What are non-ablative fractional lasers?

Non-ablative fractional lasers, such as the Palomar ICON or Lumenis Resurfyx, are a type of laser treatment that is used to improve the appearance of the skin. Non-ablative fractional lasers work by delivering laser energy in a pattern of tiny columns that penetrate the deeper layer of the skin (the dermis). The laser energy causes microscopic injury to the dermis, stimulating the production of collagen and elastin, which can help to improve the texture and appearance of the skin.

Non-ablative lasers are a gentler form of laser treatment than ablative lasers since they cause less damage to the top layer of skin (the epidermis). They typically have fewer side effects and a shorter recovery time. They are used to treat a wide range of skin conditions, including fine lines and wrinkles, uneven skin texture, and acne scars.

Alternative treatment options include doing nothing, topical treatments, injectables, microneedling and chemical peels.

A course of 3-6 treatments is usually required to see the desired degree of improvement. In most cases fractional non-ablative lasers are safe and well tolerated, however there are a number of important risks and you should consider these carefully when deciding whether the treatment is right for you.

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.
• 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

• 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 and very rarely can be permanent.
• Pain (common): There will be some discomfort during the procedure and afterwards. Very rarely pain may persist for a longer period or fail to resolve.
• Pigmentary Change (common): The treated area may become hyperpigmented (darker), hypopigmented (lighter) or redder than the normal skin color. In most cases this will fully resolve, however very rarely this may be permanent. Risks are higher in those with pigmented skin types.
• 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.
• Infection (uncommon): There is a risk of herpes virus reactivation (coldsores). There is a very small risk of other infections.
• Scarring (uncommon): Visible scarring is not common with fractional non-ablative laser but very rarely can occur. This 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.
• Bruising, bleeding, blistering, crusting (uncommon)
• Nodule or cyst formation (very uncommon)
• 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.
• 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

A test patch is advised to assess how your skin responds to the laser at a particular setting. It is necessary to allow at least a week after the test patch to assess for any late complications such as bruising or pigmentary change. 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.