Multi-Center Clinical Study and Review of Fractional Ablative CO2 Laser Resurfacing for the Treatment of Rhytides, Photoaging, Scars and Striae

April 2011 | Volume 10 | Issue 4 | Original Article | 352 | Copyright © April 2011

Macrene Alexiades-Armenakas MD PhD FAAD,a Deborah Sarnoff MD, Robert Gotkin MD, Neil Sadick MD

aAssistant Clinical Professor, Yale University School of Medicine; Director and Founder of the Dermatology and Laser Surgery Center, New York, NY


Laser skin resurfacing has shifted over the past two decades from standard ablative resurfacing to non-ablative resurfacing and most recently, to fractional laser resurfacing. In this most recent category, fractional non-ablative lasers were first introduced followed by fractional ablative lasers, which offer an improved balance between safety and efficacy. In the current article, a review of fractional ablative resurfacing is presented alongside the results from a multi-center clinical study employing the fractional carbon dioxide (CO2) laser (SmartXide DOT, DEKA) for the treatment of rhytides, photoaging, scars and striae distensae.

J Drugs Dermatol. 2011;10(4):352-362.


While highly effective in reducing rhytides, photoaging and acne scarring, standard ablative laser resurfacing was associated with significant side effects and complications.1 In an effort to improve patient safety, non-ablative laser resurfacing emerged, which while safe, proved much less effective.1 In a more balanced approach, fractional laser resurfacing was developed over the past several years in an effort to combine the efficacy of standard laser resurfacing with the safety of non-ablative modalities.2 Although the first fractional laser device was non-ablative, producing microscopic columns of thermal injury in the epidermis and upper dermis, it pioneered a novel concept in lasers which has been quickly applied to fractional ablative laser resurfacing.
In fractional ablative laser resurfacing, ablative wavelengths including carbon dioxide (CO2) (10,600 nm), erbium(Er): YAG (2940 nm) and the relatively novel yttrium aluminum garnet (YSGG) (2790 nm) lasers are delivered in a microscopic array to ablate microscopic columns of epidermis and dermis, with intervening zones of untreated tissue.1 The key adjustable laser parameters of power, pitch, dwell time and spot density determine the percent surface area, penetration depth and clinical recovery time and efficacy. An additional unique feature of the fractional CO2 device presented here (SmartXide DOT, Deka) is the multi-faceted adjustability of the size and shape of the treatment area. Fractional CO2 laser resurfacing is an important advance to the laser field, striking a balance between safety and efficacy in the treatment of rhytides, photoaging and scars.

Fractional CO

In light of the fact that fractional non-ablative resurfacing yielded minimal to modest efficacy per treatment and required multiple treatments, fractional ablative lasers offered promise of higher efficacy in fewer treatments. Instead of creating microscopic columns of thermal injury, fractional ablative resurfacing generates microscopic columns of ablated tissue extending from the epidermis into the dermis. This approach increased efficacy closer to that of standard ablative resurfacing, but without the side effects and complications of the latter. The clinical results following a single treatment are more significant as compared to fractional non-ablative laser resurfacing, but the procedure is associated with comparatively more discomfort, post-operative erythema and recovery time.