Ablative Fractional Laser

What Is It?

Ablative fractional lasers shine an intense beam of light at the skin in a dot-matrix (imagine tiny polka dots) pattern. The light completely removes (ablates) the epidermis in this dot-matrix pattern, leaving some of the skin intact. It also stimulates the underlying dermis to produce more collagen and elastin over time. Ablative fractional lasers attempt to approximate the efficacy of ablative lasers while not completely removing the entire surface of the skin, thus reducing side effects.

Good or Excellent Response

Strength of Evidence
1
2
3
4
5
46% of patients achieved a good (>50%) or excellent (>75%) improvement in scarring after 1 - 5 sessions

Moderate Response

Strength of Evidence
1
2
3
4
5
81% of patients achieved at least a moderate (>25%) improvement in scarring after 1 - 5 sessions
  1. Yang, Z. et al. Self-contrast study of pinprick therapy combined with super pulse fractional CO2 laser for the treatment of atrophic acne scars. J Cosmet Dermatol 20, 481–490 (2021).
  2. Park, C. S., Park, J.-H., Kim, C. R. & Lee, J. H. Objective analysis of volume restoration in atrophic acne scars and skin pores: a split study using human stem cell-conditioned media. J Dermatolog Treat 32, 73–77 (2021).
  3. Chen, L., Wang, Y., Jiang, L., Fang, J. & Ren, J. Comparison of 2940 nm Er:YAG laser treatment in the microlaser peel, fractional ablative laser, or combined modes for the treatment of concave acne scars. Medicine (Baltimore) 100, e26642 (2021).
  4. Pooja, T., Gopal, K. V. T., Rao, T. N., Devi, B. G. & Kumar, S. A. A randomized study to evaluate the efficacy fractional CO2 laser, microneedling and platelet rich plasma in post-acne scarring. Indian Dermatol Online J 11, 349–354 (2020).
  5. Mawardi, P. & Nareswari, A. Fractional erbium: YSGG laser compared to the combination of fractional erbium: YSGG laser and topical autologous platelet-rich plasma for treatment of atrophic acne scars: a case report. Bali Medical Journal 10, 58–62 (2020).
  6. Kwon, H. H. et al. Combination treatment with human adipose tissue stem cell-derived exosomes and fractional CO2 laser for acne scars: a 12-week prospective, double-blind, randomized, split-face study. Acta Derm Venereol 100, adv00310 (2020).
  7. Kaçar, N., Dursun, R., Akbay, M. & Gökşin, Ş. The early and late efficacy of single-pass fractional carbondioxide laser, fractional radiofrequency, and their combination in acne scars: a prospective, split-face, single-blinded, controlled clinical study. Dermatol Ther 33, e14444 (2020).
  8. Helou, J., Korkomaz, J., Stephan, F. & Soutou, B. Searching predictive factors of efficacy and safety in a fractional CO2 laser. Dermatol Ther 33, e13985 (2020).
  9. El-Hawary, E. E., Nassar, S., Hodeib, A. A., Shareef, M. M. & Fawzy, M. M. Ablative fractional carbon dioxide laser and autologous platelet-rich plasma in the treatment of atrophic acne scars: a comparative clinico-immuno-histopathological study. Lasers Surg Med (2020) doi:10.1002/lsm.23306.
  10. Dai, Y.-X., Chuang, Y.-Y., Chen, P.-Y. & Chen, C.-C. Efficacy and safety of ablative resurfacing with a high-energy 1,064 Nd-YAG picosecond-domain laser for the treatment of facial acne scars in Asians. Lasers Surg Med 52, 389–395 (2020).
  11. Cenk, H. & Sarac, G. Effectiveness and safety of 2940-nm multifractional Er: YAG laser on acne scars. Dermatologic Therapy 33, e14270 (2020).
  12. Arsiwala, N. Z., Inamadar, A. C. & Adya, K. A. A comparative study to assess the efficacy of fractional carbon dioxide laser and combination of fractional carbon dioxide laser with topical autologous platelet-rich plasma in post-acne atrophic scars. J Cutan Aesthet Surg 13, 11–17 (2020).
