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Key Points
- A single session with ablative minimally invasive fractional lasers is typically sufficient to achieve desirable results
- When buying CO2 fractional laser, know the percentage of skin being penetrated by the laser versus how much skin is left intact per pass
- Complications associated with fractional CO2 lasers include hypopigmentation, hypertrophic scars, mottling of skin
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Dr. Narurkar
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Fractional carbon dioxide lasers offer the advantage of minimal downtime, as well as clinically and photographically visible results that have made this minimally invasive modality increasingly popular among cosmetic surgeons for facial-rejuvenation and anti-aging treatments.
While this method is less risky than traditional ablative lasers — and more effective than nonablative fractional lasers — experts say it's critical to know how to manage potential complications. It's also helpful to understand the distinction between ablative, minimally invasive fractional lasers and nonablative, noninvasive fractional lasers.
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Before (left) and one month after fractionated CO2 and low-power erbium laser treatment. (Photos credit: Harry Mittelman, M.D.)
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With nonablative fractional lasers, several sessions are usually necessary to achieve acceptable results, whereas a single session is typically sufficient with ablative minimally invasive fractional lasers. Harry Mittelman, M.D., associate clinical professor, Stanford University, and founder of Mittelman Plastic Surgery Center, Los Altos, Calif., points out that the results of nonablative, noninvasive fractional lasers are "marginal, versus the results from fractionated CO2, which are substantially better."
In his role as chairman of the Emerging Trends in Technology Committee of the American Academy of Facial Plastic Surgery, Dr. Mittelman has experience with and/or knowledge of just about every facial cosmetic laser on the market. He says fractional CO2 lasers improve sun damage of skin and provide a glowing look that does not occur with noninvasive, nonablative fractional lasers. What's more, he says, fractional CO2 lasers combined with a low-powered erbium laser offer "the most gratifying, visible improvement for facial rejuvenation using minimally invasive lasers." Additionally, the duo provides "safe, effective, uniform patient acceptance and objective improvement with virtually no post-treatment pain."
STUDY DETAILS In a recent study, Dr. Mittelman treated approximately 50 patients with either a fractionated CO2 laser or a low-power erbium Nd:YAG laser, or both. He found that the fractionated CO2 alone resulted in slightly little less effectiveness with dyschromia, and that the combined lasers provided the best results without increasing downtime, pain, swelling or complications.
"The fractionated CO2 laser performs the lion's share of the work, and the low-power erbium vaporizes off the superficial layer to help with improving dyschromia, and improving further the color and vibrancy of the skin's surface," Dr. Mittelman says. There have been no significant complications in fractionated CO2 resurfacing of the face in his experience and with his fractionated CO2 laser, he says.
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Complications resulting from fractional CO2 laser resurfacing include persistent erythema, hypertrophic scarring and hyperpigmentation. This photo was taken four months after the patient underwent the resurfacing treatment.
(Photo credit: Vic Narurkar, M.D.)
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COMPLICATIONS According to Vic Narurkar, M.D., of the Bay Area Laser Institute, San Francisco, ablative fractional lasers were expected to overcome a lot of the risks associated with traditional CO2 laser resurfacing. However, he says, that hasn't necessarily been the case.
