Fractionated ablative laser
The Alma Erbium 2940nm fractionated ablative resurfacing laser is an
essential component in the treatment of acne scarring. Specifically, it is
used to treat surface textural irregularities from acne, including boxcar
scars. It is often used as part of a sequence to break down old, scarred
collagen in favor of newly repaired collagen. The result is smoother skin
with belter texture and tone, and improvement in the appearance of
acne scars.
How do fractional ablative lasers work?
A wavelength of energy in microscopic columns vaporizes the fissue in
what is known as “microscopic thermal zones.” The zones are directed
through abnormal scarred collagen. The body then naturally repairs
these zones with newly regenerated collagen and elastic fibers.
What is the difference between ‘fractionated’ ablative and ‘fully’ ablative lasers?
Fractionated ablative lasers ablate tiny columns of tissue with the
surrounding zones remaining intact. Therefore, only about 20% of the
tissue is ablated. The surrounding 80% of the tissue remains unaffected
and is essential for rapid wound healing. Because only a portion of the
tissue is ablated, multiple sessions are necessary to achieve results.
In contrast, fully ablative lasers produce 100% ablation of the entire
epidermis and part of the dermis. Although the results can be quite
good with this treatment in only one session, there is prolonged
downtime and higher risk of complications, such as scarring, infection
and hyperpigmentation.
What is the recovery after fractionated ablative laser and how much downtime is there?
You should expect about 5 days of downtime, though many patients go
back to work within 2-3 days of treatment. You will feel like you had a
moderate sunburn for a day or two. Initially, there will be swelling with
some grid like marks, followed by some mild peeling. Within less than a
week you will see new pink skin that is softer and younger looking.
Collagen production will continue for months afterwards. Three to six-
sessions are needed to achieve an optimal outcome. It is important
that you protect yourself in the sun with wide brimmed hats and
sunscreen once the skin has healed.
Can fractionated ablative laser be performed at the same time with other acne scar treatments?
Yes, it can. And often it is used as part of our trio of CROSS, subcision,
and filler in the same session. It may also be combined with Vivace RF
microneedling.
Can fractionated erbium ablative laser be used in patients with skin of color?
Yes, it can. However, patients need to be pretreated with bleaching
cream before and after treatment, along with strict photoprotection.
Despite these measures, there is still some risk of temporary
hyperpigmentation, but far less as compared to deeper CO2 ablation.
Are there risks to fractionated ablative laser?
Yes, but these are rare, and far less than with fully ablative laser. Some
of the risks include bacterial and viral infections, persistent redness,
contact dermatitis, discoloration, and worsening of scarring.