasers have been a more recent introduction in types of aesthetic equipment for skin rejuvenation.

These lasers have lower energy levels than ablative lasers (which resurface or remove the outer layer of skin completely), and try to cause damage within the dermal layer of the skin without removal of the outer epidermal layers. That is to say that the laser treats the layers of skin under the surface without damaging the surface too much. This lessens the recovery period after the treatment and reduces the number of complications that can occur.

It is thought that the laser’s heat in the dermal layers causes collagen to be produced which helps reduce the appearance of lines and wrinkles. However, the results from this type of procedure are less obvious than those which can be achieved with ablative laser skin resurfacing during which the surface of the skin is removed.

The use of different types of lasers by cosmetic clinics has increased significantly in recent years. The new non-ablative laser machines are aimed at giving maximum treatment results with minimum recovery time after the treatment. More recent still is the arrival of other non-ablative light machines, such as Intense Pulsed Light (IPL), Light Heat Energy (LHE) and Light Emitting Diode (LED) systems that can be more flexible in their use than some other lasers.

What is Fractional Photothermolysis?

Unlike with selective photothermolysis, where the whole of the selected target area is damaged; “Fractional Photothermolysis” seeks to only damage certain zones within the selected target area, (producing tiny dot, or pixel-like treated areas on the skin), leaving the other zones within it perfectly intact; hence only causing fractional damage through the heat of the light source. This allows the skin to heal much faster than if the whole area was treated, as the ‘healthy’ untreated tissue surrounding the treated zones helps to fill in the damaged area with new cells.

Fractional Photothermolysis or Fractional Laser Skin Resurfacing can therefore be compared to the precise alteration of digital photographs that we are able to do nowadays; pixel by pixel.

The concept of this fractional laser technology can be applied with either ablative laser resurfacing or non-ablative laser skin rejuvenation, using the various different wavelengths of lasers available.

This fractional approach (ablative and non-ablative) claims to achieve comparable skin improvements as obtained with conventional ablative laser resurfacing with an Er:YAG or CO2 laser, (depending on depth and severity of wrinkles), but without the associated side effects or downtime; i.e. you get the results of an ablative laser but with the downtime of a non-ablative laser.

Optimal improvement after fractional treatment is usually visible in about 2 – 3 months as collagen remodelling and skin tightening continues. The longevity of results is comparable to ablative laser resurfacing and as always is dependent on future ageing, the effects of gravity and sun exposure..

What can Fractional Photothermolysis treat?

Fractional photothermolysis is used for the treatment known as skin rejuvenation/resurfacing, which includes; the reduction and possible removal of fine lines and wrinkles, improvement of deeper wrinkles, repair of sun damaged skin on the face, neck, shoulders and hands, the reduction of age spots and blemishes, acne scars and hyperpigmentation (areas of darker pigment or brown patches in the skin).

The PEARL Fractional laser, for example, has been awarded clearance by the American Food and Drug Administration (FDA) for dermatological procedures requiring soft tissue coagulation; for the correction of peri-orbital wrinkles (crow’s feet), acne scarring and pigmented lesions, including age spots, sun spots and skin discolouration; for skin resurfacing and for the treatment of melasma, (dark skin colouration which forms on sun exposed skin – often affects women during pregnancy).
What are the risks and potential complications from Fractional Laser Skin Resurfacing treatment?
Fractional photothermolysis or laser skin resurfacing offers speedy healing and minimal to no downtime.
Depending on the area of your body treated and the type of device used, the procedure is said to be well tolerated; feeling like a mild prickling or burning sensation, or like elastic bands flicking on the skin. However, your practitioner may apply a topical anaesthetic to your skin prior to treatment to reduce any pain and discomfort, and offer you a chilled air device to hold over the treatment area yourself.

For several hours afterwards the skin will feel tight and have the appearance of a “sunburned” look. The skin will continue to look “pinkish” for 2 – 7 days (depending on the device used) and any swelling, which should be minimal, usually disappears after 1 – 3 days.

With Fraxel™, a bronzed, sun tan look caused by the dead, burnt cells at each MTZ will then remain for 3 – 14 days before naturally exfoliating.
Generally, as the skin heals itself, you will find mild to moderate skin flaking, which may last for up to 2 weeks.

Side Effects

Side effects or risks are minimal with this type of treatment and typically involve swelling and redness. There is a very limited risk of infection or scarring, with no oozing or crusting of the skin having occurred according to the manufacturers.

Unlike as noted with other laser and IPL treatments, there appears to be no risk of hyper- or hypo- pigmentation (areas of darker or lighter skin colour) with fractional photothermolysis. This is thought to be due to the fact that areas of healthy tissue are kept intact between the treated areas, unlike with ablative lasers, meaning that lasting pigment change does not occur.

If the practitioner uses the laser at higher powers, there is a risk of mild blistering (mainly on the chin and temple areas) and/or temporary skin discoloration, especially in darker-skinned patients.

Summary of Advice for Fractional Laser Skin Resurfacing

Traditional ablative laser resurfacing has been shown to be very effective in improving deeper lines and wrinkles associated with sun damaged skin. The downside is the recovery time and potential complications.

As a consequence of this, the development of lasers has focussed on non-ablative laser and IPL light sources that do not remove the surface of the skin, but still cause visible improvement of lines and wrinkles. These alternatives do not, as yet, produce such dramatic and long lasting results as ablative lasers, but they are safer and involve virtually no recovery time. The fractional laser arena can also be divided into fractional ablative and fractional non-ablative devices.

Whilst not 100% as effective as traditional ablative laser procedures, (depending on the depth and severity of the wrinkles being treated), fractional laser skin resurfacing (ablative and non-ablative) appears to achieve comparable skin improvements as obtained with conventional ablative laser skin resurfacing but with fewer potential side effects.

However whether standard ablative or fractional ablative technologies are a clear performance leader is still to be determined. Similarly, the argument for ablative fractional versus non-ablative fractional is heavily contested within the industry. We will watch this space…

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