fraxel laser treatment - skin resurfacing - laser skin resurfacing

Think of Pixels in a Photo When You Think of FraxelT Laser Treatment (FLT)

If you look at a newsprint photo up close, you'll see that the image is actually comprised of thousands of tiny spots of ink. Similarly, Fraxel Laser Treatment (FLT) produces thousands of tiny treatment zones on skin, known as "microthermal treatment zones" (MTZs) in the emerging science of Fractional? Photothermolysis.

New Advances in Laser Skin Treatment
Fraxel Laser Treatment is a safe and gradual laser procedure that stimulates the body to replace aged and photo-damaged skin. To date there have been two categories of laser skin rejuvenation-ablative and non-ablative, and both have significant disadvantages. Ablative techniques resurface broad areas of the skin, but carry a high-risk profile, produce problematic side effects and entail prolonged postoperative healing and recovery times. Non-ablative techniques, on the other hand, carry fewer risks, but generally produce only limited clinical improvement.

Fractional Photothermolysis and Fraxel Laser Treatment-and innovative science and a differentiated category of aesthetic medicine-provide the positive results of ablative resurfacing with the much less invasive biological response of non-ablative treatment.

"How Fractional Photothermolysis Works"

Whereas other lasers have a specific target that is differentiated from the rest of the skin, FLT is selectively absorbed by water, which is present in all skin tissue, and treats only a very small fraction of the skin at a time in a process called fractional photothermolysis. This creates a unique wound healing response by sparing healthy tissue. As the size of the injury gets smaller, the wound healing time gets shorter.

Wound Response
The wound healing response differs from previous techniques because the areas of epidermal tissue that are spared between treatment zones contain viable cells, including both epidermal stem cells and transient amplifying (TA) cell populations. The speed of re-epitheliazation is directly proportional to the number of density of TA and stem cells. Thus, re-epitheliazation of treatment zones proceeds rapidly, with little or none of the side effects (such as lengthy downtime, pain, fluid drainage and prolonged edema) observed after traditional resurfacing procedures.

Individual MENDs are not clinically noticeable, but for example, 2,000 MENDs per square centimeter of treated tissue give the skin a bronze appearance for about three to fourteen days depending on treatment energy and spacing of the microthermal zones. The MENDs naturally exfoliate as shown in the 16-day post in vivo histology below.

Intact Barrier Function
The stratum corneum, which prevents water loss and acts as a protective barrier, remains intact after FLT, significantly reducing the risk of infection. One reason the stratum corneum is not damaged by the laser is because it contains relatively very little water. The laser light passes through the stratum corneum like a window, thermally denaturing the epidermis and penetrating well into the dermis.

Typical Treatment Plan
Before treatment, you and your patient can discuss which areas are appropriate for treatment, what kind of response can be anticipated, what to expect after treatment, and at what intervals ongoing treatments should be scheduled. By sparing healthy tissue, FLT can also be used on delicate skin areas that require soft tissue coagulation such as the neck, chest, and hands.

Clinical studies suggest that an effective treatment regime is 3 to 5 sessions, spaced about 5 to 14 days apart. Each treatment session targets about 20% of the skin’s surface, depending on the treatment level selected. Results are immediate and progressive; optimal cosmetic improvement is usually visible in 3-6 months.

Procedure

Fraxel Laser Treatment can be performed in your office using only topical anesthesia. The following are steps involved in treatment.

1. Wash The treatment area will be thoroughly cleansed prior to the procedure using a mild, gently abrasive skin cleanser.

2. OptiGuideT Blue An FDA certified water-soluble tint is applied to the treatment area to highlight the contours of the skin. This allows the laser's Intelligent Optical Tracking System? to detect contact with the skin and to adjust the treatment pattern with respect to hand piece velocity. The OptiGuide Blue is washed off after treatment.

3. Topical Anesthesia A lipid based topical anesthetic ointment is applied to the skin prior to treatment. This serves to numb the skin and avoid any prickling or heat sensation that may be felt during this procedure. After about 45 minutes, when the patient's sensitivity to the cold of an ice cube is reduced to a low level, the contact treatment may begin, directly through the anesthetic ointment.

4. How the Fraxel Pattern is Laid Down A complete procedure consists of a series of horizontal and vertical passes with the laser. The physician simply slides the robotic hand piece over the skin. Each pass consists of overlapping strokes. By treating through the anesthetic ointment, the physician can follow the progress of the laser's track to determine the area that has been treated. Additionally, mild erythema is also a clinical endpoint.

