Fractional and Ablative lasers for laser skin tightening

AUTHOR - DR. DAVID JACK

As patients seek solutions to keep their skin looking healthier and youthful for longer, laser technology has become an important tool in the the skin health armoury in the last 20 years. Traditionally, fractional ablative lasers such as CO2 laser and fractional ErbiumYAG lasers have been associated with long downtime - a key issue for patients considering these treatments.  

Recent advances in laser technology recently have resulted in a wave of new treatments that minimise the downtime associated with fractional and ablative skin lasers, but still give the the dramatic results in terms of skin tightening and resurfacing associated with CO2 and ErbiumYAG that make the treatments attractive for patients. Leading the way is UltraClear, the world's first fractionally ablative cold fibre laser. With the introduction of UltraClear and laser coring treatments at our clinics in both London and Edinburgh, in this article I’m going to delve into how fractional and ablative laser treatments work and the numerous skin issues they treat.

Understanding Fractional & Ablative Lasers

What Are Ablative Lasers and how do they work?

Ablative lasers, such as CO2 and ErbiumYAG lasers, are designed to remove the outer layers of the skin (i.e. the ‘epidermis’) while simultaneously heating and injuring the underlying dermis of the skin. This dual action creates a controlled thermal (heat) injury in the skin which stimulates the fibroblast cells in the dermis to increase collagen production in the weeks and months’ following the treatment. In turn this leads to improved skin texture and elasticity.

Ablative lasers are highly effective for treating deeper wrinkles, acne scars and uneven skin tone. However, they require more downtime compared to non-ablative treatments. They can also help to improve skin tone and pigment for those with certain hyperpigmentation conditions, such as melasma. By ‘ablating’ the epidermis of the skin, ablative lasers excel at resurfacing the skin, improving its overall texture and tone by removing damaged skin layers so can be particularly useful in those with sun damage.

What Are Fractional Lasers and how do they work?

Fractional lasers, as the name suggests, treat only a fraction of the skin at a time, leaving surrounding tissue intact. They can be ablative (i.e. they remove epidermis wherever the skin is treated), or non-ablative (i.e. they don’t break the surface epidermis layer of the skin). Fractional lasers work by drilling individual injuries or ‘cores’ which appear as dots on the skin, with normal, untreated skin between the dots or cores . ‘Fractionally ablative’ treatments significantly reduce downtime vs ‘fully ablative’ lasers while still delivering impressive results, making them increasingly popular for patients seeking treatments which create skin tightening and skin texture improvements. Fractional lasers can be either ablative (i.e. remove part of the epidermis) or non-ablative (i.e. they do not remove/destroy the epidermis in the treated areas). UltraClear is an example of a fractionally ablative treatment where there can be ablation of the skin surface and also fractional injury to the dermis of the skin, giving both improvements in the skin surface through resurfacing, and also deeper skin tightening.

The Science Behind Fractional & Ablative Lasers

How do fractional lasers improve collagen production?

The key mechanism driving the effectiveness of these lasers is their ability to stimulate collagen production in the dermis of the skin. Collagen is responsible for skin’s firmness and elasticity and tends to decline as we age. This in turn leads to sagging, fine lines and wrinkles.

 In the 20th century it was discovered that a normal response of the dermis of the skin to injury was to increase collagen production by cells called fibroblasts - this principle is utilised by fractional lasers in their mechanism of action. By creating controlled micro-injuries in the skin, fractional and ablative lasers trigger the body’s natural wound-healing process, resulting in the production of new collagen and elastin fibres in the dermis.

Laser Skin Tightening and Resurfacing with fractional lasers

Fractional and ablative lasers are also able to tighten the skin by contracting existing collagen fibres in the dermis. This effect occurs during and after the treatment, and continues to improve over the longer term as new collagen is synthesised over the weeks and months following treatment.

How long does it take to see results from fractional laser treatments for the skin?

