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« Medspas: Disagree & Commit | Main | Is it worth buying a Dermacare franchise? JK wants to know. »
Friday
May042007

Titan vs. Fraxel vs. Co2 Laser Ablation vs. Erbium

Some excellent thoughts on Co2 laser ablation from the Thermage vs. Fraxel discussion thread on Sciton Profractional: How's the result compare to Fraxel / Palomar Fractal / Palomar fractional IR:

".. Let's not forget what the Coherent Ultrapulse (which is not to be confused with the encore from Lum) has taught us since its popular release in 1991. Beautiful machine with state of the art engineering, but a very hot wavelength with way too much heat for rapid healing and widespread acceptance in today's modern aesthetic marketplace.

NO one can argue with the fact that after much fanfare CO2 full depth resurfacing has come and gone as a tool strictly for the most seasoned of laser professionals. The initial buzz about immediate visible contraction was lost in a sea of complications associated with using a wavelength that introduces way TOO much heat into treated tissue. To this day the majority of CO2 based systems sit in the corner of the o.r. collecting dust. Why is this? What did CO2 at 100% surface coverage teach us? One hard lesson we learned involved permanent pigmentary loss due to massive heat deposition at the DE junction. Another HEAT related involved extensive healing periods with erathema up to 6 months post treatment. Heat is intrinsic to CO2... In fact, if you treat 100 microns of tissue with CO2, you get roughly 60 microns of ablation and 40 microns of thermal damage. For reference, if you treat 100 microns of tissue with a DUAL-MODE erbium, you get 95 microns of ablation and 5 microns of thermal damage. Why does it take 3X longer to reepethlialize with CO2 vs. Erbium. Because, PULL YOUR WAVELENGTH CHART OUT CO2ers, Erbium is 15X more effective at ablating water than CO2. Why the red face for so long after CO2. Quite simple, the body is doing everything in its power to remove the dessicated tissue and is rushing in as many healing mechanisms as possible. Hence the pungent red and tremendous neovascularity.

Fyi... There is one erbium laser available that offers complete coagulative capabilities. The Sciton Contour, which has arguably replaced the ultrapulse as the gold standard for resuracing. one dual-mode erbium on the market and it was created by the same principles of the UltraPulse this makes it and the resultant ash of post delayed PERMANENT hypo pigmentation cases.

Anyways. What I was saying is the Contour was created by Drs. Dale Koop and Jim Hobart. Jim FOUNDED coherent in the late 60's and Dale was the chief engineer who designed the Ultrapulse while with Coherent in the 80's.

In searching for the BEST skin rejuvenation treatment with the LEAST downtime, we have gone full circle from 100% surface coverage heavy downtime resurfacing, to non-ablative no downtime treatments (cooltouch etc) to non-ablative fractional resurfacing (fraxel 750) to minimal downtime ABLATIVE fractional resurfacing. Now that we're back to focusing on which ablative fractional therapy is best, let's not forget that CO2 is CO2 is CO2 - redness galore, serious discomfort and who knows what the future holds for lightening. Remember, when CO2 was released in 1991, no one expected to see post delayed onset hypopigmentation. Regardless of if you're at 100% surface coverage or 20% fractional coverage with a 500 micron spot. The natural properties of CO2 make it troublesome regardless of it is a whole or fractional beam.

Rumor has it Profractional can be adjusted to treat anywhere from 10 microns to 1.5 mm in a single pulse, or scan. Also, the percentage treatment area can be varied from 1.5% to 60% of area treated. Food for thought when comparing one fractional device to another.

It boils down to two things: RESULTS and DOWNTIME. How can we best sacrifice one for the other? The answer should yield which fractional device you purchase. Oh, don't forget proprietary disposable costs." - Co2 is Co2 is Co2

Reader Comments (183)

We are in the process of purchasing a fractional device for our full service medical spa. Currently it has been narrowed down to Fraxel and Profractional. Any feedback would be greatly appreciated. Fraxel is certainly the big buzz word but there appears to be mixed reviews on the results. Thanks.