  13. Al-Sultany, H. A. A comparative study of the efficacy of fractional co 2 laser versus micro needling fractional radiofrequency in the management of atrophic acne scars among Iraqi patients. Annals of Tropical Medicine and Public Health Volume 23 Issue 18, 231–816 (2020).
  14. Abdel Kareem, I. M., Fouad, M. A. & Ibrahim, M. K. Effectiveness of subcision using carboxytherapy plus fractional carbon dioxide laser resurfacing in the treatment of atrophic acne scars: comparative split face study. J Dermatolog Treat 31, 296–299 (2020).
  15. Koren, A. et al. Efficacy of a combination of diluted calcium hydroxylapatite-based filler and an energy-based device for the treatment of facial atrophic acne scars. Clin Exp Dermatol 44, e171–e176 (2019).
  16. Galal, O., Tawfik, A. A., Abdalla, N. & Soliman, M. Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: image analysis system evaluation. J Cosmet Dermatol 18, 1665–1671 (2019).
  17. Abou Eitta, R. S., Ismail, A. A., Abdelmaksoud, R. A., Ghezlan, N. A. & Mehanna, R. A. Evaluation of autologous adipose-derived stem cells vs. fractional carbon dioxide laser in the treatment of post acne scars: a split-face study. Int J Dermatol 58, 1212–1222 (2019).
  18. Abdel-Maguid, E. M. et al. Efficacy of stem cell-conditioned medium vs. platelet-rich plasma as an adjuvant to ablative fractional CO2 laser resurfacing for atrophic post-acne scars: a split-face clinical trial. J Dermatolog Treat 1–8 (2019) doi:10.1080/09546634.2019.1630701.
  19. Zhang, L., Lin, L., Zeng, J., Liu, W. & Luo, Q. Evaluation of efficacy of microneedling radiofrequency for the treatment of facial acne scars. Chinese Journal of Dermatology 51, 672–675 (2018).
  20. Shrestha, R. & Karki, A. Fractional ablative carbondioxide laser resurfacing for acne scars - a single centered study. Nepalese Medical Journal 1, 79–81 (2018).
  21. Min, S. et al. Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation. Lasers Surg Med 50, 302–310 (2018).
  22. Khamthara, J., Kumtornrut, C., Pongpairoj, K. & Asawanonda, P. Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: a randomized, split-face, evaluator-blinded, placebo-controlled, comparative trial. J Cosmet Laser Ther 20, 96–101 (2018).
  23. Elsaie, M. L., Ibrahim, S. M. & Saudi, W. Ablative fractional 10 600 nm carbon dioxide laser versus non-ablative fractional 1540 nm erbium-glass laser in Egyptian post-acne scar patients. J Lasers Med Sci 9, 32–35 (2018).
  24. Abdel Aal, A. M., Ibrahim, I. M., Sami, N. A. & Abdel Kareem, I. M. Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars. J Cosmet Laser Ther 20, 106–113 (2018).
  25. Shah, S. D., Mehta, B. D., Borkar, M. A. & Aswani, R. C. Study of safety and efficacy of autologous platelet rich plasma combined with fractional CO2 laser in the treatment of post acne scars: a comparative simultaneous split-face study. International Journal of Research in Medical Sciences 5, 1344–1351 (2017).
  26. Osman, M. A. R., Shokeir, H. A. & Fawzy, M. M. Fractional erbium-doped yttrium aluminum garnet laser versus microneedling in treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg 43 Suppl 1, S47–S56 (2017).
  27. Nilforoushzadeh, M. A. et al. Fractional carbon dioxide laser and its combination with subcision in improving atrophic acne scars. Adv Biomed Res 6, 20 (2017).
  28. Min, S. et al. Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment. Lasers Surg Med 49, 341–347 (2017).
  29. Kar, B. R. & Raj, C. Fractional CO2 laser vs fractional CO2 with topical platelet-rich plasma in the treatment of acne scars: a split-face comparison trial. J Cutan Aesthet Surg 10, 136–144 (2017).
  30. Elcin, G. & Yalici-Armagan, B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation. Lasers Med Sci 32, 2047–2054 (2017).
