Laser and Aesthetic Gurus: Calling on your expertise.

My partner dermatologist and I are seeking to improve our Aesthetic Center with the addition of a laser resurfacing modality. As novices in laser physics, we find some of the existing data confusing and would love your thoughts from the real world of aesthetics and laser technology. We are looking into fractional resurfacing technologies, including Fraxel, Affirm, Active Fx, and the nonfractional Portrait.

For a practice just starting to incorporate laser aesthetics, we're wondering if it is unwise to choose a modality like Portrait or Active Fx that involves significant downtime. BUT, we also want results, such as improvement in skin tightening, fine wrinkling, acne scars, and hyperpigmentation. Any thoughts on Affirm vs Fraxel? Any ability of these lasers to improve skin laxity? Are we missing a major market by not choosing a laser that tightens skin? Thanks so much for your thoughtful consideration of this.

DermDocs

The problem in this scenerio is that the jury is still out. Some of the fractional lasers seem to show some mild tightening but how long does the tightening last? At this time I would not depend on any of the above lasers for tightening. I have the Fraxel and you seem to see some improvement but I think it is mostly from the thickening of the skin.

The new CO2 fractionals are out and likely have some tightening but the studies are not in. They also have increased down time. I am very interested to see the new Sciton TRL although it is not fractional at this time my guess is that Sciton will have a fractional version within the next 2 years. The TRL can apparently mimic the YSSG and CO2 lasers.

I agree with LH.The current fractional lasers does not give any serious tightening.Even the non fractional CO2 or ErYAG lasers don't tighten the skin.Only the RF devices like Thermage or the IPL devices like Titan,SkinTyte.... show serious tightening of the skin.I also don't know about the new Sciton's Contour TRL,it's a question for me.

Thanks for your prompt and insightful replies. One would think that because most photodamage occurs in the first 100-300 microns, or down to the papillary dermis, the depth of ablation in a CO2 treatment, that under appropriate heat focused at this depth, collagen remodeling would occur. Collagen remodeling creates tissue contraction, tightening? Is it really neccessary to penetrate any deeper than this? Or does that just create more pain?

Have your patients and you been satisfied with Fraxel treatments? What has been your best light-based investment? Most popular treatment? Are more of your patients willing to undergo Portrait-like downtime, 7-10 days, with single-treatment results or do they prefer lesser results with less downtime?

Just trying to figure our laser conundrum out. Thanks!

Honest question about Fraxel: Most of the before and after photos I've seen of Fraxel treatments, so far, have really been pretty under-whelming to me. The results look similar to what my aesthetician could get with a mild-to-moderate strength chemical peel, let alone the stronger peels that I do.

This site seems to have a lot of Fraxel fans - can you show me some impressive photos/results that would allow me to re-evaluate this platform?