 The key concept in fractional/ablative laser treatments is that the technology is being used to stimulate a healing process in your skin, so many factors govern how long it takes to see results. Generally speaking, the initial healing process will take a few days to a few weeks (more details can be found below) but the post-healing maturation and regenerative effects can take up to six months post treatment to fully show.

Are there any ways to maximise results from fractional laser treatments?

Generally speaking, collagen regeneration can be enhanced by using good topical skincare products to boost collagen production. These include daily sunscreen (to protect both the collagen in your dermis and also the collagen producing cells from the damaging effects of UV light), vitamin C and other antioxidants, as well as retinoids. It has even been shown that - laser can actually help penetration of certain skincare ingredients provides all of these ingredients in a simple format to make looking after your skin in the months following your fractional laser treatment exceptionally simple. Similarly, maintaining a healthy diet, low in inflammatory foods and high in antioxidants (particularly vitamin C, which is a cofactor in collagen production) and protein, will help maximise the results from your treatments.

 In terms of speeding up healing from fractional CO2 or Er:YAG laser, ‘closing’ wounds created by fractional laser using occlusive dressings or creams has been shown to speed up healing and effectiveness.

 Lifestyle factors such as avoiding smoking and alcohol, as well as minimising stress (and high cortisol levels, which can inhibit collagen production) will also improve overall results.

Common Skin Concerns Treated by fractional Laser Treatments

Fractional lasers for Fine Lines and Wrinkles

Fractionally ablative laser treatments are used most often to reduce the appearance of fine lines and wrinkles on the face and other areas. These lasers do this by stimulating dermal collagen production and resurfacing the skin. Lasers such as UltraClear and CO2 (for example fraxel laser) are particularly effective in areas prone to ageing, such as around the eyes, mouth, and forehead.

CO2 and fractional lasers for Skin Laxity

Laser skin tightening is an excellent non-surgical option for patients looking to improve skin laxity without surgery. By stimulating collagen production and causing contraction of collagen fibres in the face (or elsewhere in the body), fractional laser treatments can help to tighten loose skin on the face, neck and other areas. For those undergoing skin tightening surgery, for example deep-plane facelift treatments, fractional lasers can be complimentary treatments that can help improve the outcomes of surgery.

Fractional lasers for Acne Scars and skin Texture Irregularities

Fractional and ablative lasers are highly effective for improving acne scars. By targeting dermal scarring, which typically has high levels of scar-type collagen fibres, fractional laser can help promote reorganisation and regeneration of more organised collagen collagen fibres to create a more even texture of the skin. Similarly, ablative lasers can help improve the overall look of the skin surface by stimulating regeneration of the epidermis of the skin.

Fractional lasers for surgical and other scars, laser resurfacing for stretch marks

Similar to acne scars, surgical scars and other types of scars, such as hypertrophic or stretched scars can be improved using fractional lasers. By creating injuries on the surface of skin alongside cores deep into the dermal layer of scars, irregular scar-type collagen can be restructured into more supple tissue to minimise the appearance and texture of problematic scarring.

Ablative and fractional laser for stretch marks

Problematic stretch marks result from tears in the dermis of the skin due to stretching, for example in pregnancy or fast weight gain. Fractional lasers not only help to cause contraction of the collagen fibres in stretch marks (causing the scar to contract overall), but also help to stimulate improvements in the type of collagen in the damaged tissue - resulting in improvements in the appearance and texture of stretch marks anywhere on the body.

Fractional laser for Hyperpigmentation and sun damage

Fractional lasers such as CO2 and UltraClear can address certain pigmentation issues, such as age spots, melasma, and sun damage (solar lentigines by removing areas of the pigmented layers of skin. This is followed by regeneration of the epidermis, causing restoration of a more uniform complexion. There is also some evidence that fractional or ablative lasers may even help in removing early stage skin changes that may progress later to cancers.

