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All of us over 30 begin to see distressing signs of facial aging and sun damaged skin. Sun
worshippers and smokers see these skin aging changes sooner. Fractional laser skin resurfacing,
a non-surgical anti-aging skin rejuvenation method was introduced several years ago as an
improved method for wrinkle removal and facial skin rejuvenation. 
Fractional laser skin resurfacing was developed to eliminate many of the problems associated with
traditional old time laser skin resurfacing. Traditional laser skin resurfacing was very effective at
wrinkle removal, but recovery was long and difficult and the skin often turned white, called hypo
pigmentation, 6 months after treatment. Fractional laser skin resurfacing was developed to remove
wrinkles and rejuvenate the skin with minimal downtime, quick recovery and normal skin color and
texture after the skin rejuvenation procedure. 
Recently, a new technique called combined fractional laser skin resurfacing has been developed
to improve wrinkle removal and skin rejuvenation results. This new technique provides much
better wrinkle removal and skin rejuvenation, but also plumps and improves the texture of aging
skin much better than previous techniques.
How Does Fractional Laser Skin Resurfacing Remove Wrinkles and Rejuvenate the Skin?
The basic cause of skin wrinkles and skin aging changes is loss of collagen in the skin. Collagen
in the deep layer of our skin provides moisture, nutritional support, skin plumping and elasticity
which is the firmness and skin tightening component of our skin.
As we age, exposure to years of ultraviolet (UV) radiation from sunlight, toxins in our diet and
environment, and unhealthy lifestyles such as smoking and tanning all contribute to the destruction
of collagen in our skin. When collagen is lost, our skin looses texture, elasticity and fullness, and
wrinkles and sagging skin result. For an analogy, think of a plump juicy plum with smooth skin.
Place the plum into the sun for a period of time, water (like collagen in the skin) is lost and the
plum turns into a wrinkled prune.
In an effort to protect itself, our skin surface responds to these aging changes by producing
pigment to block the UV sunlight, and our skin thickens with extra layers of dry old looking skin.
All cosmetic laser skin rejuvenation methods attempt to restore skin to a youthful state by
stimulating the skin to grow new collagen to replace lost skin collagen to plump and tighten loose
skin.  In addition, many cosmetic laser skin rejuvenation methods strip away the damaged
surface skin cells to remove pigment and dead thickened skin and stimulate new healthy looking
skin cells to grow.
Fractional laser skin resurfacing is a skin rejuvenation technique which removes dead surface skin
cells and pigment and stimulates the deep layer of the skin, the dermis to produce new collagen to
replace the collagen that has been lost by facial aging changes. In summary:
Skin aging is results in:
       Loss of collagen in the skin=wrinkles and loose skin
Skin surface changes=dry, pigmented, course skin
All cosmetic laser skin resurfacing methods rejuvenate skin by:
Removing aged skin surface cells and promoting new skin cell growth
Promoting new deep skin collagen to plump wrinkles and tighten skin
Why is Fractional Laser Skin Resurfacing Better?
Older CO2 laser resurfacing, called flat beam laser resurfacing produced excellent wrinkle removal
and skin tightening, but recovery was very difficult, requiring weeks for the skin to heal. In addition,
traditional laser skin resurfacing damaged pigment cells in the skin which caused the skin to turn
white. These problems were caused by the fact that the older lasers treated the entire surface of
the facial skin, thus healing required new skin cells to be produced by hair follicles and sweat
glands in the skin. This was a very slow process requiring up to two weeks for new skin cells to
cover the surface of the face.
New fractional laser skin resurfacing is effective but much safer than traditional CO2 resurfacing.
The fractional laser resurfacing beam is broken up into many small beams so that the laser affects
only small focused areas of the skin. Fractional laser resurfacing leaves skip areas on the skin that
are left normal and undamaged. These untreated skin cells are able to rapidly heal the treated skin
with new skin cells. The treated areas, called micro treatment zones are healed in 6 hours with the
fractional Lux2940 Erbium laser on the Starlux laser. CO2 fractional lasers like the Fraxel Repair
and Lumenis ActiveFX and DeepFX take a little longer, up to 48-72 hours.
Fractional lasers are also able to penetrate the skin into the dermis much deeper than flat beam
techniques. Deeper penetration causes more effective new collagen production. This
characteristic results in improved skin plumping and better skin texture.
Fractional laser skin resurfacing is better than old time flat beam laser resurfacing because skin
healing is much quicker, and the risk of white skin, hypo pigmentation is much less.
The benefits of fractional laser skin resurfacing are:
Quicker skin healing
Deeper penetration for better collagen production
Less risk of hypo pigmentation
Improved skin texture
More gentle, quicker recovery
Improved wrinkle removal, pigment removal and skin tightening
What Is Non-ablative Fractional Laser Skin Resurfacing-Fraxel, Starlux Lux1540, Affirm
The first fractional lasers were introduced 3-4 years ago and are non-ablative 1450nm and
1540nm (nm=nanometers or one millionth of a meter, and are the units used to measure the
wavelength of a particular laser) Erbium lasers. Non-ablative laser skin treatments go deep into
the dermis of the skin to promote new collagen, but non-ablative lasers to not ablate or remove the
surface skin cells.
