I know this has been asked before...I am considering one of these procedures for age spots, folds and fine lines. Obviously, the no down time with the non abalative sounds appealing; however, what happens to the coagulated tissue if the skin is left intact? I assume it has to break down, dissolve, heal then rebuild? I would think that vaporized tissue would heal better since it would need to only heal then rebuild? Plus 3-5 treatments at 3 days v. 1 treatment at 7-14 days equals the same.
Ablative V. Non Ablative Fractional Laser (Fraxel, Mixto, Active, Etc.)
Doctor Answers 5
Fraxel Restore vs. Repair
The recovery for Fraxel Restore is a more easy few day healing then the type of healing with Repair. There is also some more risk with adverse events with the Repair, so you can't easily compare them. If your skin may benefit from the semi-ablative Fraxel Repair, then you may not reach the same good result if you were to do several Fraxel Restore treatments. There may be more tightening of the skin lines with the Repair than the Restore. Interestingly, for some acne scars, we do get better eventual results with a multitude of Restore treatments but you are limited in how many Repair treatments you can have done. Brown spots may improve more with the Repair than the Restore, but Fraxel Dual is the Restore with a pigment laser (Thurium, 1927nm.) that can improve these sunspots or freckles in one treatment, but that has a week of healing, unless done more gently and then a couple or a few treatments.
Ablative vs non ablative laser treatments
I have the artisan system by palomar. I use the non ablative for tightening effect, scars, you usually needs 3-4 treatments with little or no down time. treatments are performed every 4 weeks. laser light is put deep into the skin, skipping the superficial surface so little down time. The ablative treatment is used for wrinkle lines. I perform a combo of both with very nice results. need about 4 days down time.
I find the artisan gets the same results as CO2. I was a long time CO2 user and thought erbium did not do it. but combo treatments are getting the same results with less down time, less pain and quicker recovery.
Ablative Laser versus Non Ablative Laser
Your age and location level of your sun damage are two important factors to consider. Ablative technologies work better for wrinkles and superficial sun damage such as brown spots and can be effective with just one treatment. Younger patients (30-40's) may benefit from nonablative treatments when wrinkles are mild, but you will have to do multiple treatments to get similar results to a gentle ablative treatment. Thermal spread can be achieved with either technology depending on the experience of the physician.
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Ablative vs Non-ablative laser depends on downtime and expectations
The way that non-ablative and ablative lasers improve skin is similar if you look at the histology. They both create zones of thermal damage that serve to "extrude" the bad stuff in your skin. The ablative lasers, especially the CO2 lasers, do a much better job at collagen remodeling and tightening and will be better for your fine lines. If you have the time to recover, the CO2 fractional laser is the way to go in my opinion. Keep in mind that "folds" as you describe in your post generally won't improve with any of these lasers.
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