Active FX and Fractinated CO2 Lasers

A question has been asked about the Active FX laser and the results compared to the Fraxel, now renamed, in the upgraded version, the Fraxel re:store. The Active FX is one of several newly introduced or about to be introduced lasers that apply the principle of fractionated resurfacing (treating multiple small areas of skin and leaving untreated areas between treated areas) to the CO2 laser. The questioner referred to an article claiming that more new collagen is created by the Active FX than by a series of Fraxel treatments.

There are a number of issues here. First of all, people are concerned about the results they can see, not by laboratory measurements such as the amount of new collagen. This may correlate to the clinical changes seen, or it may not. Or the correlation may exist, but not be proportional. A 200% increase in collagen production may yield only a 10% additional clinical improvement.
A second, and very important issue is the frequency of side effects. The Fraxel laser excels in this regard, having an extremely low incidence of side effects. The CO2 laser was the first successful skin resurfacing laser, and there has never been a laser that has surpassed it in effectiveness. However, it was the side effects that were the primary reason for the decline in the use of the CO2 laser. The side effects were the risk of scarring and the risk of permanent loss or decrease of pigmentation (hypopigmentation) in the treated area. Furthermore the hypopigmentation would often be delayed in appearance, occurring more than a year after the treatment.
When a new laser type is introduced, it takes at least a year, and often more, before the side effect profile is well understood. Only after a significantly increased number of patients have been treated do some of the side effects become evident. This is particularly applicable to a laser that is already known to have side effects that can be delayed by a year or more.
Finally, an issue that is important to many people is downtime. Here again, the Fraxel excels. Almost everyone returns to work the day after treatment. From my conversations with he representatives of the laser companies developing these devices, it is clear that the fractionated CO2 lasers will have significant downtime. The CO2 laser had scabbing and crusting of 7-10 days, followed by facial redness that could last months. We already have a resurfacing laser, the Sciton erbium YAG, that does a better job than the Fraxel on lines and wrinkles with less downtime and risk than the CO2 laser. Where the fractionated CO2 lasers will fall on this spectrum remains to be seen.

Gerald N. Bock MD
Stockton, CA
California Skin Laser Center