Thus the non-ablative fractional skin resurfacing lasers remove wrinkles by building new collagen
in the skin, but do not remove the surface aging changes of the skin.
The benefit on the non-ablative technique is that there is less recovery time for healing as the skin
is not broken. You are pink after a treatment, but can wear makeup and no recovery time is
Because non-ablative treatments are weaker, you need 4 treatments scheduled 4-6 weeks apart
for a good result.
I use the Starlux Lux1540 non-ablative laser; other models are the Fraxel and the Affirm. The best
applications are acne scar removal, scar improvement, skin plumping, pigment removal and mild
to moderate wrinkle removal
Because the skin surface is not ablated, wrinkle removal is less effective with the non-ablative
lasers, thus new ablative fractional laser resurfacing technology has been developed in the past
year and a half.
What Is Ablative Fractional Laser Resurfacing
For ablation, different laser wavelengths, the 2940nm Erbium laser and the CO2 laser are used.
These laser wavelengths are more powerful and vaporize the skin cells on the surface as well as
causing inflammation deep into the dermis.
Because surface skin cells are removed, the ablative fractional lasers are more effective at
removing wrinkles, pigment, and old dead skin cells. The downside is that some recovery is
required for skin healing, however the down time is much less, about a third of the time required
recovering from old time flat beam laser skin treatments.
The other benefit is that ablative fractional laser skin resurfacing requires only one treatment, as
opposed to the 4 treatments required for non-ablative techniques.
I use the Starlux lux2940 fractional ablative laser resurfacing method. The Starlux Lux2940 is an
Erbium laser and heals faster than the fractional CO2 lasers, the Fraxel Repair, the ActiveFX and
DeepFX ablative machines. 
What is Combined Fractional Laser Skin Resurfacing and Why is It Better?
The newest and most effective cosmetic laser skin rejuvenation treatment I combined fractional
laser skin resurfacing. After two years of research and over two hundred treatments, we have
learned that combining the Starlux Lux1540 non ablative treatment with the Starlux lux2940
ablative treatment provides the most effective wrinkle removal and skin rejuvenation treatment.
The Starlux Lux1540 and Starlux Lux2940 are done in the same treatment session. The results in
terms of wrinkle removal, skin plumping, improved skin texture, pigment removal and general skin
rejuvenation are excellent and better than either treatment done alone.
This is a very new technique; I just presented our findings in Dallas, Texas at the Palomar Medical
Advanced laser seminar on January 24, 2009. We have been working on this project for over two
How Is Combined Fractional Laser Skin Resurfacing Done?
The combined fractional laser skin resurfacing treatment is done in my office with a topical local
anesthetic cream. Your face will be cleansed and a topical numbing cream applied. I also give you
a tranquilizer and an analgesic to help you relax and be more comfortable during treatment.
The Starlux Lux1540 treatment is done first by my medical aesthetician and takes about 30
minutes. Numbing medicine is re-applied, and I or my plastic surgeon associate do the actual
Starlux Lux2940 ablative treatment.
After your treatment we apply cold wet compresses to the skin. Then a soothing ointment will be
placed on your skin, and you will go home. During the first 24 hours you will place soothing soaks
on your skin and apply ointment every few hours.
By day 2 or 3 you will finish the soaks and only apply ointment as you need it.
You will be given analgesic tablets in case you need them and Valtrex to protect you from a
Herpes Skin outbreak. We also give you prophylactic antibiotics to protect against skin infection
during healing.
What Will I look Like After Treatment and How Long Is Recovery?
Your skin will be pink to red after treatment. The first 24 hours your skin will be moist and old skin
cells will peel off and be removed by the soaks.
Your new skin will cover your face in 2 to 3 days, very different from the 2-3 weeks required for
skin healing after the old time float beam laser treatments.
Your face will remain pink for 5-7 days, but you can wear make up by day 4. This is about a third
or fourth of the recovery time from a deep chemical peel or an old time flat beam laser
When Do I See My Final Result?
You will see a remarkable improvement in wrinkles and skin texture with fresh new skin starting at
10 days and for the first 3 weeks. However, new collagen production, the main goal of this
treatment does not begin for 6 weeks and continues for one year after treatment.
The initial benefits are due to swelling of the skin which subsides at about 3-4 weeks so expect to
see your wrinkles return initially.
However at 3 months you will really start to see the improvement in your skin and at 6 months
results are very dramatic.
In my experience, wrinkle removal, skin tightening and improvement in skin plumping and skin
texture are most obvious at one year following treatment.
How Do I Find A Doctor Who Uses This Technique?
Board certified plastic surgeons and dermatologists are the experts at laser skin rejuvenation
treatments. Ablative laser resurfacing is more commonly done by plastic surgeons because of the
complexity of skin care after the procedure.
The new combined technique is so new that it will be some time before it is widely practiced.
Be certain that your physician is board certified and has experience in laser surgery-there are
many new users of lasers who simply do not have the experience required for these advance laser
Check the websites of the organizations below for credible information and guidance:
American Board of Plastic Surgeons
American Society of Plastic Surgeons
American Association of Aesthetic Plastic Surgeons
See before and after pictures [] of fractional laser resurfacing.
Read my free newsletter to learn more about facial and body rejuvenation.
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