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Fractional Resurfacing: Should We Believe the Hype?

Fractional resurfacing—a cosmetic treatment that reduces acne scarring, alleviates dark pigmentation, and improves other conditions of the skin—has been regaled as a cutting-edge innovation that promotes more rapid healing, fewer side effects and less downtime than ablative laser skin treatments. But do the results justify the cost of the treatment?

Unlike earlier laser technologies, with fractional resurfacing only a specified percentage of the skin receives the laser light. The laser delivers a series of microscopic, closely spaced laser spots to the skin while simultaneously preserving the normal healthy skin between. This allows for more rapid healing and less risk for complications. The latest fractional resurfacing treatments are office-based procedures done on an out-patient basis, with a recovery time (time away from the public eye) between three and seven days. Costs can range from several hundred to several thousand dollars, and because they are usually considered cosmetic, these procedures are generally not covered by insurance. According to ASAPS statistics, 110,392 fractional resurfacing procedures were performed in 2008.

"The goal of this panel is to try and separate fact from fiction when it comes to this 'new' technology," said Jeffrey Kenkel, MD a plastic surgeon from Dallas, TX. "We need to ask some hard questions: Is it really better? Is it a real advancement? Are our goals and expectations in line with the reality?"

Fractional resurfacing may not be ideal for every skin condition. "Deep wrinkles, for example, may require so much density from the machine that we are actually taking the treatment to confluent ablative levels in the dermis, thereby defeating the purpose of fractionation entirely. Conversely, fractional technology that penetrates deep into the dermis could be overkill for more surface blemishes," said Fritz Barton, MD a past-president of the Aesthetic Society with a practice in Dallas, TX. "We need to identify what the goals are and establish our expectations as compared to other resurfacing techniques such as peels, dermabrasion, and full ablative resurfacing."

The expert panelists will review some of the technology that is out there and share their experiences with the devices.

"Fractional resurfacing was introduced to maintain the effectiveness of ablative lasers without the complications such as loss or change in pigmentation and in some cases, scarring. Moreover, patients of color may now be safely treated for a variety of skin conditions," said Steven Cohen, MD a plastic surgeon with a practice in San Diego, CA.

While there are some clear advantages to using fractional resurfacing to treat certain conditions of the skin, there remains a place for ablative procedures in the cosmetic surgery practice. "Like everything we do in medicine, not all patients are candidates and some patients will still benefit from ablative lasers," added Dr. Cohen. "The panel should bring to light some of these nuances."