Recent Advances in Fractional Laser Resurfacing: New Paradigm in Optimal Parameters and Post-Treatment Wound Care

Abstract

Background: Laser plays an increasingly prominent role in skin rejuvenation. The advent of fractional photothermolysis revolutionizes its application. Microcolumns of skin are focally injured, leaving intervening normal skin to facilitate rapid wound healing and orderly tissue remodeling. The Problem: Even with the popularity of fractional laser devices, we still have limited knowledge about the ideal treatment parameters and postlaser wound care. Basic/Clinical Science Advances: Many clinicians believe that higher microbream energy in fractional laser devices results in better clinical outcome. Two recent studies argue against this assumption. One article demonstrates that lower fluence can induce comparable molecular changes with fewer side effects. Another study corroborates this by showing that lower-density settings produce similar clinical outcome in scar remodeling as higher-density ones, but with fewer side effects. To shed light on the optimal post-treatment wound care regimen from fractional ablative resurfacing, another paper shows that platelet-rich plasma (PRP) can reduce transepidermal water loss and skin color changes within 1 month after treatment. Clinical Care Relevance: For fractional nonablative resurfacing, lower settings in fluence or density may produce similar dermal remodeling as higher settings and with a better side-effect profile. Moreover, autologous PRP appears to expedite wound healing after fractional ablative resurfacing. Conclusion: Lower microbeam energy in fractional laser resurfacing produces similar molecular changes and clinical outcome with fewer side effects. The findings might portend a shift in the paradigm of treatment parameters. Autologous PRP can facilitate better wound healing, albeit modestly. Long-term follow-ups and larger studies are necessary to confirm these findings.

Fractional Laser Photothermolysis in the Treatment of Skin Defects: Possibilities and Effectiveness (Review)

“…When they are applied, the skin is thermally damaged but without any mechanical destruction. Its recovery after nonablative exposure takes less time, but the treatment is less effective even when several such procedures are used [1,32].…”

“…The scientific concept on which FP is based relies on the use of microscopic beams of focused light which cause small foci of tissue damage [37]. However the biological mechanisms leading to the complete recovery of the tissue without leaving any scars, and practically without side effects, are somewhat unclear [1].…”

Laser Applications in Wound and Scar Management Post-Mohs Micrographic Surgery: A Systematic Review

“…Recent advances in fractional energy-based technology have promoted an increase in the applications of lasers for post-MMS scar revision and wound healing. 15 , 16 However, there is a lack of systemic evaluation of the level of evidence for these interventions. 7 Thus, the objective of this systematic review is to evaluate the efficacy and safety of laser devices to promote wound healing and treat post-MMS scars.…”

Evidence-Based Cosmetic Surgery: Its importance and Impact on our Practice

“…Although some randomized trials can be found which review each technique, [3][4][5][6] most of the current literature on this topic includes review articles, such as Reserva et al's article, which discusses the indications of chemical peels in the male patient or Hsiao, which reviews the recent advances in fractional laser resurfacing. 7,8 Additionally, although these techniques are routinely used in our daily practice, there are currently only a handful of active clinical trials. 9 The cosmetic surgeon must make an educated decision on which technique to use and which will ultimately benefit his/her patient.…”