Phototherapy Experts Blog

Which Fractional Resurfacing Laser should I choose?  Part 2.  From the Physician’s perspective there are some additional considerations that patients don’t need to consider.  The biggest concern for a physician is “will this be good for my patients and practice?”  I’ve heard physicians say “I don’t want to buy a fractional laser that won’t be a successful investment”.  This is a very valid concern and with changes in technology it can be confusing as to which fractional system is really going to benefit both the doctor and their patients. 

The real key is PATIENT SATISFACTION!  There are 3 parts to this, the treatment, recovery/downtime and of course the results.   If we pretend that all fractional CO2 lasers will give patients a result they will be happy with then what about the treatment and recovery/downtime.  These are the 2 main factors both patients and physicians need to look at carefully.  Many physicians have stated that “Most of the laser companies have made statements that are far from accurate”.  The biggest stretch of the truth has been with how much the treatment hurts and the anesthesia requirements.  Except for the EXELO2, most fractional laser treatments hurt a great deal, some much more than others.  In addition to applying a Topical Anesthetic cream that numbs the top of the skin (only topical anesthetic is needed with the EXELO2) most fractional lasers require Nerve blocks (injections to numb entire areas) and oral medications such as narcotics or tranquilizers to make the procedure tolerable.  Some lasers, like the Fraxel re:pair,  are so painful many patients need to have General Anesthesia, this is where they are “put to sleep” and are connected to surgical anesthetic equipment to help them breath while they are “put under” the anesthesia.  NOTE: General anesthesia requires a breathing tube to be put into a patient to assist with breathing and is one of the most dangerous parts to most surgical procedures. 

The more comfortable a patient is during the treatment the happier they will be and share that experience, positive or negative.  EXELO2 patients continually recommend the treatment to people they know because they have very little pain during and after the treatment.  Plus they love the results!  Fractional Laser treatments cause pain in 2 ways.  One is from the heat they create and the other is from the “ablation”, the hole the laser makes in the skin.  The depth of that laser hole helps determine the extent of the pain and recovery time – the deeper ablation the more it hurts and longer it takes to heal.  Lasers use light to do their work and light energy is typically very hot.  The skin absorbs some of that heat (the thermal component) and of course more heat means more pain.  This is one of the reasons that the EXELO2 has integrated the chiller directly into the hanpiece.  This system allows most of the heat to be controlled in consistent and comfortable manner removing excess heat.  Heat is an important component to starting the collagen remodeling necessary to improve wrinkles, scars and other skin conditions.  But, too much heat is not only needlessly painful but can cause complication such as PIH (Post Inflammatory Hyperpigmentation).  Not enough heat equates to not a very good result or the “density”, amount of area being ablated, being dramatically increased; again to the point of increased pain and risk of complications and longer recovery times.

While in theory most fractional resurfacing lasers produce noticeable results the extent of the results vary along with the pain and recovery time involved.  For optimal results look for a fractional laser that has ports built into the handpiece, for cooling and smoke evacuation.  It’s the only way to assure the cooling will be consistent, this is critical to reduce the risk of complications and for patient comfort.  Having that consistent cooling is the only way the best possible results can be achieved.  Because the optimal balance between the ablation depth and thermal zone creation is what is required to get great results with minimal pain and downtime. The only fractional CO2 laser that has both of these is the EXELO2 fractional CO2 resurfacing laser made in Germany by Quantel-Derma and distributed in the USA by National Biological.  National Biological has been serving patients and physicians since 1967 and is the leader in UV Phototherapy equipment.

In addition to built-in safety features, the EXELO2 offers the physician some interesting and convenient features.  The biggest feature that doctors truly appreciate is the ability to control the treatment pattern and size directly from the handpiece without having to put the laser into “standby”.  This “on the fly” capability not only makes the treatment easier to administer but also decreased the time it takes to do a treatment.  Patients and physicians appreciate the shorter and easier treatments.  However, it is the patient that really appreciates the integrated cooling, during the treatment, because it dramatically decreases the pain during the treatment to the point that ONLY a topical anesthetic is necessary.  And it is the physician that appreciates the integrated cooling after the procedure when their patients tell friends and family how easy the procedure was and the doctor gets the referrals.  That is why the EXELO2 is the only choice!

This is why Patient Satisfaction is critical to a successful laser program.  We’ve all experienced what the studies have proven.  When you have a negative experience you tell 10 people how bad it was and not to do it or go there, actually most people go out of their way to share their negative experiences.   But, when you have a positive experience you tell 3-4 people that they Should do or try what you did.  Again, it all boils down to Patient Satisfaction.

The EXELO2 was specifically designed to provide the Optimal Balance Between Ablation Depth and Thermal Zone Creation so patients and physicians get the best of all worlds; a high quality system that offers the best results with the least amount of discomfort and fastest recovery times.  Most EXELO2 patients rate the In-treatment pain as 3.5 out of 10 and are back to their normal activities within 3 to 5 days and without the need for heavy narcotics. 

A bargain is not a bargain if nobody like it and it won’t use it or refer their social network of friends and family to you.  Just as patient satisfaction is important to you’re the success of your practice it is also important to the success of your laser program. 