10.26 | Unregistered Commentersue hughes

Remember the fraxel is a one trick poney. It also has consumables. The Fraxel can work well in the right hands.

10.26 | Unregistered CommenterLH

For me I'm going to stick with Erbium and Skin-tyte, I'll let the Fractional debate mature; I try to experience the 'high state' of patience as I wait for the evidence to evolve. As it looks now...if you get the fraxel...know your machine.

10.26 | Unregistered CommenterDermaRogue

Do you really thing the Fraxel results are better than a typical TCA chemical peel? I have no experience with the Fraxel - just looking at the before and after photos, I am a bit underwhelmed.

10.27 | Unregistered CommenterTF

I do both the TCA's and the Fraxel. Between the fraxel and my erbium a do very few chemical peels any more. I personally think you get longer term results with the fraxel than with a chemical peel unless you are doing a very deep peel. The TCA's tend to last 6 to 12 months.

10.27 | Unregistered CommenterLH

I would stick with Erbium and maybe titan or thermage.

CO2 has way too much risk.
Fraxel has no real studies to prove it works. Results have been limited. Can you imagine asking for 2000 dollars from someone and nothing happening after treatment. Do you give them thier money back?

By the way Thermage and Titan have their problems as well.

Erbium is the only one that has has the most success and a very favorable risk profile.

10.27 | Unregistered CommenterPMD

I personally had the thermage treatment done 2 years ago at an extreme cost. The results lasted as long as the swelling. The messy prep gave me no relief from the pain-I am good with pain and this was a complete pain workout. I am interested in resurfacing and perhaps getting into the business.

11.23 | Unregistered CommenterKT

Is it true that Fraxel can burn holes in your skin?
Also, can Fraxel cause angiogenesis?

One other thing....For Rosacea > Pulse Dye or IPL?

11.23 | Unregistered Commenterlost

lost,

1. The Fraxel can not burn holes in your skin. They can cause areas to overheat by using too high of energy with too high of MTZ's. This can lead to a scar.

2. I have done a few hundred Fraxels and have never seen angiogenesis occur.

3. Pulsed dye is the gold standard but has the purpura associated with it that can easily last 2 weeks or so. The IPL has the advantage of no downtime but the disadvantage of multiple treatments and probably does not have as long lasting of results when compared to the pulsed dye.

11.24 | Unregistered CommenterLH

For a new MedSpa, if I were to get ONE fractional laser (and we have ALL the many choices here!) - which single ONE would I need?

11.27 | Unregistered CommenterNA

The worst thing about the fraxel is that it is a one trick pony. You will need more than the fraxel in a new medspa. Have you already purchased other technology?

11.27 | Unregistered CommenterLH

We have Cynosure's Affirm in our office, and my doc tells me it's "second-generation" fraxel technology and can achieve the same quality of results that fraxel currently gives. I have seen patients get great results, and obviously there's less down-time because it's non-ablative. Any thoughts on whether or not something like the Affirm may replace fraxel all-together?

11.27 | Unregistered CommenterTony PA-C

Doubt it. I think the multiuse platforms will replace the one trick ponies. I have looked at the Sciton Pro-fractional but will wait until they figure out how to add coagulation (longer pulse width) to it before I purchase.

I did 6 cases with the pro-fractional and they had a little more downtime than I though but I did see some fairly nice results with only one treatment.

11.27 | Unregistered CommenterLH

I am not sure that the Affirm is truely a second generation fraxel technology. It is Cynosure's 1st generation fractional treatment.

The question that you should be asking is what fractional laser is going to have the best long term results? Will non-ablative (i.e. affirm or fraxel) or the ablative (i.e. erbium vs. CO2) be the best choice.

Fractional lasers will likely be around for a while and progress for the next few years. I am waiting for Sciton to add coagulation to their Pro-fractional platform. I recently had the Profractional in the office and treated 6 patients. Fairly nice results but a little more downtime than I expected.

So the answer to your question is that we likely have not seen the laser that will totally replace the Fraxel. Downtime for patients is always going to be important. Doctors are going to have their preferences.

