What is Fractional Laser and How is it Applied?

1. Definition and Basic Principle
Fractional lasers are systems developed to combine the advantages of ablative (CO₂, Er:YAG, Er:YSGG) and nonablative lasers. They aim to provide faster healing and fewer side effects by creating microscopic damage in certain fractions of the skin instead of the entire skin.

2. Microthermal Treatment Zones (MTZ)
When the laser beam is sent to the skin:

100–300 microns in diameter,

50–1000 microns in depth

ablation and/or coagulation columns (MTZ) are formed.

Since healthy tissue islands remain between these zones, healing is fast and more comfortable.

3. MTZ Parameters
MTZ density and depth can be adjusted (e.g. 400–6400 MTZ/cm²).

5% to 45% of the skin surface can be treated in a single session.

As the density increases, the effectiveness increases, but the risk of side effects also increases.

4. Fractional Photothermolysis
A concept defined in 2003 and divided into two:

Nonablative Fractional Lasers: 1410–1550 nm wavelengths (e.g. Fraxel re:fine, Lux 1540).

Ablative Fractional Lasers: 2790–10600 nm (e.g. Fraxel re:pair, Active FX, ProFractional).

5. Indications
Photoaging

Acne scars

Melasma (especially treatment-resistant forms)

Difficult areas with classical ablative lasers such as décolleté, neck, back of the hands

6. Advantages
Shorter recovery time

Less invasive procedure

Effectiveness/safety balance

7. Disadvantages and Side Effects
Erosion, intense erythema, leakage may increase the risk of scarring.

Antibiotics and topical steroid treatment may be required in the postoperative period.

Ablative fractional lasers may be as effective as classical ablation, but similar side effects may also be seen.

Radiofrequency (RF) Treatment
1. Definition and Principle
Radiofrequency energy is transmitted to the skin as an electrical current. Resistance within the tissue converts this electricity into thermal energy, leading to collagen denaturation and tissue tightening. RF is “color blind”; it does not target melanin, so it can be used safely on all skin types.

2. Indications
Face and neck sagging

Laxity in body areas such as the abdomen and knees

Noninvasive skin tightening as an alternative to surgery

3. Advantages
Suitable for all skin types

Low side effect profile

Minimal invasiveness

4. Disadvantages
Results may vary from person to person

Low predictability

Correct patient selection and parameter setting are critical for effectiveness

Results and Clinical Application Recommendations
Fractional lasers offer faster recovery and a wide range of indications as an alternative to classic ablative lasers. Ablative and nonablative forms should be selected according to patient needs.

Radiofrequency treatment can be safely used for face and body lifting in patients who do not want or are not suitable for surgery.

In both technologies, expert physician experience and appropriate parameter selection are critical for optimum results.