Ultraclear vs fractional CO2 and Erbium:YAG lasers

Ultraclear Laser is a revolutionary new laser technology designed for skin rejuvenation and resurfacing. UltraClear is the worlds first cold, ablative fractional laser. It combines the benefits of ablative and non-ablative lasers, to both improve skin texture, tone and fine lines, whilst also tightening skin. It’s ablative function also allows it to treat certain types of hyperpigmentation in the skin.

UltraClear works using a novel cold fibre laser technology - using a precision wavelength of 2910nm, which - like CO2 and Erbium:YAG targets water molecules in the skin to create fractional thermal (heat) injuries in both the dermis and epidermis of the skin. Unlike CO2 and Erbium:YAG lasers, however, the untreated skin the fractional micro-injuries created are minimally affected, enhancing healing and minimising downtime and risks of side effects such as post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE).

 These features mean that UItraclear offers not only the same (if not better) results than other fractional lasers, but also minimises the risks and high downtime that are traditionally associated with more powerful laser treatments. This also means that UltraClear may be used in darker skin types, where laser treatments may not previously have been an option.

What to expect from a fractional laser treatment as a patient

The treatment process for fractional laser

Laser treatments should always performed in a clinical setting with trained laser practitioners. Depending on the treatment depth, a topical anaesthetic may be applied topically for comfort, or with deeper treatments, injectable local anaesthetic may be performed. Once your skin has been numbed, eye protection will be placed to protect your eyes from the laser beam. The laser is then passed over the treatment area and you may feel a slight tingling sensation or mild discomfort. Each session will typically last 15-30 minutes, depending on the size of the area being treated.

What is the downtime like for fractional laser?

Recovery time and downtime varies depending on the intensity and depth of the fractional laser treatment. Some clinicians may treat with higher settings over fewer sessions, whilst others may treat using lower settings but more sessions - depending on the assessment of your individual skin needs. Deep fractional CO2 laser treatments often require 7 days of downtime, where the skin is red and sensitive (a bit like sunburn) with occasional scabbing (fully ablative treatments may even need up to 30 days of downtime and care, however these are rarely performed nowadays - fractional ablation reduces this downtime significantly).  More contemporary treatments such as UltraClear reduce this downtime to around 3-5 days, depending on the intensity of the treatment. Laser Coring (the most intense form of UltraClear laser) usually requires about 5-7 days downtime.

What is the post-treatment care for fractional laser?

Post-treatment care for fractional laser involves keeping the skin hydrated and clean. The key issue to avoid in the early stage post-treatment is skin infection or irritation of the injured skin (which can cause the skin injuries to deepen or advance). For this reason, aftercare protocols are exceptionally important. Usually an occlusive cream or ointment such as Aquaphor will be used in the days immediately following the treatment, and avoiding sun exposure is essential. Following this, prescribed skincare products to enhance healing will be given. Traditionally, saline or even dilute vinegar dressing may have been used but there are more contemporary solutions for the post care of fractional laser that we use in clinic. By following the aftercare instructions carefully, you will maximise results and minimise risks of complications such as postinflammatory hyperpigmentation, irritation or prolonged redness (post inflammatory erythema or PIE).

Are there any worrying signs I should be aware of after fractional laser skin treatments? 

Following a fractional laser treatment, the clinic team should be in regular contact with you to manage any downtime. It should be kept in mind, however, that you should contact your doctor if you notice:

•   Severe or worsening redness/swelling beyond 5 days

•   Signs of infection (pus, increased pain, warmth)

•   Unusual pigmentation changes

Conclusion

Fractional and ablative lasers are viewed by many as the pinnacle of skin rejuvenation Newer innovative lasers like UltraClear and laser coring offer solutions that minimise risk and maximise results compared to traditional CO2 or Erbium:YAG laser treatments. By addressing a wide range of skin concerns, from wrinkles and scars to pigmentation and laxity, these lasers offer transformative results for patients that may delay the need for surgery.