Fraxel Laser Only Treats 20 Percent of the Skin with Multiple Passes?

Question

During a Fraxel Restore treatment, when the technician does multiple passes over the same area, how does the laser know which area is the same skin being treated and not untreated skin?I'm trying to wrap my head around how the laser only treats 20% of the skin at a time when it does multiple passes.

John L. Burns Jr., MD · Answer

This is an excellent question.  Fraxel has a patent protected technology where by the handpiece used by the technician, nurse, or doctor can roll over the skin delivering approximately 2000 microthermal zones (MTZs) per square centimeter.  This number is an average and could vary depending on how the user programmed the laser's density setting.  In general, the doctor will program the power, density, and number of passes into the laser and the laser will calculate how densely to space apart the microthermal zones.  The power is measured in Joules and determines how deeply the laser penetrates.  Fraxel is very powerful and can penetrate into the deepest part of the skin (reticular dermis) making it very effective.  The density depends on the number of proposed passes and ranges from 10% to 70% coverage.  The 20% number you have been told is an average treatment density using average settings.  20% is a very standard treatment and well within standard of care.
In general, most users will do 4 passes (2 horizontal and 2 vertical) with a 10% overlap between passes.  The laser will calculate how densely to space the microthermal zones depending on the proposed number of passes and the desired density.  The treated skin will therefore be a computed average for coverage and does not guarantee that the laser will not treat an area that has already been treated.  However, this average is very precise and if the doctor or nurse who is treating is very precise with their treatment then the delivery of energy is extremely accurate.

Ron Shelton, MD · Answer

Different settings in energy levels affect the density of the laser beams and the number of passes also affects the percent of area treated. This is a summation of every microlaser beam that goes through the epidermis. It is not meant to say that there aren't repetitive strikes in the same exact microbeam area. By treating the skin this way, compared to the older laser technology which destroyed all the epidermis in the path of the diameter of the laser beam. This made healing take much longer and there is a greater risk, although small, of scarring with the older treatment.
Fraxel Restore provides faster healing because of the lack of 100% surface area treatment per session.

Michael A. Persky, MD · Answer

Hi Gengen,
The "20%" number is arrived at by the ratio of the total surface area of laser hits on the skin to the total surface area of the treated skin. 
The surface area of the face is say 100 sq cm.  The area of a single laser hit with Fraxel is about 1/10 the diameter of a hair follicle.  Add millions of those microscopic hits up until they reach 20 sq cm, and you have a "20%" treatment. 
Is there overlap of some of these microscopic laser hits?  I would imagine that there is.
Now I am ready to help my daughter with her algebra homework.  Be well.
Dr. P

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