Fractional photothermolysis has been reported in the literature to improve both the pigmentary and textural changes associated with photoaging. The objective of the study was to review the literature of non-ablative fractional laser (NAFL) and ablative fractional laser (AFL) resurfacing for the treatment of photoaging. This is a review of the Medline literature evaluating NAFL and AFL for photoaging. Review of the literature supports the use of NAFL and AFL as safe and effective treatments for photoaging. It is likely that the controlled, limited dermal heating of fractional resurfacing initiates a cascade of events in which normalization of the collagenesis/collagenolysis cycle occurs. The advent of fractionated resurfacing for the treatment of photoaging is a significant advance over ablative laser resurfacing treatments, which were complicated by prolonged erythema, delayed onset hypopigmentation, and scarring.

We present our experience with the Shaw scalpel in the treatment of a patient with extensive rhinophyma. The heated blade of the scalpel provides rapid maintenance of hemostasis with minimal tissue damage and thus allows for rapid and accurate removal of tissue. After removing the bulk of tissue with the Shaw scalpel, the carbon dioxide laser and dermabrader are used to refine nasal contours.

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