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Fraxel Fractional photothermolysis (Fraxel™ laser*) is a revolutionary new concept in laser treatment in which the skin is resurfaced fractionally at one time. A Fraxel laser beam creates numerous microscopic thermal treatment zones surrounded by islands of normal skin. The uppermost layer of skin remains intact during treatment and acts as a natural bandage. Areas are treated in a pixelated fashion (15 to 20%), leaving the majority of the skin undamaged to facilitate rapid repair and minimise healing time. Patients typically receive four to five treatments spaced 14 to 21 days apart. Conditions such as skin splotchiness, melasma, brownish discoloration, freckles, age spots, and acne and surgical scars, stretch marks, photo aging, wrinkles and skin crepiness of the face, neck, chest and arms can all be successfully treated. Prior to the procedure the skin is cleaned and topical anaesthetic applied. A water-soluble blue tint acts as a tracking guide for the laser system. Skin is treated with the laser in increasing fractionated doses. Post operatively patients experience mild pinkness for 1-2 days, followed by 2- 3 days of skin bronzing and slight peeling. Recovery time is minimal, and makeup can be worn a few hours after the procedure. The most effective treatment of facial wrinkles and photo damage is carbon dioxide laser resurfacing. However this procedure is associated with prolonged recovery time. A series of Fraxel treatments significantly and safely improves texture, dyschromia, lines and wrinkles of the face, neck and chest, tightening the skin and resulting in a dramatic difference. Biopsy results confirm the presence of new collagen. Melasma, a splotchy brownish discoloration of the skin, is a condition often resistant to topical creams, chemical peels, and intense pulsed light (IPL). Q-switched, carbon dioxide or erbium laser treatments for melasma are not usually recommended given their high incidence of hyper pigmentation (temporary skin darkening) and long recovery times. In resistant cases, Fraxel is an effective and safe treatment for the removal of pigmentation associated with melasma. Current laser treatment of acne scars utilises both invasive and non-invasive approaches. The former is limited by prolonged recovery time, the latter by subtle and gradual rate of improvement. A series of Fraxel treatments can result in significant improvement in skin texture, appearance and contour of acne scars. Hypertrophic scars are a common complication after surgery, removal of skin cancers, and traumatic wounds and are of cosmetic concern, especially on the face. They are elevated, firm and pink to red due to increased microvasculature supplying nutrients necessary for growth. Fraxel allows a light penetration of about 1000 um into skin, which makes the targeting of deeply located blood vessels effective. Its ‘fractional’ nature of treatments avoids bulk heating, reducing the risk of irreversible non-specific thermal injury to the skin, which may worsen scars. Fraxel is a safe and effective technique for treatment of stretch marks, significantly improving appearance and texture. There are numerous advantages to the technique of fractional resurfacing. Patients do not have open wounds therefore recovery time and complications such as infection are minimised. Areas that would be highly prone to scarring with traditional resurfacing lasers, such as neck, chest, and arms can be safely treated. Carbon dioxide resurfacing targets approximately 200 to 400 microns of tissue ablated during multiple-pass procedures. Using Fraxel, tissue can be penetrated more deeply, safely, because removal of the entire skin surface does not occur. Significant collagen is stimulated resulting in an improvement in skin texture, lines and wrinkles. The 1550nm wavelength of Fraxel targets tissue water not melanin making this treatment modality safe for patients of all skin types.
Public Presentations Fraxel Resurfacing Workshop, Treating Physician - Australian College of Cosmetic Surgery, Adelaide, Australia, May 2006 Fraxel Workshop, Treating Physician - Eighth Annual Mount Sinai Winter Symposium, Advances in Medical and Surgical Dermatology, New York, N.Y., December 2005
(Reliant Technologies, Palo Alto, CA, USA)
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