A fractional laser resurfacing technique based on the principle of fractional photothermolysis (FP) has recently been developed to address the drawbacks of both ALR with its significant side effects and nonablative dermal remodeling with its limited efficacy.3
The wounding spectrum of fractional laser resurfacing is in the middle of conventional ablative resurfacing with CO2 and erbium:yttrium-aluminum-garnet lasers and nonablative resurfacing technologies.1
The first device to implement the FP concept used a 1550-nm erbium-doped fiber laser to thermally coagulate microscopic columns of dermal tissue in regularly spaced arrays over a fraction of the skin surface with little to no ablative effect on the epidermis. Leaving intact tissue bridges between minute cores of coagulation necrosis within the dermis results in faster healing time, as healing originates not only from the skin adnexa but also from these skin bridges. With absence of significant epidermal disruption, this technique has been classified as nonablative fractional resurfacing (NAFR).
This intermediate approach increases efficacy compared with nonablative resurfacing, however with a faster recovery period compared with ALR.
Neither conventional nonablative nor nonablative fractional laser resurfacing offers therapeutic outcomes comparable
with ALR, but both have become much more popular than the latter because the risks of adverse effects are limited in the face of acceptable improvement.