Commentary: Predicting Efficacy of Fractional Carbon Dioxide Laser Treatment for Resurfacing

Abstract

is an impor-tant advancement in our knowledge of in vivo der-mal modeling after fractional ablative lasertreatment. Maximizing clinical response and mini-mizing adverse events are the ultimate goal of everylaser surgeon. We have all had patients who pre-operatively presented as excellent candidates forablative treatment only to have suboptimal responseto multiple sessions. Conversely, other patients havean outstanding response to identical parameters andend up as an example of success on our lecture slides.This type of rigorous scientific work adds to ourunderstanding of the factors that may differentiatethese two types of patient responses.The objective nature of this work challenges usto reassess our assumptions regarding clinical results.The finding that midfacial areas such as forehead,lip, and chin had a statistically significantly greaterincrease in dermal collagen than cheeks and neckis surprising. In practice, patient satisfaction istypically higher in the thinner skin of the cheeks,particularly in the periocular area. This may be afunction of the thicker skin in this central area, re-quiring a larger increase in collagen to confer asimilar clinical response.The future for fractional ablative lasers will probablyinclude real-time adjustment of fluence and pulseduration from ultrasound feedback of ablation depthas a ratio to tissue depth. This may be coupledwith feedback on tissue temperature and othermeasurements to optimize results. Perhaps aninterface will also have information such as patientage, retinoid use, and other variables to adjustparameters accordingly.