CO2 Fractional Lasers: Home Run or Hype?

The first of the fractional lasers was the Fraxel 750 which has evolved into the Fraxel Restore. This laser was clearly a significant advance over previous lasers, particularly in treating skin discoloration and acne scarring. It also helped lines, wrinkles and skin texture, but the improvement was not nearly so dramatic. The next advance, which was supposed to improve wrinkling as well as do everything that the Fraxel Restore could do, was the fractional CO2 laser, the application of the fractionated concept to the CO2 laser. The original CO2 laser was the most effective resurfacing laser, but one that, at times, produced unwanted side effects.

The hope, and expectation, was that by fractionating the CO2 laser, it would be possible to achieve results similar to that of the old CO2 laser, with less risk of side effects and less downtime. These results would ideally be seen after a single treatment.
There have been a number of fractional CO2 lasers released, by a variety of companies, but the one that most closely resembles the original Fraxel laser is the Fraxel Repair. It was released for treatment of lines and wrinkles, and later approved for acne scarring. Initially it was said to require only one treatment for good results, and in over 500 treated patients there had been no evidence of scarring or significant color change.
With time and experience, it has become clear that, for adequate results, more than one treatment is frequently needed, especially for acne scarring. Furthermore, the downtime was close to one week, rather than the few days, as initially stated.
Now, in the March 2009 issue of "Lasers in Surgery and Medicine", there are two separate reports of multiple cases of significant scarring after fractional CO2 laser therapy. All the scarring occured on the neck, except for one case of scarring involving the lower lid, resulting in a downward displacement of the lid margin.
It is clear that the fractional laser treatments involve more risk than previously believed, and that their effectiveness, at least for a single treatment, is less than the traditional resurfacing lasers.
Based on our experience, it seems that the Erbium YAG laser, the Sciton Profile, is more effective than the fractionated CO2 laser, and it may be safer as well.

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

fraxel

Comments

[Tania]

Thanks for article. Everytime like to read you. Thanks Tania

[Skin Care]

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