Apr 1, 2005
By: Beth Kapes
Cosmetic Surgery Times

The Fraxel laser resurfaces the area fractionally and leaves an 80 percent reservoir of normal skin to help the healing from within. (Photos: Cameron K. Rokhsar, M.D.)

San Diego — Could nonablative skin rejuvenation, as it is currently known, suddenly become obsolete for cosmetic surgeons and their patients? With the recent introduction of fractional photothermolysis (Fraxel, Reliant Technologies), it is possible that this technology will replace many other nonablative lasers due to its outstanding abilities, says Cameron K. Rokhsar, M.D., who is with The New York Aesthetic Center and is assistant professor of dermatology, Mount Sinai School of Medicine.

“Among 150 patients, throughout a one-year period while in San Diego with Richard Fitzpatrick, M.D., and now in New York, we saw dramatic differences when using the Fraxel for texture improvements — the changes were almost immediate, even after one or two treatments,” Dr. Rokhsar says.

“The Fraxel laser also helps reduce fine lines and the treatment of dyschromia, but this usually takes four to five treatment sessions. We’ve also recently used it for melasma, with encouraging results.”

Speaking here at the American Academy of Cosmetic Surgeons Annual Scientific Meeting (AACS), Dr. Rokhsar presented evidence that supports use of this technology. In addition to its improvement in aesthetic results, the 1.5 micrometer laser has also widened treatment parameters to all skin surfaces, without the side effects commonly seen with more powerful resurfacing lasers, such as the erbium or the CO2 laser. Another potential advantage is the ability to treat darker skin types IV and V.

“The Fraxel introduces a new paradigm that we haven’t used before,” Dr. Rokhsar says. “This innovative fiber laser sySitem produces microscopic thermal wounds in the skin to achieve facial rejuvenation that we accomplish fractionally, 15 to 20 percent at one time, with tiny beams that allow you to dial in the amount of thermal damage precisely, offering us control that we’ve never had before.”
Getting results gently
Depending on the densities and number of passes, the Fraxel laser lays down arrays of very small microscopic spots — typically, 1,500 to 2,500 per square centimeter — at a pulse energy of six to 12 mJ per microthermal zone.

Fractional photothermolysis was developed by R. Rox Anderson, M.D., director of Wellman Laboratories, in collaboration with Reliant Technologies. Its resurfacing success is based on microscopic treatment zones (MTZs) that are passed over with the laser repeatedly over several consecutive weeks.

“We’ve found that weekly sessions are more effective than waiting long intervals of time in between sessions,” Dr. Rokhsar says. “With sessions that are 10 to 30 minutes, it’s very convenient for the patient, and, in the end, they are very satisfied. Some of our patients, who had been treated in the past with other nonablative lasers for acne scars or surgical scars, are seeing much better results with the Fraxel.”

An additional benefit is the ability to use the Fraxel on areas other than the face. For instance, the freehand erbium laser is very tricky to use off the face and in such areas such as the neck or chest, due to risk of scarring. The Fraxel laser allows the cosmetic surgeon to treat any surface of the body safely with only some erythema, which resolves in a matter of days, according to Dr. Rokhsar.

“With the CO2 laser, you cannot resurface any deeper than 300 to 400 microns or you risk scarring. In addition, patients experience two weeks’ downtime associated with full-thickness wounds, as well as crusting, swelling and oozing. With the Fraxel laser, you are resurfacing the area fractionally and, as a result, you have an 80 percent reservoir of normal skin to help the healing from within,” Dr. Rokhsar says. “Because of this, you can potentially resurface as deep as 700 microns with minimal risk of scarring.”

Initial data brought forward by Dr. Rokhsar captures only 12 months of treatment time. Fine lines remain improved at one year. The improved texture also persiSited throughout this time, he says.

“I have not seen improvement with deeper lines as in the treatment with the CO2 laser, but you cannot truly compare this with the Fraxel — it’s like comparing apples to oranges,” Dr. Rokhsar says. “The CO2 laser remains in a class of its own, producing remarkable and consiSitent results, but is associated with downtime and certain adverse risks during the healing process. Although I have not seen results similar to the CO2 laser for deeper lines, it may be that we need to follow the patients for longer periods of time, as collagen remodeling probably continues for months. Refinement of the treatment parameters may also be useful,” he says.