Fractional Resurfacing Laser — Should We Believe the Hype?

June 23, 2009. 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). American Society for Aesthetic Plastic Surgery (ASAPS) figures indicate that laser skin resurfacing was the fifth most common cosmetic treatment in the United States in 2008 with over 570,000 treatments, an increase of 12% on 2007 statistics. Last May, the leading experts held a panel discussion at the ASAPS annual meeting in Las Vegas, asking, “Is laser far superior to chemical peels and dermabrasion?”

First, let’s describe the fractional resurfacing laser technology and how it works. Unlike earlier laser technologies, with fractional resurfacing only a specified percentage of the skin receives the laser light. It was introduced to maintain the effectiveness of ablative lasers while minimizing the complications such as loss or change in pigmentation and in some cases, scarring. Moreover, patients of color may now be safely treated for a variety of skin conditions with this type of less invasive laser. Fractional laser technology delivers a series of microscopic, closely spaced laser spots to the skin while simultaneously preserving the normal healthy skin between. It allows for more rapid healing and less risk for complications. The latest fractional resurfacing treatments are office-based procedures done on an out-patient basis, with recovery time (time away from public eye) between three and seven days. Costs can range from several hundred to several thousand dollars, and because they are usually considered cosmetic, these procedures are generally not covered by insurance.

After all the discussion of the pros and the cons, the ASAPS panel of leading experts concluded that there is no clear answer to whether laser is superior to the more traditional techniques of dermabrasion and chemical peels. True, recovery time from fractional laser tends to be less than from dermabrasion and chemical peels, but a lot of questions such as the ideal depth and strength of the laser beam and the long term impact of laser on the skin, remain unanswered. On the other hand, laser is easier to control for specific spots, whereas a peel or a dermabrasion works a general surface area of the skin.

Dr. Mark Mitchell Jones has followed the discussion of these techniques closely over the years, and tends to side with what is the safest for the patient and with the least risk of any adverse effects. “Safety has always been the primary concern of my practice, and the long term consequences from burning the dermis of the skin, which laser effectively does, are difficult to predict,” Dr. Jones exclaims. “The impact of any kind of burn is likely to vary from person to person, depending on their skin type and condition,” he continues.

The ASAPS panel also concluded that fractional resurfacing may not be ideal for every skin condition. Deep wrinkles, for example, may require so much density from the machine that severity of the treatment compare to the ablative laser in the dermis, thereby defeating the purpose of fractionation entirely. Conversely, fractional technology that penetrates deep into the dermis could be an overkill for someone with only surface blemishes. For best results, it is important for the plastic surgeon to identify the goals of the treatment and establish clear expectations with the patient. Only then can the surgeon recommend the most effective resurfacing technique to accomplish the desired results, whether with laser, dermabrasion, or chemical peel. The most popular option is not always the most appropriate option.