Is "Stacking" Profractional Laser Treatment at Higher Settings Reasonable?

The answer is yes, you can stack profractional treatments safely around the eyes. Because the epidermal layer of the skin is thinner around the eyes, the depth settings here are more conservative. Levels of 100 microns cause less pinpoint bleeding than those of 150 microns, but results are likely to be less as well. My preference is for 150 as well. The typical density of the pattern in the newest profractional systems (XC) is 11%, so I assume that is what you had in your single pass treatment. My preference is to perform three passes at this setting, along with a coagulation setting of one. That logically means we are treating about 33% of the skin surface now. So healing is slower, and there is more swelling, but the results have proven to be worth it. A single pass of 150 microns is safe, and easy on the patients, but did not result in the degree of change I was looking for.
The truth is we are still all looking for the best treatment parameters. I have taken part in large user meetings for this laser, and the settings seem to be different in almost every office. So I will just finish by stating that I have treated up to three passes in the eye region safely.

Pulse stacking is OK for erbium laser but not CO2. I think 150 around the eyes is a perfect number (micron wise) HOWEVER, the only thing I do differently is to add CO2 Fractional on top of the 150, and do 2-4 passes at 5% density. This gives even better tissue contraction. One has to be careful not to contract too much as this can cause ectropion of the eyelids- however most cases settle. All the bestDr Davin LimLaser and Cosmetic DermatologistBrisbane, Australia