title: Recent Advances in Fractional Laser Resurfacing: New Paradigm in Optimal Parameters and Post-Treatment Wound Care.
abstract: BACKGROUND
  Laser plays an increasingly prominent role in skin rejuvenation. The advent of fractional photothermolysis revolutionizes its application. Microcolumns of skin are focally injured, leaving intervening normal skin to facilitate rapid wound healing and orderly tissue remodeling.
  
  
  OBJECTIVE
  Even with the popularity of fractional laser devices, we still have limited knowledge about the ideal treatment parameters and postlaser wound care.
  Many clinicians believe that higher microbream energy in fractional laser devices results in better clinical outcome. Two recent studies argue against this assumption. One article demonstrates that lower fluence can induce comparable molecular changes with fewer side effects. Another study corroborates this by showing that lower-density settings produce similar clinical outcome in scar remodeling as higher-density ones, but with fewer side effects. To shed light on the optimal post-treatment wound care regimen from fractional ablative resurfacing, another paper shows that platelet-rich plasma (PRP) can reduce transepidermal water loss and skin color changes within 1 month after treatment.
  For fractional nonablative resurfacing, lower settings in fluence or density may produce similar dermal remodeling as higher settings and with a better side-effect profile. Moreover, autologous PRP appears to expedite wound healing after fractional ablative resurfacing.
  
  
  CONCLUSIONS
  Lower microbeam energy in fractional laser resurfacing produces similar molecular changes and clinical outcome with fewer side effects. The findings might portend a shift in the paradigm of treatment parameters. Autologous PRP can facilitate better wound healing, albeit modestly. Long-term follow-ups and larger studies are necessary to confirm these findings.
authors: Department of Dermatology, University of California , Davis Medical Center, Sacramento, California.
authors: Francis C
authors: FC
authors: Hsiao
authors: California Skin and Laser Center , Stockton, California.
authors: Gerald N
authors: GN
authors: Bock
authors: Department of Dermatology, University of California , Davis Medical Center, Sacramento, California.
authors: Daniel B
authors: DB
authors: Eisen