That is why the EXELO2 is the best choice.  It is also one of only two lasers that have the FDA’s new “ONG” fractional laser classification.  This is because Quantel-Derma did the histology and research required by the FDA to get this prestigious distinction.

In short, if you are looking to get great results, have little to no pain during and after the procedure, have little to no risk of complications, a quick return on your investment and your patients have a quick return to your normal life then the EXELO2 Fractional CO2 laser resurfacing is the only choice!

Which Fractional CO2 Laser should I choose?  This is a question that both physicians and patients are asking.  Let me start by addressing the concerns patients have.  While your doctor will have the same concerns as you they need to evaluate some additional factors.

Here are the 4 most common concerns:

1) What will this really do for me?  Fractional CO2 lasers have the ability to help improve the overall condition and look of the skin by tightening, removing sun damage, decreasing pore size, improving the texture and feel of the treated areas. There are other skin conditions and issues that fractional CO2 lasers address such as scars, pigmentation issues and stretch marks.  Additional improvements from the Collagen Remodeling typically take 3 to 6 months for the full results. 

 2) How much will this hurt? This is a rather subjective question since we all have varying degrees of pain tolerances. However, there are some features to look for in a fractional resurfacing laser procedure.  The pain during the treatment is mainly caused by 2 factors Depth and Thermal aspects of the treatment.  Let’s look at Depth first; the deeper the laser Ablation is the more pain is felt.  So, how deep is really necessary?  That has been at the heart of many debates but it is generally agreed that the area of the skin where most of the damage has really occurred is between 400um to 700um, this is in the middle of the Dermis.  There are some CO2 fractional resurfacing lasers where the standard treatment goes much deeper, like the Fraxel, which usually ablate to a depth of about 1000um.  This causes a very painful treatment that requires extensive anesthesia including General Anesthesia where patients are put to sleep.  General Anesthesia greatly increases the risks involved with the procedure especially since there are lasers, like the EXELO2 fractional CO2 system, that are done with only a Topical Anesthetic applied to the skin prior to the treatment.  The other side of depth is not going deep enough and this has been the limiting factor with the Erbium fractional resurfacing lasers.  Typically Erbium fractional lasers require at least 4 to 6 treatments and are quite painful. As for the Thermal component, too much can cause complications such as Post Inflammatory Hyperpigmentation (PIH) where the area treated is darker than it originally was – this is almost always temporary but may last up to 6 months.  Too little of a Thermal component then Density (amount of skin be treated with the Micro Ablation Zones) needs to be much higher and typically patients experience mild to moderate bleeding.  Without enough of a Thermal component the Micro Ablations Zones are not cauterized.  However, the Thermal component is heat and that can cause pain during the treatment.  That is why the EXELO2 has an integrated Cooling into the Hand-piece to remove the heat caused during the treatment.  That is why EXELO2 patients experience only mild discomfort during an EXLEO2 fractional CO2 laser treatment. 

 3) How long before I can return to my normal activities? This depends upon a few factors.  The Deeper treatments need a longer time to heal; more damage was done to the skin so it takes longer to heal.  Lasers with that require higher Densities also take longer to heal; again more area of the skin was treated causing longer healing times. For example, the Fraxel re:pair has almost no thermal component and goes very deep so most patients need 5 to 7 days of serious narcotics before the Micro Ablation Zones have healed over.  In contract, the Micro Ablation Zones with EXLEO2 patients typically occurs within the first 72 hours.  Also, EXELO2 patients experience only mild discomfort for 2 to 4 days.  As to “normal activities”, it depends on what you consider normal.  If normal is being able to apply makeup and go to work, dinner or shopping without people wondering what you had done, you need to wait for the skin to heal over.  Again that will greatly vary from the different lasers and how powerful of a treatment you had.  If “normal” involves strenuous activities or extended time in the sun you may need some extra time.  All fractional CO2 treatments cause injury to the skin and the body needs time to recover.

4) Will I be happy I did the treatment?  That may be the most subjective question a patient can ask.  Define “happy”.  Is it just the result, or how much time was need to recovery?  Or, is it based upon how painful the treatment and recovery were?  Most patients feel it is a bit of all of the above, and I agree.  While you may eventually be “happy” with a very painful treatment with good results you most likely told your friends it was not worth it.  Personally, I feel the “happiest” patients are the ones that have had a treatment with a system that provides the Optimal Balance between the Depth and Thermal Zone creation.  That’s why I love the treatment I had with the EXELO2 fractional CO2 laser.  Its Optimal Balance provides a very effective treatment while minimizing the discomfort and recovery time. 

If you are looking for results you’ll be happy with and don’t want intense pain or long recovery times then consider the EXELO2 Fractional CO2 laser.  It was designed specifically for fractional resurfacing and provides the Optimal Balance between the Depth and Thermal properties.  That’s why EXELO2 patients constantly recommend the procedure to their friends and family. 

This is the factor I believe is most important.  If all the systems provide some degree of “good results” then it comes down to how much it will hurt and how long will it take to recover.  Studies have proven that when people are NOT happy with a treatment, restaurant, movie… they tell 10 others NOT to do it.  However, when people ARE HAPPY they tell 3 to 4 others TO DO IT.