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