New Fraxel Laser Gaining Popularity in Practices

LAS VEGAS—A new version of the Fraxel laser penetrates more deeply—yet causes less pain and requires fewer treatments—than does the original Fraxel system, speakers said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

The new Fraxel SR1500, approved by the Food and Drug Administration in August 2006, promised enhanced efficacy and safety, said Dr. Richard Fitzpatrick, a dermatologist in private practice in La Jolla, Calif.

"For the most part, I think that has held up," he said.

The idea behind Fraxel lasers is to deeply penetrate dermal tissue in a specific pixel-like pattern, leaving behind healthy tissue surrounding the tiny wounds.

The original Fraxel was approved by the FDA in 2003 for the treatment of wrinkles, melasma, and scars from acne and surgery, among other indications. The new Fraxel, which costs in the range of $110,000, is capable of deep penetration—to 1,200 microns—and includes a telescopic lens and dosage-control system that permits the use of much higher energy ranges.

"You almost have to rethink Fraxel" in adjusting to the new device, said Dr. Vic Narurkar, who is in private practice in San Francisco. "Depth really does matter."

Moreover, it is important to understand the confusion regarding the term "fractional resurfacing," he said in an interview following the meeting.

True nonablative fractional resurfacing requires a midinfrared wavelength, such as the 1550-nm wavelength of the Fraxel SR1500 and the original Fraxel SR750. "Most other fractional devices are marketing toys and are not supported by clinical and histologic studies," Dr. Narurkar said.

Although Dr. Fitzpatrick limited his energy settings to about 8–20 mJ/cm

Dr. Narurkar now routinely treats Fitzpatrick skin types I-III at 40 mJ/cm

"Coverage"—the number of microthermal zones of damage required—depends on the condition being treated and the anatomical location, the speakers agreed.

A level 6 setting on the laser translates to 20% coverage, with levels building or declining in 3% increments, Dr. Fitzpatrick explained. A level 7 achieves 23% coverage, for example.

The ease of the system does not negate the importance of being careful, however. The laser's capability of going to extreme depths with a high degree of energy can produce "an intense collimated dermal reaction," which Dr. Fitzpatrick said is unlike any he has ever seen.

Choosing a coverage setting that is too high can be dangerous.

"You will reach the point, if you go too far, where you will risk bulk heating. You will generate thermal necrosis of the area," he said.

On the other hand, significant swelling and erythema are very unusual, and the increased energy delivery makes for better results, Dr. Fitzpatrick said, adding, "High pulse energies are more effective for almost everything."

For mild to moderate photodamage on the face, he performs four treatments using energy in the range of 10–20 mJ/cm

For acne scars, he starts at 25 mJ/cm

"The Fraxel does better with acne scars than any device I've ever used," he said.

Dr. Narurkar agreed, saying that both the first- and second-generation Fraxel lasers are "rapidly becoming the treatment of choice" for this indication.

Across indications, fewer treatments are required with the second-generation Fraxel, although patients can expect more edema when higher settings are used, he said.

"They will see results in three treatments instead of five," Dr. Narurkar said. "It hurts less and my patients are extremely satisfied with the treatment."

Both speakers disclosed that they have received grant or research support from Reliant Technologies Inc., maker of the Fraxel laser. Dr. Fitzpatrick is a paid consultant to the company as well.

'Most other fractional devices are marketingtoys' that are not supported by clinical studies. DR. NARURKAR

LAS VEGAS—A new version of the Fraxel laser penetrates more deeply—yet causes less pain and requires fewer treatments—than does the original Fraxel system, speakers said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

The new Fraxel SR1500, approved by the Food and Drug Administration in August 2006, promised enhanced efficacy and safety, said Dr. Richard Fitzpatrick, a dermatologist in private practice in La Jolla, Calif.

"For the most part, I think that has held up," he said.

The idea behind Fraxel lasers is to deeply penetrate dermal tissue in a specific pixel-like pattern, leaving behind healthy tissue surrounding the tiny wounds.

The original Fraxel was approved by the FDA in 2003 for the treatment of wrinkles, melasma, and scars from acne and surgery, among other indications. The new Fraxel, which costs in the range of $110,000, is capable of deep penetration—to 1,200 microns—and includes a telescopic lens and dosage-control system that permits the use of much higher energy ranges.

"You almost have to rethink Fraxel" in adjusting to the new device, said Dr. Vic Narurkar, who is in private practice in San Francisco. "Depth really does matter."

Moreover, it is important to understand the confusion regarding the term "fractional resurfacing," he said in an interview following the meeting.

True nonablative fractional resurfacing requires a midinfrared wavelength, such as the 1550-nm wavelength of the Fraxel SR1500 and the original Fraxel SR750. "Most other fractional devices are marketing toys and are not supported by clinical and histologic studies," Dr. Narurkar said.

Although Dr. Fitzpatrick limited his energy settings to about 8–20 mJ/cm

Dr. Narurkar now routinely treats Fitzpatrick skin types I-III at 40 mJ/cm

"Coverage"—the number of microthermal zones of damage required—depends on the condition being treated and the anatomical location, the speakers agreed.

