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DRaGZ

Why Do Fractional Lasers Work When They Don't Seem To Specifically Target The Depressed Scars?

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I have done quite a bit of research on the topic, and having reviewed several different methods for each laser, this got me to thinking.

I understand that most modern lasers, non-ablative or ablative, work through the fractional method, called so because it leaves portions of the skin in the treated area intact, thus allowing for faster healing. The theory behind this is so that it promotes coagulation of tissue in the epidermis and dermis, thus inciting the skin to produce new collagen to fill in depressed areas.

So my question is this: why is this supposed to specifically fill in depressed areas (i.e. our scars) when it’s targeting all of the skin around the depressed area as well? If I understand the skin correctly, it doesn’t differentiate between the “normal” skin and the “scarred” skin; as far as the body is concerned, both are healthy skin doing its job. If that is the case, why does evenly distributed collagen production across both healthy and “scarred” skin do anything at all? At best, wouldn’t it just promote collagen production evenly everywhere it’s treated, meaning all it would do is just raise scarred and healthy skin alike, leading to a net difference of nothing? It’d be the equivalent of getting a filler across the ENTIRE affected area, all it would do is just raise the entire portion of skin up, scars and all.

Please correct me if I am wrong so far.

If we really are to go with this modality of promoting collagen production, wouldn’t it make more sense to promote collagen production ONLY in depressed areas? I know that this is somewhat accomplished by doing multiple passes at specific spots, but, as far as I can tell, most laser handpieces aren’t specific enough to only handle one tiny little area if necessary. For instance, some scars are about a single millimeter across, no handheld is precise enough to target only that. Even a scar that is as large as 1/2 an inch across is still too small for specific treatment by most handheld lasers devices. And God forbid if you have clusters of scars in a specific area, you’d just be targeting everything indiscriminately.

As far as I can tell, there is no laser technology out there that specifically targets only depressed or raised areas. We have traditional ablative CO2, which just completely removes the top layer of skin without discriminating what is or isn’t raised/depressed tissue area, and fractional laser technology, of which there is a wide variety but all of which seem to be indiscriminate in how much collagen production is promoted in the affected areas (i.e. anywhere the laser hits there is promotion of collagen production, whether the tissue is depressed, raised, or just normal).

Why hasn’t anyone developed a technology to specifically target only depressed or raised areas of the skin for a laser? It seems counter-productive to just target everything, healthy skin and all, and hope that it somehow all fills in. To me, it seems like any results that would be seen from this kind of method (whether it’s temporary or permanent) would simply be a result of the skin swelling due to collagen production, and thus the scars are literally just being stretched so that they are harder to see. In other words, it seems like it would simply be “plumping up” the skin so that depressions merely look shallower, not specifically treating the scars themselves.

I really hope I am wrong about this. Is there actual reasoning to suggest that fractional laser treatments, both non-ablative and ablative, promote more collagen production in depressed indentations as opposed to healthy skin, thus leading to genuine smoothing out of the skin, despite the fact that the collagen production is not specifically targeted in depressed areas? I’d really like to know the reasoning behind this kind of modality.

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Your question is out of my paygrade and you should direct it towards the company that actually did the research. http://www.fraxel.com/FAQs-Fraxel/ An uninformed laymans explanation is that both damaged and undamaged skin is removed, and they are both replaced with new undamaged skin.

Edited by DudleyDoRight

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I just talked with the technician at my dermatologist's clinic, and she explained to me that, apparently, the body does recognize which skin is damaged and which skin isn't, thus collagen promotion is actually accelerated at areas the body thinks it needs collagen most (like depressed areas, but especially at areas with discoloration). Unfortunately, what the body recognizes as damaged skin can apparently be unpredictable, which is why sometimes treatment just doesn't work, i.e. the body thinks the skin was fine the way it was before so it just heals it back as before.

I think that's what makes the results so unpredictable: a large portion of the healing process comes down to how your body interprets the treatment, which, unfortunately, you can't really change.

In any case, I am planning to forward the question to both Fraxel and Palomar and see what they think.

And really, this question is more out of curiosity than anything else. There is strong evidence to suggest that fractional lasers of all types have some beneficial effect, I am just curious as to what the actual effect is a result of.

EDIT: I just sent the e-mails to "[email protected]" and "[email protected]" (they seemed to be the only relevant links). I will post any replies here.

Edited by DRaGZ

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I've read that and many others (which all use the same diagrams and the same pictures of that lady).

Considering both companies did a lot of research on it, it seems apropos to ask both.

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Guest

Seriously, I also thought the same as you about the lasers! I just didn't know how to formulate the question because I'm not that good at writing in English... So yeah...this is why I'm skeptical about doing a laser (fraxel, co2) treatment, cause I'm afraid the result will be 0, and my scars will still be there, even if they will be "raised", but if my healthy skin will also be raised, then where's the difference?! But still, I saw some before and after laser pictures, and you could actually see the difference, I think it depends on how deep the scars are... Anyway, keep us updated if the companies will give you some answer.

Edited by Guest

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Okay, got a reply back from Fraxel, and it is extremely generic (though I don't think it's a form reply).

In treating scars there are many factors to consider and the issue is not ablative or non ablative alone. There are many varieties of laser’s and light based devices used in medicine today. They vary in many ways, including but not limited to, lasing mechanisms, method of delivery, wavelength, pulse width, ablative, non ablative, fractional, and non fractional. These variations determine what the light source is attracted to in the skin, spot size of the beam, depth of penetration, energy that can be delivered, aggressiveness and so much more.

Fraxel lasers target a chromophore of water and can treat superficially or deeply, and treat scarring very well. The physician administering your treatments is the best person to answer your questions in depth.

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This is why I think the aftercare is so important. Fraxel will damage both good and bad skin alike and it IS how your skin is programmed to heal back that will determine how it will heal. With TCA cross method your body is essentially going to produce more scar tissue in the pits because it is stronger repair response, more type 2 collagen, if I am correct. There are different types of collagen your body builds in repair. There is also the issue of collagenase, you can google. With something like stem cells or recell it would hopefully tell your skin to reprogram as normal skin. Copper peptides would also help. If you have a new scar perhaps there is not as much memory in your skin to build it back as scar tissue. Everyone does heal different, but I believe with lasers there is also a tightening effect that you don't get with peels. There may be more dangers of fat loss as well.

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This is why I think the aftercare is so important. Fraxel will damage both good and bad skin alike and it IS how your skin is programmed to heal back that will determine how it will heal. With TCA cross method your body is essentially going to produce more scar tissue in the pits because it is stronger repair response, more type 2 collagen, if I am correct. There are different types of collagen your body builds in repair. There is also the issue of collagenase, you can google. With something like stem cells or recell it would hopefully tell your skin to reprogram as normal skin. Copper peptides would also help. If you have a new scar perhaps there is not as much memory in your skin to build it back as scar tissue. Everyone does heal different, but I believe with lasers there is also a tightening effect that you don't get with peels. There may be more dangers of fat loss as well.

If there's anything consistent I have read about fractional lasers, it is that they have a "plumping" effect on the skin, which probably equivalent to the "tightening" you are talking about.

I am still unsure as to what the actual modality of treating these scars are. Maybe the experts aren't sure either.

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