Continuous or fractional ablative lasers are lasers that remove 'pieces' of skin. Their target is the water contained in the superficial layers of the skin.
There are two ablative lasers :
-The CO2 laser at 10600nm. Its ablative effect is accompanied by a significant thermal effect.
-The Erbium laser: Yag at 2940nm. Fraxel laser. The Erbium: Yag laser has an affinity for water 10 times higher, resulting in a nearly pure ablative effect (if very short times are used) by spraying the tissues. The thermal effect can be modulated by varying the time (firing time = duration during which the energy is given).
There are two treatment modalities :
-In continuous, the 100% of the surface is treated.
-Fractional, a variable percentage of the surface is treated because the laser beam is fragmented into several microscopic beams.
Fractional lasers are currently the most used because they give spectacular results with the advantage (compared to the continuous modality) of having lighter consequences, less social eviction and a lower risk of complications.
INDICATIONS
All areas of the body can be treated (with the erbium laser) and not just the face, neck, décolletage or the back of the hands.
All skin types can be treated (with the erbium laser), even the darkest of skins. Tanning in itself is not a problem (with the erbium laser).
The main uses are:
– Improvement of wrinkles and lines.
– Rejuvenation of sagging skin without surgery.
– Scars, including acne scars.
– Diminishing pores and improving skin complexion.
– Stretch marks.
– Pigmentary marks; notably melasma/chloasma (pregnancy mask).
Effects often last more than three years.
The best results (and therefore indications) are obtained on thin and slightly wrinkled skins.
session
The day before treatment, an anti-herpes prevention is started if there is a history of oral herpes.
An anaesthetic cream is applied one hour before the start of the session. The treatment itself takes about 20 minutes.
The eyes are protected by ocular hulls.
You will apply at least 2 times a day a healing cream for 10 days and a total sunscreen for 1 to 3 months depending on the parameters used.
3 or 4 sessions are needed, depending on the state of the skin, and sessions are at intervals of every 3-4 weeks.
Side effects and after effects
The consequences and side effects depend on the type of laser used (CO2 or erbium), the modality (continuous or fractional) and the parameters used (which will be discussed with the patients, they determine the importance of the result and the consequences).
Fractional erbium laser at the end of the session, a feeling of warming is felt; the treated area is red (whose intensity and duration depend on the parameters used).
The down time is short and the risk of disorders of pigmentation (spots) is low.
Fractional CO2 laser
The side-effects are more onerous than with erbium laser treatment: patients experience the sensation of sunburn or of burning
There will be 7 days’ recovery time.
Scars, hyperpigmentation, acromia (lighter marks), and infections have been linked to the use of very high settings in the most ‘at risk’ zones (notably the neck).
Continuous wave laser : 15 days’ recovery time should be allowed. During this time, you will need closed plasters applied on a daily basis for around 5 days. Post-laser pain is moderate.
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