11.27 | Unregistered CommenterLH

I have done 3 Fraxels and I see a little bit of improvement, however, it caused milia to form all over my forehead, which are difficult to get rid of since they are not exactly like pimples. I still have scars that I was hoping would diminish with the Fraxel treatments. I didn't think it was worth the amount of money I spent. And you better have a very high pain threshold because Fraxels hurt like hell.

I think the Affirm is great in that it doesn't hurt (especially if you use a little BLT first), there's virtually no down-time (you have what looks like a slight sun-burn for 24, maybe 48 hours max), and it works. Perhaps you may get a better result with an ablative procedure, but in today's society, down-time is very important. People want to be in and out, little pain and little down-time, and get results. If a non-ablative laser can achieve that and it takes maybe one or two extra treatments why wouldn't you choose to go that route?

I have yet to see a non-ablative laser achieve what you can do with an ablative laser. I own both.

12.1 | Unregistered CommenterLH

sirenchick,

I have done a few hundred Fraxels and I have never seen someone get milia from it. I have seen it with the ablative lasers though. Retin A would likely benefit it.

Scars tend to take 4 to 6 treatments and respond differently depending on location. I would assume you are talking about the face considering you now have milia. Even with 3 treatments you should see improvement and will continue to see some improvement ove the next 3 months or so. I would recommend that you complete at least 2 more sessions. Or you can do an ablative laser but will have a longer downtime.

Most people that have the Fraxel done do not feel like it "hurts like hell". Of course it is not pain free but there are ways to control your discomfort.

12.1 | Unregistered CommenterLH

I read this statement you made in this forum > (The worst thing about the fraxel is that it is a one trick pony. You will need more than the fraxel in a new medspa. Have you already purchased other technology?) <

What exactly does this mean and should I be concerned about getting a profraction (fraxel) treatment at a "NEW SPA "facility that only has the fraxel laser and not the other technology that should be coupled with it? They recomend 4 treatments @ 1000u each. I want to make sure they are efficiently equipped.
thanks

Concerned,

I was just stating that a new medspa will want more than just the fraxel when they first open. It is difficult to have only one product available and be able to make it financially. I was talking from a business point of view.

The Fraxel does only one thing and that is fractional nonablative skin resurfacing. If they have the Pro-fractional they have more than the Fraxel. They have ablative resurfacing and likely can do hair removal and probably veins. The Sciton system can do many procedures unlike the Fraxel.

12.3 | Unregistered CommenterLH

We are opening a new office and are looking at either a Cutera Xeo with titan vs a Palomar with deep IR, and 1540, and NdYag. Any thoughts on which would be better. I also have a satelite clinic and need a machine that is somewhat portable to take with me.

12.5 | Unregistered CommenterJR

Lumenis Encore:

Pigment FX , Active FX, Deep FX, Total FX

SINGLE TREATMENT better collagen than 5 aggressive Fraxel Treatments ----- see published article Lumenis website

Deep FX - same spot size .120 mm
as Fraxel's "new" fractional CO2 called re:pair BUT---
NO SHAPE, PATTERN, NO DENSITY configuration, NO Active FX setting which spot size changes to 1.6 mm.

Fraxel's NONablative device has had its day ; its been 5 years - thats the life a new technology and now on its way OUT>

12.6 | Unregistered Commenterohyeah

I am looking into getting Fraxel done after my forehead lift. I have been receiving peels for the last five years. My friend had it done and the procedure removed fine lines and freckles as well as evened out her skin tone in just one procedure. Do you feel strongly that this is common for all patients? Fraxel's website also states it is great for wrinkles around the eyes and crowsfeet. Is this true? Would it be worth $4000 for 4 procedures?

