Non-ablative Fractional Laser

Non-ablative Fractional Laser works best on ice pick, rolling, and boxcar scars

* Laser resurfacing is less effective for ice pick scars than for boxcar and rolling scars.

Laser resurfacing is a non-invasive procedure (does not involve cutting or inserting tools into the skin) that consists of shining an intense beam of light onto the skin. Because the light is concentrated and intense, it causes controlled damage to the skin. The type and extent of the skin damage depends on the type of laser. This controlled damage aims to stimulate skin healing and/or regrowth, which results in a smoother and more even skin surface–in other words, the skin is “resurfaced.”

Non-ablative (non-skin-removing) lasers: These lasers work by causing a controlled injury in the dermis (the deep layer of the skin), which triggers skin remodeling and the formation of new collagen in the dermis. Because non-ablative lasers cause the skin to slowly reshape itself from the inside, the results they achieve are more gradual and moderate compared to ablative lasers, but they offer the advantages of a short recovery time and a relatively low risk of side effects.2

Types of lasers

Fractional lasers, also known as fractionated lasers: These newer lasers deliver many small pinpoints of laser light in a grid-like pattern, so that areas of skin in-between the pinpoints are left untouched. Because only a small portion of the skin is damaged, healing time is shorter than with non-fractional lasers.2

Non-Ablative Fractional Laser:

  • How they work: Damage the dermis in pinpoints in a grid-like pattern.
  • # of treatments: 4-6 treatments at intervals of 1 month3.
  • Advantages: Lowest risk of side effects, safest for dark-skinned people2.
  • Disadvantages: Moderate results, requires multiple sessions2.

There are many different subtypes of lasers, each named after the material it is made with. Lasers can be created using glass, crystals, or gasses, and the specific material determines the color of the laser light. The following table shows the materials in lasers used for skin resurfacing.2

 Non-fractionalFractional
Non-ablativeNd:YAG (neodymium:yttrium-aluminum-garnet) laser

Diode laser
Nd:YAG (neodymium:yttrium-aluminum-garnet) fractional laser

Er:glass (erbium glass) fractional laser

Each laser subtype penetrates the skin to a different depth. In general, ablative lasers cause more damage to the skin, but do not penetrate as deep into the skin, whereas non-ablative lasers are less damaging, but penetrate into deeper skin layers.

Laser depths

As with all scar revision treatments, laser resurfacing is sometimes combined with other scar revision procedures to attain desired results.

People with active acne should not undergo acne scar repair of any kind, including laser resurfacing. Make sure your skin is completely clear of acne before beginning scar treatment.

Laser resurfacing cannot be performed while there is an active skin infection or skin condition such as a bacterial infection, eczema, or psoriasis. Ensure your skin is clear before seeking laser resurfacing.1

Doctors do not recommend undergoing laser scar treatment for 6 months after taking oral isotretinoin (Accutane®), because during this time, the skin may respond unpredictably to laser treatment.1

If you have a history of keloid scarring, approach laser resurfacing with caution, as you may have a higher chance of developing keloid scars as a side effect of laser resurfacing.1

Patients with darker skin are at increased risk of pigmentation (skin coloring) due to laser treatment, especially hyperpigmentation (skin darkening).

Before agreeing to undergo laser resurfacing, discuss your treatment options, expected outcomes, and treatment prices with multiple doctors.

Procedure details:

Laser treatment

Before booking your treatment, your doctor should first schedule a session to discuss the procedure, expected results, and possible complications with you and to answer your questions.

If you are planning to undergo treatment with an ablative laser, your doctor may prescribe antiviral medications for you to take before the procedure in order to prevent a viral skin infection from developing after treatment.3

Laser resurfacing is usually performed in an outpatient setting. During the treatment, the doctor will give you protective eyewear to prevent the laser from damaging your eyes.

No matter which type of laser your doctor uses, she will have to fine-tune the laser settings in order to get the best results while minimizing recovery time and side effects.

In general, ablative lasers cause more skin damage than non-ablative lasers. Still, how much skin damage any given laser produces can vary significantly depending on several variables.

One of these variables is the wavelength that the laser material creates:

  • Wavelength: Each type of material creates a laser with a specific wavelength. The wavelength of a laser is a number in nm (nanometers) corresponding to a specific color of light. Most lasers used for skin resurfacing emit colors of light that are invisible to the human eye, so you will not be able to see the laser beam during your treatment. For example, a diode laser emits infrared light with a wavelength of about 800 nm, which you cannot see, but may feel as heat during treatment.
 Wavelength
Non-ablative lasersNd:YAG – 1,064 nm
Diode – 810 nm
Er:glass – 1,540 nm

Other settings that determine how much damage a laser causes can be controlled by the doctor:

  • Delivered fluence,also known as energy density: Fluence or energy density is a measure of how much energy the laser delivers per unit area of the skin–in other words, how intense the laser is. It is important for the doctor to set the fluence high enough to cause a controlled injury to the skin, but not so high as to create unnecessary damage. The doctor may need to set the fluence higher to target a particularly strong or large structure, like a severe or wide scar. Delivered fluence only depends on the doctor’s settings, not on the type of laser.3
  • Pulse duration: Normally, the light from a laser is delivered in a series of short bursts, called pulses, with short breaks in-between. Pulse duration is a measure of how long each pulse lasts. The longer the pulse, the more skin damage it causes, so this is another setting that the doctor needs to carefully fine-tune in order to obtain the best results and minimize the side effects. Just like delivered fluence, pulse duration only depends on the doctor’s settings, not on the type of laser.3

Anesthesia:

Laser scar treatment can be uncomfortable and even painful. To numb your skin before the procedure, your doctor may:

  • Inject a local anesthetic into your skin before beginning treatment.
  • Apply a topical anesthetic to your skin 30-60 minutes before the treatment.
  • Provide you with a topical anesthetic to apply to your skin before you arrive at the doctor’s office for your treatment4-7.

Before-and-after:

Before and after trying non-ablative fractional laser

Acne scars before (left) and 4 weeks after (right) 4 treatments with non-ablative fractional laser.

References
  1. Sobanko JF, and Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol. 13(5), 319-30 (2012)
  2. Preissig J, Hamilton K, and Markus R. Current laser resurfacing technologies: A review that delves beneath the surface. Semin Plast Surg. 26(3), 109–116 (2012).
  3. Uptodate.com. Management of acne scars. Available from: https://www.uptodate.com/contents/management-of-acne-scars?source=search_result&search=subcision&selectedTitle=1~4. Last retrieved on 30 June, 2017.
  4. Alexis AF, et al. Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI. Dermatol Surg. 42(3), 392-402 (2016).
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  7. Chae WS, 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(2), 100-6 (2015).
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  9. Engın B, et al. Evaluation of effectiveness of erbium:yttrium-aluminum-garnet laser on atrophic facial acne scars with 22-MHz digital ultrasonography in a Turkish population. J Dermatol. 39(12), 982-8 (2012).
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  12. Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, and Chen TM. Treatment of punched-out atrophic and rolling acne scars in skin phototypes III, IV, and V with variable square pulse erbium:yttrium-aluminum-garnet laser resurfacing. Dermatol Surg. 35(9), 1376-83 (2009).
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