A level 6 setting on the laser translates to 20% coverage, with levels building or declining in 3% increments, Dr. Fitzpatrick explained. A level 7 achieves 23% coverage, for example.

The ease of the system does not negate the importance of being careful, however. The laser's capability of going to extreme depths with a high degree of energy can produce "an intense collimated dermal reaction," which Dr. Fitzpatrick said is unlike any he has ever seen.

Choosing a coverage setting that is too high can be dangerous.

"You will reach the point, if you go too far, where you will risk bulk heating. You will generate thermal necrosis of the area," he said.

On the other hand, significant swelling and erythema are very unusual, and the increased energy delivery makes for better results, Dr. Fitzpatrick said, adding, "High pulse energies are more effective for almost everything."

For mild to moderate photodamage on the face, he performs four treatments using energy in the range of 10–20 mJ/cm

For acne scars, he starts at 25 mJ/cm

"The Fraxel does better with acne scars than any device I've ever used," he said.

Dr. Narurkar agreed, saying that both the first- and second-generation Fraxel lasers are "rapidly becoming the treatment of choice" for this indication.

Across indications, fewer treatments are required with the second-generation Fraxel, although patients can expect more edema when higher settings are used, he said.

"They will see results in three treatments instead of five," Dr. Narurkar said. "It hurts less and my patients are extremely satisfied with the treatment."

Both speakers disclosed that they have received grant or research support from Reliant Technologies Inc., maker of the Fraxel laser. Dr. Fitzpatrick is a paid consultant to the company as well.

'Most other fractional devices are marketingtoys' that are not supported by clinical studies. DR. NARURKAR

LAS VEGAS—A new version of the Fraxel laser penetrates more deeply—yet causes less pain and requires fewer treatments—than does the original Fraxel system, speakers said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

The new Fraxel SR1500, approved by the Food and Drug Administration in August 2006, promised enhanced efficacy and safety, said Dr. Richard Fitzpatrick, a dermatologist in private practice in La Jolla, Calif.

"For the most part, I think that has held up," he said.

The idea behind Fraxel lasers is to deeply penetrate dermal tissue in a specific pixel-like pattern, leaving behind healthy tissue surrounding the tiny wounds.

The original Fraxel was approved by the FDA in 2003 for the treatment of wrinkles, melasma, and scars from acne and surgery, among other indications. The new Fraxel, which costs in the range of $110,000, is capable of deep penetration—to 1,200 microns—and includes a telescopic lens and dosage-control system that permits the use of much higher energy ranges.

"You almost have to rethink Fraxel" in adjusting to the new device, said Dr. Vic Narurkar, who is in private practice in San Francisco. "Depth really does matter."

Moreover, it is important to understand the confusion regarding the term "fractional resurfacing," he said in an interview following the meeting.

True nonablative fractional resurfacing requires a midinfrared wavelength, such as the 1550-nm wavelength of the Fraxel SR1500 and the original Fraxel SR750. "Most other fractional devices are marketing toys and are not supported by clinical and histologic studies," Dr. Narurkar said.

Although Dr. Fitzpatrick limited his energy settings to about 8–20 mJ/cm

Dr. Narurkar now routinely treats Fitzpatrick skin types I-III at 40 mJ/cm

"Coverage"—the number of microthermal zones of damage required—depends on the condition being treated and the anatomical location, the speakers agreed.

A level 6 setting on the laser translates to 20% coverage, with levels building or declining in 3% increments, Dr. Fitzpatrick explained. A level 7 achieves 23% coverage, for example.

The ease of the system does not negate the importance of being careful, however. The laser's capability of going to extreme depths with a high degree of energy can produce "an intense collimated dermal reaction," which Dr. Fitzpatrick said is unlike any he has ever seen.

Choosing a coverage setting that is too high can be dangerous.

"You will reach the point, if you go too far, where you will risk bulk heating. You will generate thermal necrosis of the area," he said.

On the other hand, significant swelling and erythema are very unusual, and the increased energy delivery makes for better results, Dr. Fitzpatrick said, adding, "High pulse energies are more effective for almost everything."

For mild to moderate photodamage on the face, he performs four treatments using energy in the range of 10–20 mJ/cm

For acne scars, he starts at 25 mJ/cm

"The Fraxel does better with acne scars than any device I've ever used," he said.

Dr. Narurkar agreed, saying that both the first- and second-generation Fraxel lasers are "rapidly becoming the treatment of choice" for this indication.

Across indications, fewer treatments are required with the second-generation Fraxel, although patients can expect more edema when higher settings are used, he said.

"They will see results in three treatments instead of five," Dr. Narurkar said. "It hurts less and my patients are extremely satisfied with the treatment."

Both speakers disclosed that they have received grant or research support from Reliant Technologies Inc., maker of the Fraxel laser. Dr. Fitzpatrick is a paid consultant to the company as well.

'Most other fractional devices are marketingtoys' that are not supported by clinical studies. DR. NARURKAR