I am a nurse who has had 4 Fraxels with in the last 8 months and instead of my last (5th) scheduled Fraxel I opted for a fractionated CO2.
Fraxel hurts but CO2 hurts worse. I think hurts like hell is an accurate description as some one noted. I birthed two of my children with no meds so I am a pretty good judge. But the procedure does not last that long. I braced for each swipe, squeezed the rubber balls given to me and concentrated hard.But I survived. With Fraxel I took no meds just the BLT and was on levels between 8 and 11.For the fractioned CO2 I took one valium, one lyrica and dental block. I also had to take an antibiotic and acyclovir for 7 days. No narcotic because I vomit from narcotics. It still hurts during the procedure.I was at 40%. It does not hurt in the days after. Ice the first 24 hours. Swelling is severe for 3-4 days. I am in day 5 after the fractionated CO2. I now have a face (85% swelling resolved)and the scaling (peeling)is 90% done. I am VERY red. I need another week to make any kind of judgment call on wrinkles and probably months to comment on toning.

Milia is quite common with the Fraxel. I did have some milia every time .I see many patients who do as well.It is not a big deal they are very tiny and resolve easily.

The results of my Fraxel were minimal. I did have an evening of my skin tone. No noticable difference in wrinkles or mouth lines.
I patiently await the results of the Fractionated CO2.

Florida Laser Clinic Operators Arrested

TAMPA - Two people reported to the state Health Department that they were permanently scarred after being treated at a Westchase-area clinic run by a Hillsborough County Commission candidate and his wife.

The state Department of Health on Tuesday charged Rita Moroz Kruse, 45, who operates Tampa Laser Touch at 11309 Countryway Blvd., with the felony unlicensed practice of medicine and 20 misdemeanor counts of unlawfully dispensing prescription drugs.

State investigators that day also charged her brother-in-law, Michael Kogan, 49, who operates Perfect Laser Touch at 1155 S. Dale Mabry Highway, with felony unlicensed practice of medicine, records show.

Rita Kruse and Kogan are each free on $15,000 bail.

Don Kruse is a Republican running for the county commission in District 6 against Brian Blair.

A sales manager for Bill Currie Ford, Don Kruse also manages the business affairs of his wife’s clinic and The Electrolysis Institute of Tampa with her.

The clinic was closed Thursday because investigators had seized the equipment as evidence.

The Kruses said the charges were a misunderstanding. They were confident Thursday that Rita Kruse and Kogan would be exonerated.

Department of Health spokeswoman Eulinda Jackson, however, said Kruse broke the law. “She’s practicing without any supervision,” she said. “She’s beyond her scope.”

The Health Department said Kruse allowed several people, including students, to perform laser hair removal without the direct supervision of a licensed Florida physician.

Direct supervision, under state statutes, means on the premises. A licensed physician, Charles Alvarez, was attached to the clinic but died in December, Jackson said.

In interviews, the Kruses said they thought they had 60 days to replace Alvarez. They also said they had hired another physician, who was due to sign a contract the afternoon Kruse was arrested.

Jackson said there is no grace period. “She cannot practice one second without a licensed supervisor,” she said.

A few people complained to the Health Department that they had been burned during treatment, said the Hillsborough County Sheriff’s Office, which assisted the Health Department in the arrest. Two said they were permanently scarred.

Asked about the complaints, Kruse said she only knows of one from a previous student. “While I was not here, she sneaked in with other students and were using the laser,” she said.

State records show Kruse has a license in electrolysis issued in 2004 that is valid until May 31. She also has been certified since 2004 by the Society of Clinical & Medical Hair Removal Inc., as required by law, records show.

Kruse said she has allowed students to perform laser hair removal on each other, friends or relatives while in school, a practice similar to student hairdressers performing beauty treatments on each other.

“They never do clients,” Kruse said. “It is free. It’s no charge. It’s allowed by law.”

This is incorrect, Jackson said. “That should not be done, be it a student or the general public.”

Investigators also said Kruse called in prescriptions to local pharmacies under physicians’ names without authorization.

Kruse said the prescription was for a numbing cream that clients apply before treatment. The prescription and doctor’s authorization are on file with a pharmacy, she said.