  31. You, H.-J., Kim, D.-W., Yoon, E.-S. & Park, S.-H. Comparison of four different lasers for acne scars: resurfacing and fractional lasers. J Plast Reconstr Aesthet Surg 69, e87-95 (2016).
  32. Petrov, A. & Pljakovska, V. Fractional carbon dioxide laser in treatment of acne scars. Open Access Maced J Med Sci 4, 38–42 (2016).
  33. Noor, S. M., Paracha, M. & Rehman, S. Effectiveness of carbon dioxide laser in post acne scarring prospective interventional study from Khyber Pukhtunkhwa. Khyber Journal of Medical Sciences 9, (2016).
  34. Mohammad, L., Elgarhy, L. H., Saad, D. & Mostafa, W. Fractional ablative CO2 laser treatment versus scar subcision and autologous fat transfer in the treatment of atrophic acne scars: New technique. Journal of Surgical Dermatology 1, 29–36 (2016).
  35. Faghihi, G. et al. Efficacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: a split-face randomized clinical trial. Indian J Dermatol Venereol Leprol 82, 162–168 (2016).
  36. Reinholz, M. et al. Comparison of two kinds of lasers in the treatment of acne scars. Facial Plast Surg 31, 523–531 (2015).
  37. Chae, W. S. et al. Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar. J Cosmet Dermatol 14, 100–106 (2015).
  38. Brauer, J. A. et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol 151, 278–284 (2015).
  39. Yuan, X.-H., Zhong, S.-X. & Li, S.-S. Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial. Dermatol Surg 40, 545–552 (2014).
  40. Qian, L., Gao, L., Liu, B., Gao, T. & Wang, G. A randomized controlled clinical trial of 10600 nm CO2 fractional laser and 2940 nm erbium fractional laser in the treatment of acne scars. The Journal of Dermatology 41, 17–114 (2014).
  41. Majid, I. & Imran, S. Fractional CO2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars. J Cutan Aesthet Surg 7, 87–92 (2014).
  42. Kim, H. W., Chang, S. E., Kim, J. E., Ko, J. Y. & Ro, Y. S. The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin. Dermatol Surg 40, 1361–1366 (2014).
  43. Jung, J. Y. et al. Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial. Acta Derm Venereol 94, 521–525 (2014).
  44. Goldust, M. & Raghifar, R. The efficacy and safety of Er:YAG laser for treatment of atrophic acne scars. Glob Dermatol 1, 47–50 (2014).
  45. Gawdat, H. I., Hegazy, R. A., Fawzy, M. M. & Fathy, M. Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg 40, 152–161 (2014).
  46. Cameli, N., Mariano, M., Serio, M. & Ardigò, M. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg 40, 553–561 (2014).
  47. Bjørn, M., Stausbøl-Grøn, B., Braae Olesen, A. & Hedelund, L. Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Lasers Surg Med 46, 89–93 (2014).
  48. Zhang, Z., Fei, Y., Chen, X., Lu, W. & Chen, J. Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg 39, 559–566 (2013).
  49. Schweiger, E. S. & Sundick, L. Focal Acne Scar Treatment (FAST), a new approach to atrophic acne scars: a case series. J Drugs Dermatol 12, 1163–1167 (2013).
  50. Nirmal, B. et al. Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars. Indian J Dermatol Venereol Leprol 79, 193–198 (2013).
  51. Manuskiatti, W., Iamphonrat, T., Wanitphakdeedecha, R. & Eimpunth, S. Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatol Surg 39, 111–120 (2013).
  52. Hwang, Y. J., Lee, Y. N., Lee, Y. W., Choe, Y. B. & Ahn, K. J. Treatment of acne scars and wrinkles in asian patients using carbon-dioxide fractional laser resurfacing: its effects on skin biophysical profiles. Ann Dermatol 25, 445–453 (2013).
  53. Hsiao, P.-F., Lin, Y.-C., Huang, C.-C. & Wu, Y.-H. Efficacy and safety of a single treatment using a 10,600-nm carbon dioxide fractional laser for mild-to-moderate atrophic acne scars in Asian skin. Dermatologica Sinica 31, 59–63 (2013).
