What are ablative fractional lasers?

Ablative fractional laser resurfacing, for example the Lumenis Ultrapulse carbon dioxide laser, is a type of laser treatment that causes microscopic columns of injury to improve the texture and appearance of the skin. The laser energy penetrates the skin, leaving the surrounding tissue intact. This allows the skin to heal faster and with less downtime compared to more invasive ablative laser treatments, which remove the entire outer layer of skin.

Ablative fractional laser resurfacing can be an effective treatment for conditions including textural change, acne scars and aging-related changes, however it can be associated with a prolonged period of healing and some significant risks and it is important that you read the following information carefully when deciding whether it is the right treatment for you.

Alternative treatments depend upon the condition but would include doing nothing, topical treatments, non-ablative fractional lasers, chemical peels and microneedling.

Contraindications

Certain conditions significantly increase the risks of treatment. It is important to inform Dr Lynch if any of the following apply :-

• Hypertrophic or keloidal scarring (lumpy scars): If you have previously experienced hypertrophic or keloid scars you can be at risk of developing scars from minor injuries such as laser treatment.
• Treatment with isotretinoin (roaccutane) within the last year: This increases the risk of unsightly scarring and poor healing.
• Tanning / sun exposure: Tanning increases the risks of laser treatment. Inform Dr Lynch if you have been in the sun, have had a tan, or a sunburn, within the last 4 weeks.
• Recurrent coldsores: Coldsores can be triggered by laser treatments. If you frequently experience herpes virus infection (coldsores) near to the site of treatment then you may need antiviral prophylaxis to decrease this risk.
• Pregnancy: It is not recommended to have laser treatment during pregnancy due to an increased risk of complications.
• Important events: Due to the risks of unsightly changes in appearance of the skin it is not advisable to have treatment shortly before important events such as weddings or important business meetings etc.
• Vitiligo or other inflammatory skin disease such as psorisasis or lichen planus: If you suffer from an inflammatory skin disease, laser treatment can cause this to be triggered at the site of treatment . It is essential to inform Dr Lynch so that the risks and benefits of treatment can be discussed.

Risks

• Pain (common): The treatment is performed with topical or injected local anaesthetic but there may still be pain during the procedure or afterwards. Pain can persist for a number of days. Very rarely pain may persist for a longer period or fail to resolve.
• Bruising, bleeding, blistering, crusting (common): Immediately following the treatment, the surface of the skin will appear red, swollen and inflamed with some bleeding and crusting. These changes will usually settle over 2 weeks, however there can be ongoing blistering, crusting and oozing during this time.
• Redness and inflammation (common): The treated area will be red, sore and inflammed immediately after treatment. In most cases this will persist for 1-2 days, although rarely redness can last longer - it will usually resolve within weeks, however it can remain for months or rarely can be permanent.
• Swelling (common): Swelling is usual immediately after the procedure. It may increase for a few days after treatment. Very rarely it may fail to resolve completely.
• Darkening of the skin or loss of pigmentation (common): The treated area may become hyperpigmented (darker), hypopigmented (lighter) or redder than the normal skin color. There may be patchy changes in skin pigmentation. In most cases pigmentary changes will resolve within weeks-months, however occasionally they can be permanent. Risks are higher in those with darker skin types.
• Infection: There may be bacterial or viral (herpes) infection. Very rarely there may be less common infections that fail to respond to treatment.
• Gridmarks (common): The laser treats the skin in a grid. This pattern may be visible shortly after treatment but usually resolves quickly. Very rarely it can be persist or be permanent.
• Scarring (common): Scarring can occur and rarely can result in unsightly scar formation. These may be raised or lumpy (including hypertrophic or keloid scar), depressed, different in color from the adjacent skin (redder/lighter/darker), or different in texture (for example more shiny) in comparison with the adjacent skin. • Infection (uncommon): There is a risk of herpes virus reactivation (coldsores). There is also a risk of bacterial or yeast infection.
• Nodule or cyst formation, acne (uncommon): Occasionally fractional laser resurfacing or the greasy moisturisers used afterwards can trigger nodule or cyst formation (lumps beneath the skin surface) or acne lesions.
• Skin laxity, volume loss, skin aging (very uncommon): A very small proportion of patients believe that fractional laser resurfacing has resulted in undesirable skin changes such as looseness of the skin, volume loss or an aged appearance.
• Hair loss (uncommon): Treatment of areas bearing hair can cause hair loss through damage to the hair follicles.
• Sun sensitivity (common): There may be increased sensitivity to sunlight. It is essential to avoid excessive sunlight exposure and to use a sunblock cream for a minimum of 6 weeks after treatment.
• Failure to Achieve Desired Results, worsening of appearance: It is possible that this procedure does not lead to the degree of improvement that you desire. Very rarely you may feel that the overall appearance has been worsened by laser treatment.
• Recurrence of the condition: The treated condition, for example fine lines and wrinkles, can recur.

Additional risks

Test patch

Due to the potential for complications it is always advisable to attend for a small test patch of treatment first and then assess healing prior to treating a larger area. A test patch reduces but does not eliminate the risk of complications.

Aftercare

It is essential to avoid excessive sunlight exposure and to use a sunblock cream for a minimum of 6 weeks after treatment. Improvements are seen over a number of weeks following treatment with most patients needing a course of several treatments to see significant improvement.