Ablative Fractional Versus Nonablative Fractional LasersWhere Are We and How Do We Compare Differing Products NAFLs are currently approved by the Food and Drug Administration FDA for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratosis 7. However, NAFLs are routinely used, successfully, for several off label indications, such as cosmetic rejuvenation, and have become popular due to their relative comfort compared to AFL treatments. NAFL may also offer a lower incidence of adverse side effects, which includes erythema, edema, pain and post inflammatory hyperpigmentation 8. The following sections will focus on the three most common indications for NAFLs and AFLs dyspigmentation, scarring, and photoaging. Disorders of Pigmentation. In the last 2 years, three controlled trials have demonstrated no additional benefit from NAFLs when compared with standard, topical therapies in the treatment of melasma 9, 1. In 2. 01. 2, Karsai et al. Their results showed an identical improvement in both groups, leading to their conclusion that NAFLs do not show any benefit over using a broad spectrum sunscreen by itself 9. Similarly, a randomized controlled study in 2. NAFL to triple topical therapy hydroquinone 5 , tretinoin 0. Twenty patients were given either a total of four laser treatments spaced every two weeks apart, or triple topical therapy used daily. I have large pores and am looking for a way to make them smaller or at least less noticeable Do you think IPL would work Dermotologist Los Angeles 8185059300 Skin Treatments Acne Scars Botox Restylane Fraxel Juvederm Laser, Studio City Gene Rubinstein, M. D. Advances in dermatology. Mirabile is a full service medical spa womens clinic offering surgical nonsurgical gynecology, aesthetics care services in Overland Park, Kansas City KS. The Lumenis Aesthetic devices division is a worldwide leader in energybased aesthetic devices. Lumenis is a pioneer in the field of laser aesthetics and was the. Lasers and lightemitting devices are popular and often effective treatments for those with signs of aging not ready for cosmetic surgery. These procedures can. ActiveFX DeepFX Co2 laser skin treatment is considered the gold standard most advanced fractional laser in laser skin resurfacing. Contact us 016766527. In our practice we are very happy with the Active FX fractional CO2 laser. It provides our patients with most of the benefits of the CO2 laser without the downsides. A similar efficacy between the two regimens was noted, with a majority of patients in both groups experiencing recurrence of melasma within 6 months. Given the cost and pain associated with NAFL however, the authors concluded that triple therapy should continue to be the standard of care 1. Later in 2. 01. 0, several of the same authors performed a randomized, controlled, split face study of 2. Their results showed a significant post inflammatory hyperpigmentation PIH in areas treated with the laser and, again, the authors concluded NAFL was not superior to topical therapy 1. In addition to melasma, NAFL has shown limited efficacy in the treatment of other pigmentary disorders. A pilot study from 2. EDP and PIH using a 1. Two similar test spots in eight patients with EDP and six with PIH were given either five treatments of NAFL in combination with topical bleaching regimen or the topical bleaching regimen alone. At three month follow up, three patients were noted to have developed laser induced PIH, and overall laser therapy provided no added benefit 1. In summary, one must be approach NAFL cautiously when treating dyspigmentation, as it may worseninduce hyperpigmentation. Topical bleaching agents such as triple preparations and strict photoprotection should be considered first line, especially in year round sunny environments. Scars Acne, Burn, and Surgical and Striae. Patients that undergo NAFL treatment for acne scarring experience 13 days of intense erythema that generally resolves within one week, a maximum of 2. The severity of acne scarring is an important factor to consider when counseling patients on the potential benefits of NAFL. In a study of eighty seven patients, those patients with moderate acne scarring showed better improvement than those with severe scarring after six sessions of 1. NAFL 1. 4. A review done by Ong et al. AFL, 1. 3 NAFL focusing on acne scarring and noted overall improvement with NAFL, however it did not break down results into types of acne scar ice pick, boxcar, rolling, and hypertrophic. Further studies examining the efficacy of NAFL in treatment of these different types of scars could help direct treatment in the future 1. Benefit with NAFL in atrophic processes other than acne scarring has also been demonstrated. In a study of 5. 1 patients with striae rubra or alba, de Angelis et al. NAFL 1. 5. Histological sections from treatment areas revealed thickening of the epidermis and dermis, neocollagenesis, and increased elastin deposition 1. Improvement in striae with minimal adverse effects has also been demonstrated following treatment with 1. NAFL 1. 6, 1. 7. The benefits of NAFL are not limited to atrophic scarring. In a randomized, controlled trial of 1. Haedersdal et al. P  0. 0. 00. 7 improvement in scar texture 1. NAFL treatments when compared to no treatment 1. Similarly, Waibel et al. NAFL 1. 9. While pulsed dye laser has long been viewed as the gold standard for correction andor prevention of hypertrophic or otherwise unsightly post surgical scars, Tierney et al. NAFL than PDL P lt 0. Mohs surgery 2. 0. However, in a randomized, controlled split scar trial of 1. Mohs surgery in the previous three years, Verhaeghe et al. NAFL using a validated Physician Global Assessment, but the patients global assessment favored 1. NAFL at 3 month follow up P  0. In our opinion, NAFL, in its infancy, if has demonstrated significant potential in the treatment of post surgical, burn, and other traumatic scarring with minimal adverse effects, however the optimal time to treat, treatment parameters, and appropriate follow up have yet to be elucidated. Cosmetic Rejuvenation. There is an ever expanding market for safe, reliable, and well tolerated technologies capable of reversing cutaneous photodamage, rhytides, and dyspigmentation. In 2. 00. 7 Wanner et al. P lt 0. 0. 01 in cutaneous photodamage that were retained for 9 months in 7. NAFL 2. 2. Others have since shown similar benefit in the treatment of facial rhytides, but improvements have been less well sustained at twelve weeks following treatment 2. Regarding treatment of nonfacial sites, Peterson et al. NAFLs in this location 2. Given the early success of NAFL in cutaneous rejuvenation several studies have sought to expand the cosmetic applicability of such devices. For example, Saedi et al. NAFL, however their study was hampered by a short 2 week follow up period 2. Leyden and colleagues recently studied an at home handheld 1. NAFL unit Palo. Via device in 1. Treatments were daily for four weeks active phase and then twice daily for either four or twelve weeks maintenance phase, with 9. Fitzpatrick Wrinkle Scar after the active phase and 7. Such studies only sample NAFLs potential for in office and at home cosmetic rejuvenation.