Use of Fractional Lasers in Skin Rejuvenation

The use of light in medical treatment has become an extremely popular practice thanks to the amplification of the radiation emitted by laser. Starting from the 1960s, many laser devices have been developed for various treatment applications. Lasers direct a high-energy light beam to specifically selected tissues. These light beams are of one color or wavelength, of different strengths, and target different tissue types. The light source directed to a specific layer of the skin causes damage. This is called selective photothermolysis. (photo = light, thermolysis = decomposition by heat)
Lasers can be divided into 2 general groups: ablative and nonablative: Ablative lasers (ex: 10 600 nm CO2 laser, 2940nm erbium: YAG), intense laser energy sent to the skin targets and heats the water in the skin, which causes evaporation of water and tissues. Following this injury and healing process in the skin, new collagen production occurs. These treatments have various complications such as infection, healing by leaving scars, leaving light colored spots, and causing unnatural results in the structure of the tissue. However, it takes months for the skin to fully heal after these applications and very good care must be taken. Their areas of use are also limited.
Nonablative treatments are safer, but the effectiveness of the treatment is less because cooling is required during application. Nd:YAG 1320 nm pulsed laser and IPL are examples of these.
Along with fractional photothermolysis, fractional skin resurfacing is presented as the newest class in treatment. Here, microscopic wounds surrounded by thousands of healthy tissues are created on the upper layer of the skin with various wavelengths. The regeneration effect on the skin occurs due to coagulation in the middle layer of the skin, and the deeper restructuring and collagen formation effect occurs due to the breakdown in the protein structure of the dermis. In fractional photothermolysis, only specific zones in the target area are affected, other zones are preserved intact. In fractional lasers, the wavelength starts from 1550nm. Fractional lasers can be used both ablative and nonablative, and the side effects of other ablative lasers are not seen in them.
Fractional photothermolysis was first used in 2003 (Palo Alto, Calif.) under the name of >Fraxel SR. In America, wrinkles around the eyes in 2004, skin rejuvenation and melasma (pregnancy spot) in 2005, pigmentation in 2004. lesions (dark spots), freckles, age spotsand in 2006, it received FDA (Food and Drug Administration) approvalfor the treatment of acne. Fraxel SR creates 400-6400 treatment zones per cm2 with a diameter of 50-150 microns. Each of the microscopic treatment zones consists of heat-disintegrated collagen columns extending from the upper layer of the skin to the middle layer. Unlike ablative lasers, fractional lasers coagulate only 20% of the treated skin, thus the protected skin islands and untreated dermis areas accelerate healing by preserving the skin's barrier function during skin rehealing.
Fraxel SR Laser ( Solta Medical, Inc.) creates thousands of microthermal treatment zones in the deep dermis (deep layer of skin). Since fractional laser skin rejuvenation ensures that healthy tissues remain around these zones, skin healing is much faster. More importantly, late complications (undesirable results) seen in CO2 laser are not observed and all skin types can be treated safely. In the treated area, most of the stem cells and melanocytes (cells that give the skin its color) in the papillary dermis are unharmed and protected. Both rapid healing of the skin and collagen production are achieved. In clinical studies, it has been shown that 4-6 treatments with 1 week intervals are sufficient. Applying topical anesthesia (numbing with cream)makes the treatment easier.
Side effects are generally minimal. Mild sunburn sensitivity occurs 1 hour after the treatment. The pinkness on the skin lasts for 1-3 days. This is a normal indicator of healing. Swelling is very low. New epidermis forms within 24 hours. At this stage, the skin becomes flaky and tanned. Sunscreen should definitely be used. The skin recovery process takes 3-6 months.
Fraxel 1500 (Fraxel Re:store, Solta Medical, Inc.), the frax we use in our clinic. It is an ionel laser and is the form of the previous SR version, which has advanced optical technology, is 30% more effective than the Fraxel SR laser, and has safer dose control. It is effective up to 1mm below the skin surface. The most difficult area to treat with this device is wrinkles around the mouth, which requires 4-6 treatment sessions at 2-4 week intervals. A combination with fillers and fat injections is often required in the treatment of wrinkles around the mouth. With this device, it is aimed to