Source: The Tampa Tribune / Tampa Bay Online

02.5 | Unregistered Commenterhey

I need some honest advise in layman's terms. I have scarring as a result of adult acne. The acne is under control now and I haven't experienced a new break out for quite some time. But, I have scarring. I have tried several proceedures to clear the scars, always with great promises, but have never seen any great results. I have done several treatments of Levulan, Smooth Beam and Fraxel. I had 1 treatment of Erbium. I actually thought the Erbium showed better results then 4 treatments of the Fraxel. My doctor has spoken to me about the Profractional laser. He assures me it will give me great results. Am I just wasting more money? Can anyone tell me what will give me the best results. The scarring is the primary concern, but anything that will help tighten and tone would be good too. Down time is not a major concern as I work from home. Thanks.

Acne scarring is difficult to eradicate. My experience is that the "lighter" peels and laser treatments just aren't very effective for ice-pick acne scars.

I've had moderate success with the CO2 laser - but that requires the patient to be very committed to the significant recovery process and post-op erythema.

02.6 | Unregistered CommenterTF

ice pick as opposed to box car scarring is probably the most difficult to treat and no real signifant treatment. however we have now had 20 patients go throught 4 days down time with the DEEP FX fractional CO2 with excellent results --- not completely gone but the best improvement I have seen in last 10 years. Fraxel I would say modest at best. I assume you should see the same with MIXTO and the new RE:PAIR. Fractional CO2 as presented last week at AAD is here.

frustrated,
the doctor is trying to sell you pro-fractional by scition because that what he has. right? pro-fractional fractional erbium will definetly NOT be better than fractional co2 hands down. CO2 is the gold standard. whether you go with MIXTO, REPAIR or DEEP FX ---- all microablative fractional CO2 will give you better results (if done properly) than any Erbium. see Dr. Brooke Seckle ; Harvard professor and author "save your face .com "

02.6 | Unregistered Commenteroeljd

frustrated:
the only skin resurfacing that is of promise is CO2 laser. If you are light skin Caucasian go for the full CO2 , not fractional version. otherwise, try fillers such as radiesse. Good luck

02.6 | Unregistered Commenterpmdoc

if you are caucasion or any skin for that matter clinical outcomes aslms reveal that > than 90% !! of full co2 have hypopigmentation.....(following patients out > 2 years) thats why full co2 (MAX FX) may not be the best nor safest option... but thats my opinion....

02.6 | Unregistered Commenteroeljd

fractinal co2 still is very early but look promising.... you may want to wait ....

02.6 | Unregistered Commenteroeljd

Thanks to all who responded. Very helpfull! As I understand the replies, the Full C02 will give the best results but has a high risk of hyperpigmentation? It appears that I should wait and learn more about the Fractional C02. (I am a Caucasian female.)

"I have looked at the Sciton Pro-fractional but will wait until they figure out how to add coagulation (longer pulse width) to it before I purchase."

- I would like to know from anyone what the significance of coagulation is. I've had the profractional done, can't see any results, and wonder if this is why? Any insight would be helpful. Thanks.

02.9 | Unregistered CommenterJulie

The reason that CO2 lasers have more benefit ofr tightening o of the skin is due to coagualtion. The erbium and CO2 lasers both are ablative treatments. The erbium in general dues not have coagulation which is heat developed below the level of ablation. The erbium produces less heat therefore less deeper trauma. The heat produced by a CO2 below the layer of ablation is what causes tha contraction (or caogulation of the cells and blood supply)of the skin but also increases the side effects and downtime. The erbium laser is almost completely ablative and will only cause coagulation about 5 to 10 microns deeper than the ablation as the CO2 will be 100microns plus for coagulation.

One company has been able to get coagulation with an erbium and it is Sciton. They do it by increasing the pulse width and double pulsuing the area. The first pulse is ablatieve and the second pulse to the same spot is coagualtion. They probably do not get as deep of coagulation but they do get some. I do see skin tightening with it. I am hoping that they will do their profractional the same way so that it will more mimic the CO2 but still give me the option of straight ablation. The nore heat or coagulation the more downtime the patient will have.

