Why do Fractional laser results not last long?

Question

I found this study on fractional devices, PMID: 20166157. Take a look at the photo of this patient Before, 3m, and 2y later. 3m later, seems like massive improvement, but 2 years later she looks almost same as before treatment - with slightly less wrinkling. Normally people don't age like that in 21 months (3months to 2 years post). Makes me wonder whether at 3m, there is significant micro-swelling which results in skin looking nicer/plump but skin actually hasn't improved that much?

Brian M. Harmych, MD, FACS · Answer

Looking carefully at the photo you've provided, I would agree the patient looks better at 3 months post fractionated laser treatment. The post-treatment swelling may improve the appearance of fine lines and wrinkles. This is relatively common. You can still see fairly significant results in the photo provided at 2 years. However, most of these permanent changes effect the skin only. In the two years following the initial laser treatment, the patient has (1) aged by two more years (2) Accumulated some addition sun / actinic damage (3) experienced fairly significant overall volume loss, which is either age-related or perhaps the patient had lost some weight over that time period and (4) additional gravitational effects of aging are advancing. In the end, we can assume from the changes we are seeing in the photos that the patient looks a little better than she otherwise would have had she never undergone the laser procedure at all. Keep in mind that most facial rejuvenation procedures (this includes neck lift, facelift and skin resurfacing such as fractionated laser resurfacing) "set the clock back" so to speak. The patients permanently look younger, better. But, unfortunately the aging process continues.

Raffy Karamanoukian, MD, FACS · Answer

Of course fractional lasers cannot be a cure-all for all sun damage. They are an important part of a regimented approach to facial rejuvenation.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

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