Typical treatment densities are about 2000 MTZs per cm2; somewhat lower densities are appropriate at higher treatment energies, depending on the physician's clinical judgment.

The FraxelTM SR Laser in Action The mid-infrared wavelength of the Fraxel Laser allows deeper penetration into the tissue, without the bulk injury observed with ablative laser techniques. The Fraxel SR device is designed to ensure proper levels of treatment at all times.
Unique Tracking System in Hand Piece The hand piece of the Fraxel SR features an Intelligent Optical Tracking System in the laser unit, which ensures that the laser creates a consistent treatment zone pattern. The device self-adjusts to velocity and ensures a constant pattern density of microthermal spots. Further, the laser will not fire unless the optical hand piece is in contact with skin and there is relative motion between the skin and the hand piece. Of course, proper safety procedure requires that the food pedal should never be engaged unless the laser is in contact with the skin and treatment is intended. The laser hand piece features two unique disposable tips to facilitate treatment. The large tip treats an area of 15 millimeters; the smaller tip treats an area of 7mm, allowing you to reach small areas.

Safety Features

Tracks speed of application and matches the number of MTZs laid down. Prevents over-treatment.
Stops firing if removed from skin.
Early trials indicate it is safe for most skin types.

What Can Your Patient Expect After Treatment?
When used with topical anesthetic ointment, there is no need for systemic pain medicine either during or following treatment because there is minimal discomfort. There is a mild sunburn sensation for about an hour and then virtually no discomfort after that. The skin will have a pinkish tone for 5-7 days, which is a normal sign that the skin is healing, there's new collagen growth, and good blood circulation. Swelling is minimal and generally resolves in 2 to 3 days.

Patient Can Apply Make-up Soon After Treatment.
Because FLT spares the stratum corneum, the skin is strong enough immediately after the procedure to apply topical agents, cosmetics or for men to even shave. Typically patients find they can go back to work after treatment or the next day.

New Skin Develops Immediately.
Within 24 hours, re-epitheliazation is complete, with preservation of barrier function.

Bronzing:The bronze appearance created by the MENDs lasts for anywhere between 3 and 14 days, depending on the treatment level and density of the microthermal zones.

Flaking: The MENDs naturally exfoliate as the reorganized epidermal skin replaces the dead tissue. Flaking is similar to that of minor sunburn, but without the associated pain.

Questions and Answers

Has the Fraxel™ Laser Received FDA Clearance?
The Reliant Fraxel Laser is FDA cleared for the following uses with CO2 as one of the predicate devices:

Dermatological procedures requiring the coagulation of soft tissue;
Treatment of periorbital wrinkles
Photocoagulation of pigmented lesions, such as, but not limited to lentigos (age spots), solar lentigos (sun spots) and dyschromia.

How Many Treatments Are Necessary?
Depending on the nature of the patient’s skin condition, a series of 3-5 treatments, spaced four to seven days apart has been found to be effective. It is also an option to treat at longer intervals. Each treatment session addresses approximately 20% of the skin surface. Results are immediate and progressive; optimal cosmetic improvement is usually visible in 3-6 months.

Is There Any Skin Discoloration or Pigment Changes Associated with Treatment?
Based on clinical research to date, there is no evidence or indication of hyper- or hypo-pigmentation. Because this procedure spares islands of healthy tissue, lasting pigment change hasn’t been observed.

What Kind of Anesthesia is Used?
A lipid base topical anesthesia is recommended. Many patients may not need it for small treatment areas.

What Kind of Aftercare is Recommended?
Applying hypoallergenic moisturizer can help with some of the bronzing and flaking symptoms. Make-up can be applied immediately to cover the blush of the skin’s natural healing process. Avoiding sun exposure is always a smart policy.

The Reliant Fraxel™ SR Laser
The Reliant Fraxel™ SR Laser has received FDA 510(k) clearances for skin resurfacing procedures; the photocoagulation of pigmented lesions, such as lentigos (age spots), solar lentigos (sun spots) and dyschromia; treatment of periorbital wrinkles and for dermatological conditions requiring the coagulation of soft tissue.

Patients

Think of your skin as a family portrait or digital photograph in need of high-quality restoration or touch up.
Just as a damaged painting is delicately restored one small area at a time, or a photographic image is altered, pixel by pixel, Fraxel™ Laser Treatment improves your appearance by affecting only a fraction of your skin at a time with thousands of tiny microscopic laser spots.

Turn Back the Clock on Aging
After your very first Fraxel Laser Treatment, you will begin to feel the difference in your skin, as it gradually becomes softer, smoother and fresher. Fine lines around your eyes will noticeably fade. So will uneven coloring and the brown spots caused by aging and sun exposure.

