Conventional laser-skin-resurfacing is, besides deep chemical peelings, one of the most effective Interventions to treat signs of skin ageing. Although impressive results can be achieved with this technique it is often limited due to significant downtime and adverse effects. To address this matter the concept of fractional laser-therapy was introduced little more than a decade ago and has become more and more established in the clinical practice. In fractional laser devices the laser beam is divided into multiple microbeams that are arranged in a systematic pattern. Upon interaction with skin these microbeams generate so called microthermal treatment zones (MTZs; ablative and non-ablative lasers) or micro ablation zones (MAZ; ablative lasers). Within each MTZ old epidermal pigmented cells are expelled and penetration of collagen in the dermis causes a reaction that leads to collagen remodelling and new collagen formation. By using this microthermal treatment zones, the laser targets and treats intensively within the zone whilst surrounding healthy tissue remains intact and unaffected and helps heal the wound. Hence, fractional treatment allows for aggressive treatments with reduced downtime and risk of adverse effects. Fractional laser resurfacing has been shown to be particularly effective when combined with additional minimal invasive aesthetic treatments, such as neurotoxin- and/or filler-injections. Furthermore, recently ablative fractional laser techniques have been applied to enhance the efficacy of topically applied drugs by means of a laser assisted drug delivery (LADD). If for example combined with photodynamic therapy (PDT) this technique is referred to as laser- or power-PDT, with has been shown to generate superior cosmetic results.
Here we present the principle and clinical efficacy of fractional ablative laser therapy, ranging from fractional resurfacing, over multi-modal approaches, to laser assisted drug delivery.