02.9 | Unregistered CommenterLH

I currently have the Cutera Xeo platform with Titan. I work with a darker-skinned population and see quite a bit of acne scarring and pigmentation concerns. Anyone have experience with Fraxel in this population? Anecdotally I've heard of worsened hyperpigmentation following Fraxel...any thoughts?
Also, any comments on working with Fraxel as a company (I am way less than thrilled with Cutera)? Thanks

Skinhealthmd:
I work mostly with Ftz III, IV and V using Fraxel 1500. In general, Fraxel is pretty safe in this population as long as you go low and gradually increase the fluency subsequently. Even in cases that PIH occurs (likely to be much less often in general than with other skin resurfacing platforms for these population such as CO2, Erbium, Plasma), it is not as bad and intractable generally speaking. If you search out B&A photos of companies with any of these platforms, you hardly ever see photos of people of darker skin except for Fraxel, CoolTouch3TC or Lutronic MOSIAC. I hope this helps. Good Luck

02.10 | Unregistered Commenterpmdoc

Pink, sensitive skinned white female needs advise on Palomar 1540 or the new Fraxel re:pair laser. Major concerns are lip, crows feet, forehead and neck wrinkles with the need to tighten somewhat and get rid of one vein that's still there after IPL along with minor discoloration. Only have 7 days for downtime and I'm worried about the potential with the new Fraxel re:pair for scarring or other damage but have been less than enthused with the case photos I've seen with the other lasers and was hoping the new Fraxel re:pair might be less harmful than other Co2 lasers but still give the benefits I was looking for

skinhealthmd

I use Fraxel 1500 70MJ. PIH is not a big issue (750 had pigment issues for me). With darker skin types MJ is not an issue, but treatment level can be. I will not go over level 6 or 7 and do an extra treatment. PIH from fraxel will resolve usually in about 4 months, treated lasts 2 months. At lower treatment levels percentage of PIH is pretty low.

Fraxel salesman is a ghost after you write a check. On the other hand nurse educator is only a call away with good information on peer usage and outcome. Part of her pay is based on tips sold so she is always there with good information to help you burn them up. Had a problem error code, made a call, had loaner fraxel at noon the next day.
Over all good service.

Have a palomar collecting dust, cant get a call back.

Got into a debate with Cutera rep about skin anatomy, laser physics and efficacy of the Pearl (pretty sure I was right). Have not seen him since

02.12 | Unregistered CommenterFlorida PA

Need Advise:
If you can live with a 10-14 day downtime for close to what you like to achieve I would recommend,based on your Caucasian skin type, an ablative CO2 procedure with something such as Lumines Active FX. There are an ongoing debates and studies (per my own knowledges and on this postings) on whether fractional CO2 can get you the same thing. The problems also with this scenario are there are yet clear consensus guidelines, be it how much power (Joules) and how many treatments (2 to 4 times total). A Palomar 1540 or Fraxel 1550 RE:STORE can deal with sun damages, pigmentary damages, fine wrinkles around your eyes but not for true tightening or deep wrinkles.

02.13 | Unregistered Commenterpmdoc

Has anybody looked at or tried the new Palomar 2940 Fractional Resurfacing Laser? It appears to provide a single pulse or a double pulse. The first pulse is ablative and the second is non ablative. Could this be the best of both worlds?

02.19 | Unregistered CommenterMJS

MJS:
2940 is essentially ERBIUM in nature. The second pulse protocol is an attempt to provide "skin tightening" effect which traditionally Erbium is not known to be capable of due its very high water affinity. This results in too rapid evaporation of heat, thus preventing the necessary "thermal coagulation" needed in collagen tightening scenario . Does this "second" pass protocol work in reality??, I don't know for sure. I believe owners of the Sciton Erbium have been incorporating this protocol recently.

02.19 | Unregistered Commenterpmdoc

pmdoc and Florida PA, thank you for your feedback. I'll be trying out the Fraxel next week and look forward to seeing the results!!

I am a nurse who has severe peri oral and peri orbital wrinkles. One physician wants to do co2 laser around my mouth, and portrait on the rest of my face. The other wants to do erbium on my entire face, but fractional co2 over the erbium around my mouth. I had a co2 laser treatment in 2001 around my mouth but the results were not visible. I am fair skinned and am concerned about hypopigmentation. Any advice?

