Archive for March, 2014


Wednesday, March 19th, 2014


There has been a dramatic proliferation of “fractionated” lasers being marketed for improvement in skin quality. Overall, they are not cost effective.

In order to understand the issues, a little biology lesson is needed.

The skin surface cells are in a layer called epidermis. These flat, layered cells are responsible for dryness, sun damage changes ( actinic keratoses) and pigment irregularity ( “age spots’ or solar lentigines).

Procedural correction of the skin surface has traditionally been accomplised by one of three methods: chemical peels, lasers, or dermabrasion. All these methods create removal of the entire epidermis, followed by reparative healing. The advantage of these methods is effective correction. The disadvantage is potential removal of all skin pigment cells ( melanocytes), leaving white, unpigmented skin.

Enter the concept of “fractionation” of lasers…The idea being to drill a grid of injury columns into the skin while leaving the tissue between columns undisturbed. The process is similar to aerating a golf green or yard. The advantage is sparing of pigment cells. The disadvantage is that only part of the skin surface is treated.

For skin problems involving abnormal pigment or sun damage the problem is uniform. Therefore, “fractionated” treatments would only partially remove the problems. Simpler, cheaper methods such as chemical peels are more practical and more effective.