What are ablative fractional lasers, and how are they used?

Ablative fractional lasers fire a vaporizing pulse into the skin. There is a column of tissue ablation formed. The fractional lasers spread the pulses out using a variety of scanning devices. The theory of these fractional ablative lasers is to markedly reduce the healing time by spreading the pulses out, leaving normal epidermis between the pulses. As with nonfractional laser pulses, Er:YAG is more purely ablative than CO₂. The latter uses the surrounding tissue heating to help collagen contraction and remodeling. The first ablative fractional laser used was a 2940-nm (Er:YAG) laser called PIXEL. This has been joined by other Er:YAG fractional devices and many CO₂ 10,600-nm fractional lasers. There is even a diode 532-nm ablative fractional laser.

Fractional lasers are primarily used for cosmetic purposes. They help with mild to moderate facial rhytids, hyperpigmentation, and lentigines, and are very effective in helping acne scarring. Table 54-11 lists the ablative fractional lasers.

Brightman LA, Brauer JA, Anolik R, et al: Ablative and fractional ablative lasers, Dermatol Clin 27:479–489, 2009.

Table 54-11. Ablative Fractional Lasers
	WAVELENGTH		TYPE		COMPANY		NAME
	2940 nm		Er:YAG		Alma		PIXEL
	2940 nm		Er:YAG		Cynosure		Affirm
	2940 nm		Er:YAG		Focus Medical		NaturaLase Er
	2940 nm		Er:YAG		Fotona		XS Dualis
	2940 nm		Er:YAG		Fotona		Venus-i
	2940 nm		Er:YAG		Palomar		Lux2940 Fractional
	2940 nm		Er:YAG		Sciton		ProFractional
	2790 nm		Er:YSGG		Cutera		Pearl Fractional
	10600 nm		CO2		Alma		Pixel CO2
	10600 nm		CO2		Candela		Quadralase
	10600 nm		CO2		Cynosure		Afirm CO2
	10600 nm		CO2		Eclipse		SmartXide DOT
	10600 nm		CO2		LaseringUSA		MiXto XS
	10600 nm		CO2		Lumenis		Ultrapulse
	10600 nm		CO2		Lutronics		eCO2
	10600 nm		CO2		Solta Medical		Fraxel re:pair