Ablative Fractional Versus Nonablative Fractional Lasers—Where Are We and How Do We Compare Differing Products?

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The concept of nonablative fractional photothermolysis was introduced almost a decade ago to address the main shortcomings of non-fractionated, nonablative devices available at that time. By delivering laser light as a series of fractionated columns, the 1550 nm Er:doped laser was able to achieve greater penetration depths and spare areas of normal intervening skin, allowing epidermal contribution to a more rapid healing process. Yet these devices, despite their more predictable outcomes, were felt to lack the efficacy of complete epidermal ablation, spawning the expansion of fractionated devices to include ablative wavelengths, which have proven more consistent and safer than pre-existing pulsed ablative devices. This article will summarize an ever-expanding literature to facilitate the application of both nonablative and ablative fractional technologies in clinical practice, and establishes grounds by which varying fractional lasers can be compared.