Last Updated on February 9, 2021 by Alice Pien, MD & Asher Milgrom, PhD

Watch the video : The science of erbium and CO2 fractional laser resurfacing

Today, fractional lasers and laser resurfacing are what Dr. Pien and I are going to be discussing.

The Science of Fractional Lasers

Dr. Milgrom – As you know, we have over 25 different types of lasers here with many different kinds of frequencies and many different types of geometries. What I mean by that is that the science of laser medicine is not just about the power and the frequency of the energy coming out of the laser but also the geometry of the beam itself.

There are many different geometries of laser beams.

There are many different geometries of laser beams.

Is it a solid beam? Is it a rounded beam? Is it a square edge beam? Or in this case is the beam fractionated? Fractionated means that we have taken the solid beam of laser energy and broken it into many tiny pixelations of energy. Little micro-columns of energy that can penetrate into the skin leaving most of the skin unaffected.

Solid Beam of Energy

When you have a solid beam of laser energy that is occupying 100% of its beam width on the skin, the energy is absorbed as it penetrates down deeper and deeper and deeper.

With a solid beam of energy the energy is absorbed as it penetrates deeper into the skin.

With a solid beam of energy the energy is absorbed as it penetrates deeper into the skin.

If I want to get the energy down to the bottom of the dermis, where all that collagen is that we need to work with, then I am going to have to use a high energy level at the surface of the skin and that might actually cause the skin to be burned.

Fractionated Beam of Energy

On the other hand, if I can pixelate, or fractionate, the beam into tiny little micro-columns of energy, where most of the skin is not affected but only a certain percentage of it is, then I can us a much higher level of energy.

With a fractionated beam of energy the laser energy can penetrate all the way down deep into the dermis.

With a fractionated beam of energy the laser energy can penetrate all the way down deep into the dermis.

Because the energy is in little micro-columns I can use high energy and I do not risk burning the surface of the skin. The laser energy can penetrate all the way deep into the dermis where I need to effectuate changes in the dermal matrix of collagen.

The CO2 Fractional Laser

Watch the video : What is fractional CO2 laser resurfacing

Dr. Milgrom – You have probably heard a lot about the CO2 fractional laser because it is incredibly effective on working with the collagen of your dermis. And very effective of giving an overall lift and tone of the skin, tightening of the pores and thickening of the dermis especially with aged and sun damaged skin.

In this photo of CO2 fractional laser treatment you can see the treated and untreated areas.

In this photo of CO2 fractional laser treatment you can see the treated and untreated areas.

Dr. Pien – The fractional CO2 laser is one of my favorite lasers for resurfacing the skin. What it does is that the laser is fractionated. Now you are breaking those laser beams down to hair follicle size. So tiny and the beams are alternating.  You have treated area, untreated area, treated area, untreated area. The untreated area will help the healing of the treated area. So the fractional laser allows healing time to be much shorter.

What The CO2 Fractional Laser Treats

Dr. Pien – The fractional Co2 laser, is to me, jack of all trades. This laser does a lot of things. It’s a great laser to do a series of treatments in the beginning if you have never had any laser work done. The fractional Co2 laser really helps to get your body to generate collagen, tighten up the pores, resurface the skin, remove all the surface dead skin.

Works on Every Skin Color

Dr. Pien –The wonderful thing about the fractional Co2 laser is you can do it on any skin color. On fair skin, on medium skin like myself and on darker skin. You just have to be very good in assessing the patient’s skin first before doing a full on fractional laser treatment on their face.

The Results 

Dr. Pien – It’s a progressive improvement of your skin. You need a series of laser treatments to see results. For many people, I get calls after one treatment excited that they already see results. The results achieved from the laser resurfacing really depends on the patients physiology.

Everyone’s skin is very different. Even on the same patient, their forehead and their cheeks are very different kinds of skin. The skin around the eyes is very thin and has a lot less collagen. The skin around the eyes is harder to see changes right away. Especially the smiley lines or crows feet. We’ll always have some, they will never 100% go away, but they will be softer. All the areas of the face will respond differently.

After their initial laser treatments, I recommend to my patients that they come once every 6 months, or once a year, to do a maintenance treatment.

Pain and Downtime

Dr. Pien – When you are getting the fractional Co2 laser resurfacing treatment, we numb you first with topical anesthetic. By the time you are numb what you are feeling during the treatment is minimal. The laser treatment itself is about 15 to 20 min long so it’s a quick treatment. Afterwords you will feel a mild sunburn sensation.

Immediately after the CO2 fractional laser treatment your skin will turn from barely pinkish red to sunburn red depending on the power used.

Immediately after the CO2 fractional laser treatment your skin will turn from barely pinkish red to sunburn red depending on the power used.

The downtime for fractional Co2 laser resurfacing is minimal depending on the setting. You can go from barely pinkish red to sunburn red. There is no blood involved. There is no oozing.

After that you are pretty much back to normal. You can definitely put some makeup on the next day. Sunblock is very important for the aftercare. You want to minimize sun exposure over the next few days while you are healing time.

Final Thoughts on the CO2 Fractional Laser Treatment

Dr. Milgrom – We rarely use a laser by itself. We get much better results when we recognize that your physiology is like a symphony and we want all the different components of your symphony to be playing for which you need different lasers.

If we were to do a single laser skin resurfacing just to tighten up your collagen and tighten up your pores and give you a lift the CO2 fractional laser is the one we would use.

The CO2 fractional laser is by far the most effective for laser resurfacing as a single laser to use in those kind of conditions.

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