Fractional ablative vs fully ablative - which treatment provides a greater difference in the skin?

A full blade of laser is an alligator to mowing the lawn. All of the skin in the area treated will be vaporized a certain depth each time the laser is fired. This allows a tremendous amount of energy to enter the tissue and is excellent for surface regularities on the skin, such as benign growth, Sun, damage, surface pigmentation, thick, textured skin, and in general because of the amount of energy that is applied to the skin. There is notable skin shrinkage which occurs.
Fractionated lasers on the other hand, or more like irrigating the lawn. Well, generally, the percentage of the area to be treated can be adjusted fairly high percentages, but the skin, it by definition does not treat 100% of the skin surface in the area, the laser is fired and Because untreated areas remain the downtime is generally shorter. Because there is a relative decrease in the total energy place within the tissue you do not generally see impressive shrinkage of the skin. Instead, fractional lasers are better used for very deep laser treatments in areas where the tissue quality might be compromised such as in scars, where there is a relatively poor healing potential and thus treating a small percentage of it very deeply the safest. Fraction of laser treatment is also excellent for addressing unevenness in skin thickness (think different level of the actual skin surface, such as in patient with acne scars) where vaporizing little columns of skin all over the uneven area will better help to blend the relative surface of the skin. The right choice for you really depends on your tolerance for downtime and the specific concerns you’d like to prioritize targeting.
Brandon Lambiris, MDBoard-certified plastic surgeon | Sarasota, FL

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

The factors that determine the amount of energy that you receive are the amount of skin damage (sun, aging, acne scars) and the amount of recovery time that you can allow. Fully ablative treatment requires up to a month of recovery. A fractional treatment can result in a 2-week recovery. We have very fine control over the parameters of energy and surface area. Go on some consultations with doctors who regularly perform CO2 laser resurfacing. In your case, perhaps you don't need a fully ablative treatment. Some of my patients need a quick recovery so I will use less energy and they will return for another short recovery treatment in 3-6 months.