  54. Azzam, O. A., Atta, A. T., Sobhi, R. M. & Mostafa, P. I. N. Fractional CO(2) laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study. J Drugs Dermatol 12, e7–e13 (2013).
  55. Qian, H. et al. Treatment of acne scarring with fractional CO2 laser. J Cosmet Laser Ther 14, 162–165 (2012).
  56. Hedelund, L. et al. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med 44, 447–452 (2012).
  57. Ahmad, T. J. et al. Efficacy and safety of ablative fractional carbon dioxide laser for acne scars. Journal of Pakistan Association of Dermatology 22, 41–44 (2012).
  58. Trelles, M. A., Shohat, M. & Urdiales, F. Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: A clinical and histologic study. Aesthetic Plast Surg 35, 31–42 (2011).
  59. Omi, T., Kawana, S., Sato, S., Bonan, P. & Naito, Z. Fractional CO2 laser for the treatment of acne scars. J Cosmet Dermatol 10, 294–300 (2011).
  60. Lee, J. W., Kim, B. J., Kim, M. N. & Mun, S. K. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial. Dermatol Surg 37, 931–938 (2011).
  61. Kim, S. Treatment of acne scars in Asian patients using a 2,790-nm fractional yttrium scandium gallium garnet laser. Dermatol Surg 37, 1464–1469 (2011).
  62. Hu, S. et al. Ablative fractional erbium-doped yttrium aluminum garnet laser with coagulation mode for the treatment of atrophic acne scars in Asian skin. Dermatol Surg 37, 939–944 (2011).
  63. Asilian, A. et al. Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. J Res Med Sci 16, 1189–1195 (2011).
  64. Alajlan, A. M. & Alsuwaidan, S. N. Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines. Lasers Surg Med 43, 787–791 (2011).
  65. Wang, Y.-S., Tay, Y. K. & Kwok, C. Fractional ablative carbon dioxide laser in the treatment of atrophic acne scarring in Asian patients: a pilot study. J Cosmet Laser Ther 12, 61–64 (2010).
  66. Ortiz, A. E., Tremaine, A. M. & Zachary, C. B. Long-term efficacy of a fractional resurfacing device. Lasers Surg Med 42, 168–170 (2010).
  67. Manuskiatti, W., Triwongwaranat, D., Varothai, S., Eimpunth, S. & Wanitphakdeedecha, R. Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol 63, 274–283 (2010).
  68. Katz, B. Efficacy of a new fractional CO2 laser in the treatment of photodamage and acne scarring. Dermatol Ther 23, 403–406 (2010).
  69. Jung, J. Y. et al. Lower-fluence, higher-density versus higher-fluence, lower-density treatment with a 10,600-nm carbon dioxide fractional laser system: a split-face, evaluator-blinded study. Dermatol Surg 36, 2022–2029 (2010).
  70. Cho, S. B. et al. Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation. J Eur Acad Dermatol Venereol 24, 921–925 (2010).
  71. Chan, N. P. Y., Ho, S. G. Y., Yeung, C. K., Shek, S. Y. N. & Chan, H. H. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med 42, 615–623 (2010).
  72. Walgrave, S. E. et al. Evaluation of a novel fractional resurfacing device for treatment of acne scarring. Lasers Surg Med 41, 122–127 (2009).
  73. Kim, S. & Cho, K.-H. Clinical trial of dual treatment with an ablative fractional laser and a nonablative laser for the treatment of acne scars in Asian patients. Dermatol Surg 35, 1089–1098 (2009).
  74. Deng, H., Yuan, D., Yan, C., Lin, X. & Ding, X. A 2940 nm fractional photothermolysis laser in the treatment of acne scarring: a pilot study in China. J Drugs Dermatol 8, 978–980 (2009).
  75. Cho, S. B. et al. The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 35, 1955–1961 (2009).
  76. Chapas, A. M. et al. Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med 40, 381–386 (2008).

Side Effects

Medium-High
Medium-high side effects and adverse reactions

Reviews

2.8
111 Reviews