Fractional photothermolysis—an update

The novel concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, resurfacing techniques. Unlike conventional ablative and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair. Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. In this review we discuss the two concepts, their technical details and clinical indications, and we describe the current literature available.

[1]  H. Laubach,et al.  Skin responses to fractional photothermolysis , 2006, Lasers in surgery and medicine.

[2]  P. Friedman,et al.  Fractional resurfacing: a new therapeutic modality for Becker's nevus. , 2007, Archives of dermatology.

[3]  S. Grunewald,et al.  Fractional laser skin therapy , 2009, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[4]  P. Friedman,et al.  Fractional photothermolysis for the treatment of surgical scars: A case report , 2006, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[5]  M. Lapidoth,et al.  Novel Use of Erbium: YAG (2,940‐nm) Laser for Fractional Ablative Photothermolysis in the Treatment of Photodamaged Facial Skin A Pilot Study , 2008, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[6]  M. Gold.  Fractional technology: a review and clinical approaches. , 2007, Journal of drugs in dermatology : JDD.

[7]  R. Geronemus,et al.  Short-term side effects of fractional photothermolysis. , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[8]  E. Tanzi,et al.  Fractional Photothermolysis: Treatment of Facial and Nonfacial Cutaneous Photodamage with a 1,550‐nm Erbium‐Doped Fiber Laser , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[9]  M. T. Clementoni,et al.  Non‐sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: Preliminary clinical report , 2007, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[10]  R. Fitzpatrick,et al.  The Treatment of Melasma with Fractional Photothermolysis: A Pilot Study , 2005, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[11]  E. Graber,et al.  Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments , 2008, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[12]  T. Alster,et al.  Fractional photothermolysis of residual hemangioma. , 2008, Dermatologic Surgery.

[13]  Leonard J. Bernstein,et al.  Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing , 2008, Lasers in surgery and medicine.

[14]  Stacey K Naito.  Fractional photothermolysis treatment for resistant melasma in Chinese females , 2007, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[15]  L. Goldberg,et al.  Fractional Photothermolysis for Photoaging of Hands , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[16]  E. Tanzi,et al.  The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[17]  K. Beer,et al.  Ablative fractional laser resurfacing for the treatment of a third-degree burn. , 2009, Journal of drugs in dermatology : JDD.

[18]  W. Hall,et al.  Selective Photothermolysis : Precise Microsurgery by Selective Absorption of Pulsed Radiation , 2005 .

[19]  C. Zachary,et al.  Ex vivo histological characterization of a novel ablative fractional resurfacing device , 2007, Lasers in surgery and medicine.

[20]  R. Geronemus.  Fractional photothermolysis: Current and future applications , 2006, Lasers in surgery and medicine.

[21]  David Tabatadze,et al.  Micro‐fractional ablative skin resurfacing with two novel erbium laser systems , 2008, Lasers in surgery and medicine.

[22]  Z. Tannous.  Fractional resurfacing. , 2007, Clinics in dermatology.

[23]  R. Anderson,et al.  Fractional Photothermolysis: A New Concept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury , 2004, Lasers in surgery and medicine.

[24]  P. Friedman,et al.  Fractional photothermolysis for treatment of poikiloderma of civatte. , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[25]  P. Friedman,et al.  Fractional Resurfacing for the Treatment of Hypopigmented Scars: A Pilot Study , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[26]  R. Fitzpatrick,et al.  Complications of fractional CO2 laser resurfacing: Four cases , 2009, Lasers in surgery and medicine.

[27]  Dong Hun Lee,et al.  Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients. , 2008, The Journal of dermatological treatment.

[28]  Tatiana B Krasieva,et al.  Detection and diagnosis of oral cancer by light‐induced fluorescence , 2003, Lasers in surgery and medicine.

[29]  David Eimerl,et al.  Intradermally focused infrared laser pulses: Thermal effects at defined tissue depths , 2005, Lasers in surgery and medicine.

[30]  J. Nelson,et al.  Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing , 2009, Lasers in surgery and medicine.

[31]  P. Friedman,et al.  Fractional photothermolysis for the treatment of telangiectatic matting: A case report , 2007, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[32]  SangEun Kim,et al.  Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients , 2009, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[33]  D. Goldberg,et al.  A Prospective Study of Fractional Scanned Nonsequential Carbon Dioxide Laser Resurfacing: A Clinical and Histopathologic Evaluation , 2009, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[34]  L. Goldberg,et al.  Mohs Micrographic Surgery for Deeply Penetrating, Expanding Benign Cutaneous Neoplasms , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[35]  Dong Hun Lee,et al.  Fractional Photothermolysis for the Treatment of Striae Distensae in Asian Skin , 2008, American journal of clinical dermatology.

[36]  D. Goldberg,et al.  Histologic and ultrastructural analysis of melasma after fractional resurfacing , 2008, Lasers in surgery and medicine.

[37]  Y. Suga,et al.  Clinical trial of a laser device called fractional photothermolysis system for acne scars , 2006, The Journal of dermatology.

[38]  H. Chan,et al.  Prospective direct comparison study of fractional resurfacing using different fluences and densities for skin rejuvenation in Asians , 2007, Lasers in surgery and medicine.

[39]  S. Mordon,et al.  Results of fractional ablative facial skin resurfacing with the erbium:yttrium-aluminium-garnet laser 1 week and 2 months after one single treatment in 30 patients , 2009, Lasers in Medical Science.

[40]  K. Beer,et al.  Botulinum toxin type A enhances the outcome of fractional resurfacing of the cheek. , 2007, Journal of drugs in dermatology : JDD.

[41]  Z. Tannous,et al.  Utilizing fractional resurfacing in the treatment of therapy‐resistant melasma , 2005, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[42]  M. Gold,et al.  Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO2 laser device. , 2008, Journal of drugs in dermatology : JDD.

[43]  R. Moy,et al.  Nevus of Ota successfully treated by fractional photothermolysis using a fractionated 1440-nm Nd:YAG laser. , 2008, Archives of dermatology.