What are nonablative fractional lasers, and for what are they used?

The Fraxel (Reliant Technologies, Palo Alto, CA) was the first fractional laser. This was a nonablative 1550-nm erbiumdoped fiber laser that generated what was termed microscopic treatment zones (MTZ). Being nonablative, the epidermis is thought to remain intact. Within the area of the thermal damage, there is heat-coagulated tissue termed microepidermal necrotic debris (MEND) that is exfoliated through the intact epidermis. The theory is that there will be melanin and elastic tissue removed, and the thermal injury will lead to collagen stimulation.

Since this first laser, there have been many nonablative lasers with a variety of wavelengths and theoretical mechanisms. These include 1410-nm, 1540-nm, and a combination of 1440- and 1320-nm light. These lasers are purported to treat acne scars, surgical scars, and facial photodamage, including fine rhytids and dyschromia, melasma, and striae distensae. Table 54-10 lists the nonablative fractional lasers.

Narurkar VA: Nonablative fractional laser resurfacing, Dermatol Clin 27:473–478, 2009.

Table 54-10. Nonablative Fractional Lasers
	NAME		TYPE		WAVELENGTH
	Fraxel re:fine		Single-mode fiber		1410 nm
	Affirm		Nd:YAG		1320 nm/1440 nm
	Lux1440 Fractional		Nd:YAG		1440 nm
	Lux1540 Fractional		Er:glass		1540 nm
	Fraxel re:store		Erbium fiber		1550 nm