After several treatments, your friends and family will marvel at how youthful and healthy your skin looks. The results are so discreet and natural that only you and your doctor will know you've had a laser surgical procedure.

Fraxel Laser Science

Until today, most lasers treated the skin with high power levels and macroscopic spot sizes. The problem with this approach is that healthy tissue is often damaged along with the skin that is being treated. In addition, there was no overriding technological intelligence for controlling the amount of thermal injury that the skin receives.

Reliant's approach is based upon the evolving science of Fractional Photothermolysis. This has been developed by Drs. Rox Anderson and Dieter Manstein of Harvard's Wellman Laboratories in collaboration with Dr. Scott Herron and Len DeBenedictis, of Reliant Technologies.

Treating the skin fractionally with patterns of microscopic laser spots, each of which is 70-100 microns in diameter, results in a unique wound healing process. This is aided by the fact that each laser spot (known as a MicroThermal Zone, or MTZ) is surrounded by healthy tissue. Many of the stem cells and melanocytes in the papillary dermis are spared. Fractional wound healing results in both rapid reepitheliazation of the epidermis as well as collagen remodeling to depths of 400-700 microns.

As seen under a microscope, Reliant's Fraxel® SR laser produces hundreds of microthermal zones as shown in this skin sample. The MTZ's are not visible to the naked eye.

Fraxel Laser Treatment

Think of pixels in a photo when you think of Fraxel® Laser Treatment (FLT). If you look at a newsprint photo up close, you'll see that the image is actually comprised of thousands of tiny spots of ink. Similarly, FLT produces thousands of tiny treatment zones on skin, known as MicroThermal Zones (MTZs), in the emerging science of Fractional Photothermolysis.

These MTZs penetrate deep into the dermis and eliminate old epidermal pigmented cells. Just as important, though, are the areas of skin the Fraxel laser leaves untouched. The Fraxel laser is so precise that it penetrates through the stratum corneum, as if it was a window, and leaves it completely intact. For every MicroThermal Zone the laser targets and treats intensively, it leaves the surrounding tissue unaffected and intact. This "fractional" treatment allows the skin to heal much faster than if the entire area were treated at once, using the body's natural healing process to create new, healthy tissue to replace skin imperfections.

Reliant Fraxel® SR Laser

Designed with ergonomic use in mind, the approximately 55lb (25kg) Fraxel SR Laser is easy to handle and maneuver. It comes with an integrated treatment stand featuring convenient drawers for storage of disposables. The hand piece is connected to an articulated arm for unrestricted movement around the treatment area.

Working through a technologically advanced system of optics, the Fraxel SR Laser delivers 2,000 microthermal sones (MTZs) per square centimeter in a regular treatment session. The technology provides for optimal spacing between MTZs, a distance of 200 to 300 microns, although the physician has the ability to vary the spot pitch in addition to fluence.

The laser hand piece is designed to comfortably glide across the skin. The unique feature of this hand piece is Reliant Technologies' patent pending Intelligent Optical Tracking System (IOTS), which ensures that the laser creates a consistent treatment zone pattern. The device self-adjusts to velocity and ensures a constant pattern density of MicroThermal Zones. For instance, if you move at 2 cm per second, it lays down the predetermined grid of MTZs at the same speed. For additional operator safety, the laser will not fire if the optical hand piece is not in contact with skin.

The Fraxel SR hand piece features two unique disposable tips to facilitate treatment. The large tip treats an area of 15 millimeters; the smaller tip is 7mm in diameter allowing you to treat small areas around the nose or eyes.

Safety Features

Tracks speed of application and matches the number of MTZs laid down to prevent over-treatment
Stops firing if removed from skin
Early trials indicate it is safe for most skin types

The Reliant Fraxel® SR Laser has received FDA 510(k) clearances for skin resurfacing procedures; the photocoagulation of pigmented lesions, such as lentigos (age spots), solar lentigos (sun spots) and dyschromia; melasma; treatment of periorbital wrinkles and for dermatological conditions requiring the coagulation of soft tissue.

Before & After

Patient 1

Before Treatment	1 Month after 4th Treatment


Before Treatment	1 Month after 4th Treatment

Patient 2

Before Treatment	1 Month after Treatment 4th Session


Before Treatment	1 Month after Treatment 4th Session

Patient 3

Before Treatment	After 4th Treatment


Before Treatment	After Treatment

Other Patients

Before Treatment	After 4th Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment


Before Treatment	After Treatment

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