What's the Difference Between Fractional and Yag Laser?

Question

I have ice pick acne scars. I went for a free consultation and they said I would receive Fractional laser therapy.

	Later on I went to their website and noticed they are using the 1064nm ND: YAG laser. It does not mention anything about Fractional. I would like to know the difference between Fractional and the 1064nm ND: YAG laser or if it's the same thing. Also, how effective is Yag Laser for acne scars?

Harold J. Kaplan, MD · Answer

Hello Shei2i,
The question you are asking has to do with two different apsects of lasers.  The first, the "fractional" technology has to do with the pattern of the laser beam.  In fractional technology, the beam of light is split into thousands of microbeams.  In this manner, the laser treatment typically does not effect the whole face, but rather a small %.  The goal behind fractional technology was to create a resurfacing technique that had similar or like results as traditional CO2 and Erbium laser resurfacing without the redness, peeling and extended recovery.  Whether the technology has accomplished this is open to debate, but essentially the Fraxel and others like it were developed for those patients with an appetite for traditional laser resurfacing but with less downtime.
The 1064 Nd:Yg laser is a particular type of laser, rather than a particular type of beam technology.  The 1064 wavelength comes in two varieties we know of, q-switched and long pulsed.  The Q-switched 1064 lasers are most often used for pigmented lesions such as tattoos, sun spots, freckles, etc. although some manufacturers do have an FDA approval for wrinkles & collagen stimulation.  The other type of 1064 laser is a long pulsed 1064.  Within this category there are several different laser manufacturers but this type of laser is most often used for leg veins and hair removal (dark skin types).  But some of these machines do have FDA approved indications for wrinkles and collagen stimulation.
To sumamrize, the short answer to your question is that the fractional technology and the 1064 wavelength are different because one represents a beam splitting technology and the other represents a specific type of laser.  Fractional technology is used for 1550, 2790, 2940 and 10,600 wavelengths, which are all different types of lasers and all different from the 1064.  We do use our q-switched 1064 laser for acne scars but more often for dark acne scars (dark skin types) and for mild textured acne scars.  If the scars are more severe (ice pick), you may want to consider fractional technology like the Fraxel or even Erbium or CO2 resurfacing.  
Hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Matthew Richardson, MD · Answer

There are many different types of fractional and yag lasers. There are also different types of 1064nm ND:YAG lasers. In my practice, I utilize a 1064nm ND:YAG laser primarily for treating vascular lesions (broken capillaries, veins, cherry angiomas, etc), and a fractional CO2 laser for skin resurfacing, acne scars, wrinkles, etc. I also utilize a different type of YAG laser, an ablative Erbium:YAG laser, for skin resurfacing in select patients.All the best,

Johnny Mao, MD, FACS · Answer

The word "fractional" in terms of laser simply means that the laser is applied in multiple beams of light energy directed in a small area so the laser "drill" columns of holes into the region leaving areas of healthy skin to help promote faster healing. Typically for moderate-severe, or severe acne scar resurfacing, you want "ablative" lasers to superficially smooth the surface irregularity so the skin appears more even.  To my knowledge, there are only two types of ablative laser for this purpose:  Fractional CO2 laser at 10600nm, and Fractional ERB:YAG, or erbium laser at 2940nm.  YAG lasers is a general term and includes ND:YAG, ERB:YAG, and others like the long pulse 1064nm ND:YAG which is mostly used for leg veins.  When you speak to your provider, make sure they know their laser in terms of nanometer (nm) because that is what truly dictates effectiveness.  ERB:YAG or erbium:YAG lasers at 2940nm can be applied in a fractional mode and achieve "ablation" which is what you want.  To be honest, 1064nm ND:YAG is not a true "ablation" laser and not used commonly for scar resurfacing.

Colin Campey, MBBS (retired) · Answer

Hi shei2i
Fractional laser can be performed with either a CO2 or Erbium system.  Many years ago both these systems performed invasive full skin resurfacing (removal of tissue) meaning downtime and recovery with associated risks.  The development of the fractional laser using columns of energy made it possible to treat the skin without the down time and minimal risks.  
The ND YAG laser is used in two modes, Q switch or long pulse.  We have both types in our clinic and successfully treat veins, removal of tattoos, lines, wrinkles and skin tightening, loss of facial volume, stretch marks and scars of all types.  
We treat acne scaring using both ND YAG and Fractional Erbium.  This treatment works deep in the skin to promote collagen and it also involves fractional resurfacing to remove tissue.  Combined together we achieve great results.

Regards
Dr Colin Campey, Brisbane Australia

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