I frequently get asked what is the new in the world of medical skin care by my patients as well as others. As I think back over 2007, I have put into my practice the following anti-aging medical treatments which I feel are quite promising.
The removal of an outer facal skin layer to improve its tecture is a concept that has been around for decades. Historically, this has included chemical peels and, in the past decade, laser resurfacing. Laser resurfacing essentially ‘burns’ off a top layer (the depths can be very varied from 6 microns to hundreds of microns) and allows new skin (epithelium) to heal over it, removing some imperfections and improving the texture of the skin. Recovery from laser resurfacing varies by the depth to which it is done, a 10 micron laser peel may be a few days, a 100 micron laser peel will be 7 to 10 days. The depth issue aside, laser resurfacing always involves some recovery (as it is a burn) and it only treats the outer layers of the skin.
Fractional CO2 laser resurfacing takes a conceptually different approach. Rather than ‘burning’ 100% of the skin’s surface that it hits, it only treats or penetrates a ‘fraction’ of it. For every area treated, it may only actually hit 10 – 20% of the skin area. Hence, a fractional treatment approach. But equally importantly, the laser penetrates much deeper (hundreds of microns) into the skin, actually stimulating the deepest part of the skin layers. (think of it as boring holes much like you do to your lawn to allow nutrients to get ‘to the roots’ so to speak) Because only a fraction of the skin is treated, there is less recovery than with traditional laser resurfacing even though the depth of laser penetration is much deeper. Also because it is fractional, it requires a series of treatment, at least five, to effectively get all of the skin’s surface treated. In theory, there is more of an anti-aging effect (due to the deeper penetration) but less recovery due to less skin being injured at any one time.
Fractional laser resurfacing of facial skin is being currently touted as being better than traditional laser resurfacing. The evidence to support that claim, to date, is still conclusively lacking. Plus, I am not sure how the laser knows during sequential treatments to hit previous skin areas that have yet to be treated. (of course, it cannot know, so some skin areas undoubtably get treated more than once and some probably are missed altogether as we are talking about fractions of millimeters here) For this reason, it probably take 6 or 7 treatments to truly treat all facial skin areas in the laser’s target. Despite these reservations, fractional laser resurfacing remains appealing and more time will tell exactly what its role in medical skin resurfacing actually is.
Dr Barry Eppley
Indianapolis, Indiana