Anthony M. Rossi, MD
Dr. Rossi is a Fellow in Procedural Dermatology and Mohs Surgery, Memorial Sloan-Kettering and Weill Cornell/New York-Presbyterian Hospital, both in New York, New York.
Dr. Rossi reports no conflicts of interest in relation to this post.
The September 2012 issue of Dermatologic Surgery (2012;38:1477-1489) featured a randomized controlled trial of 4 different fractionated ablative lasers used in the treatment of facial photoaging. The authors utilized 4 different lasers on 12 participants, with the treatment area being the face (divided into 4 quadrants). The lasers tested included the Fraxel Repair (Solta Medical Inc) fractionated CO2 10,600-nm laser, Active and Deep FX (Total FX; Lumenis) fractionated CO2 10,600-nm laser, Quadralase (Candela) fractionated CO2 10,600-nm laser, and Pearl Fractional (Fx; Cutera) fractionated yttrium-scandium-gallium-garnet (YSGG) 2790-nm laser. The authors calibrated each device to deliver a “moderately aggressive” treatment based on the investigator’s clinical experience. Pain and posttreatment improvement in facial rhytides, lentigines, texture, and pore size were assessed. Additionally, biopsies of each quadrant were obtained immediately posttreatment in 2 participants. Posttreatment healing time, postinflammatory erythema, and edema were similar in all devices, and although all devices resulted in improvement of overall photoaging at 6 months, there was no statistically significant difference between devices in the degree of improvement. Although not statistically significant, the Fraxel Repair laser had a higher patient pain score as well as intraoperative pinpoint bleeding; the investigators also deemed it the most time efficient.
What’s the issue?
Are all fractionated ablative lasers created equal? According to this study, yes. As the patient market for fractionated ablative facial resurfacing grows, so will the numbers and types of laser platforms that are available to them. It can, therefore, be difficult for physicians to navigate the marketing jungle. This randomized controlled trial nicely compares 4 different platforms on one face, which is not an easy task. This trial does show that the degree of improvement is similar across all devices both clinically and histologically, regardless of manufacturer type. It reaffirms that regardless of laser cavity configuration, dwell time, beam profiles, and delivery systems, the end results are equivocal, which may provide the physician with some comfort when choosing a laser platform. This study does not describe in detail other nuances that separate laser devices, such as ease of handling, combination platforms, or price. Physicians should be familiar with different laser platforms, as each laser has subtleties that will distinguish it from another one. However, do these differences correlate to noticeable differences clinically?