03.2 | Unregistered Commenterlahela

I would say the "safest" choice would be the erbium and fractionated CO2 or just have the do deep resurfacing around the mouth with the erbium as well. If they have the Sciton erbium they can use coagulation around the perioral region. It has the benefit of tightening the skin but with less risk of hypopigmentation. You will likely not get as much tightening with the erbium as you would with the CO2.

If you had CO2 previously with very little improvement they did not go deep enough. The nice thing about the fractionated CO2 is that it can easily be repeated.

03.2 | Unregistered CommenterLH

I am now 7 weeks post fractionated CO2 at performed at 40%. ( now there is something you should be asking about.. what % he/she will treat you at)) I have totally healed. I still have some redness and increased redness when washing my face. I am a very fair woman. My make up goes on great.. with make up my face looks 90 % flawless. If I get the chills I feel it in the nerves on my face. I do have two spots of hyperpigmentation (brown spots). The Dr says he will use IPL on them. If it were not free I would not be a happy camper. Who wants to trade one problem for another. I think fractioned or full CO2 is the way to go. We had someone storm out of the office this week because they had not seen results with one erbium Fraxel.($1,000 ) I believe you will not see any results with one Fraxel. I think one just lays the foundation for the next one..In my opinion one Fraxel is a waste of money. (I have had 4) I would do a CO2 fractioned every 5 years as an option or full CO2. The office I work in offers both. But lets be real about the procedure. You are on an antibiotic for a week. There is blood and you NEED to take a full week off from work. You need to take care of yourself well for those first two to three days.Also PLEASE make sure your DR is using the HIGHEST setting you can tolerate. Then you get your moneys worth. I was at 40%. We have done patients at 20% or 30% and up to 60 %.Personally for my money I want the highest level of treatment! Patients don't know to ask or make sure... You have more swelling at a higher level but its your money!! I want the best result if I am going to take a week off from work etc.

MJD made a comment above a day or two ago about Palomar's new 2940 claiming to make one "ablative" pass and a secong "non-ablative" pass. I also just read an article claiming that only 2940 fractional lasers are truly "ablative" since all the near infrared wavelengths (i.e., 1500, 1560, 1320) only "heat" the dermis, etc. I have noted that many of the mfr. web sites actually call their devices "non-ablative fractional" but then they describe how their "micro thermal zones" actually ablate tiny columns of tissue as deep as 2000 microns, etc. Doesn't a fractional C02 actually work on a similar principle as all the other fractional lasers except that due to the differences in wavelength (and related absorption coefficients) there is considerably more thermal diffusion radiating out from the MTZs? The literature tells you very specifically how much penetration you achieve with either 2940 or 10,600 nm-- and if you use high enough fluence you penetrate quite deeply.

medspaguy:
Ablative: means you take out the entire epidermal layer
Non-ablative: means the epidermal layer is left intact despite it is partially treated or "drilled down" and that re-epithilialization on these treated columns can happen within 24hrs.

If a procedure already does a full ablation on the first pass then it is an ablative procedure no matter how one wants to spin it. Any skin resurfacing procedure technically can be delivered non-ablatively or ablatively simply based on whether the treater wants to treat over 100% or the skin surface or not. You mentioned "thermal diffusion" (related to water absorption coefficient), it is actually "thermal coagulation" A skin resurfacing platform that has less water absorption thus a higher thermal coagulation ability will result in the additional benefit of skin tightening. You see this in full ablative CO2 and plasma platforms. I am yet convinced if you can get this with fractional CO2.

03.7 | Unregistered Commenterpmdoc

I had a pro-fractional treatment all over my face, using 175mm. What may I expect from this treatment? I paid $1000 and was told it was a discounted price. What is the average price for this procedure? Also, When may results start to be noticeable?
Thank you
mar, OC, CA

03.8 | Unregistered CommenterMAR

MAR:
I don't do the profractional. What were your intentions to get out of this procedure?? For a "fractional procedure" you need to do about 4-6 times to get reasonably good results. With this price tag per time I am not sure if you would end up feeling like your $ was well-spent thu. What is your age and ethinic skin type?

03.8 | Unregistered Commenterpmdoc

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