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B. KENT REMINGTON, M.D., F.A.C., F.R.C.P., Calgary, Canada
R. JAMES KOCH, M.D., Palo Alto, California

INTRODUCTION/BACKGROUND                             ProFractional capability that allows users to
                                                    adjust a scanned pattern size from 6 x 6 mm to
The successful treatment of scarring secondary      20 x 20 mm and a precise penetration depth of
to active acne vulgaris is a major challenge        25–1000 µm. This allows the physician to treat
to practitioners of aesthetic medicine. To          different types of scars gently or assertively, as
the patient, acne scarring is as physically and     the patient requires. There is still a little down-
emotionally traumatic as active acne. The           time—patients look like they have a sunburn
number of patients requesting cosmetic              for a short time. The economics of the
improvement of acne scars is rising rapidly,        ProFractional are advantageous since there are
and armed with knowledge about emerging             no consumable components.
technology, so are their expectations. But even
with new therapies, the issue is still a complex    PROFRACTIONAL VS.
one. Many available treatment options do not        TRADITIONAL FRACTIONAL
seem to satisfy patients, and as such, 50%          TECHNOLOGY
improvement is considered a success.
                                                    The advent of fractional technology came
Patients come into our clinics daily looking to     with the promise of better results with less
improve their appearance by reducing acne           downtime, even with acne scarring. The
scarring. Until recently all we had to offer them   ProFractional device ablates narrow, precise
were ablative modalities such as dermabrasion,      channels into the dermis with no collateral
chemical peels, or CO2 laser resurfacing, all of    thermal necrosis, stimulating neocollagenesis
which require the patient to accept a significant   and wound healing in the dermis to create
amount of downtime in one form or another.          smoother, softer skin that feels better to the
Technology has since evolved for improvement        touch. The untreated surrounding tissue
of the different phases of scars. Intense pulsed    promotes rapid, uniform healing. With
light (IPL), vascular lasers, and fractional        ProFractional, precise depths can be selected
systems that started with Fraxel™ (Reliant          as can the pitch or distance between the spots.
Technologies, Palo Alto, CA), offer the same        In comparison, Fraxel creates necrotic micro-
level of improvement as previous modes with-        thermal zones to a depth of 90 microns; Pro-
out the downtime and hassle. Fraxel, however,                   al
                                                    Fra c t i on can ablate from 25 µm to 1.5 mm.
had the difficult-to-remove blue dye, signifi-      ProFractional can be as effective as other
cant discomfort and required a long treatment       fractional devices but offers the physician
series. Even the new generation of Fraxel does      more treatment flexibility. This leads to
not provide adequate control over the device        positive results that can be seen in fewer
according to some.                                  treatments and less overall downtime.

The new ProFractional™ (Sciton, Inc. Palo           More importantly, ProFractional users can treat
Alto, CA) softens and blends scars, and             individual scars as minimally or as aggressively
patients can feel the difference. Building up       as necessary to create an overall evenness to the
on the Contour™ 2940 Er:YAG laser (used to          skin. Deeper scars that require more aggressive
perform MicroLaserPeel®), Sciton added the          treatments can be treated accordingly, while
more shallow scars on the same patient can           Patients with skin types I to IV have been
be treated at a different setting. Though            treated more often than V and VI, but the evi-
ProFractional can spot treat, treating the whole     dence so far suggests that ProFractional can
face at varying intensities creates a uniform        treat even darker skin types without unwanted
color, texture, and tone.                            pigmentation changes.

                                                     WITH MICROLASERPEEL
ProFractional protocols will vary according to
each patient’s individual needs and we continue      ProFractional is also being used in combination
to improve techniques and outcomes. Factors          with Sciton’s MicroLaserPeel® (MLP)
that affect treatment include the number of          procedure to treat acne scars. Acne scars cause
treatments required; location, type, depth, and      uneven texture, and often uneven color and
severity of the scar; and age of the patient.        tone in the skin as well. This uneven appear-
                                                     ance is accentuated with accumulated sun
The nice thing about the ProFractional is that       damage. The one-two punch of superficial
it’s easy to precisely regulate treatment depth,     resurfacing and deep penetration collagen
which is shallower for the forehead and nose         remodeling helps blend these textures, tone
and deeper on the cheeks. A single pass is all       and color.
that is required for most patients. Patients don’t
require dressings, pain killers or wound care.       The ProFractional creates small channels that
Acne scars require four or five treatments about     stimulate collagen remodeling, giving the
a month apart using conservative protocols.          benefits of deep resurfacing without creating
The interval is approximate; four weeks gives        excess necrotic debris that hinders wound heal-
the patient time to heal, and allows time for        ing. The adjustability of ProFractional is useful
collagen remodeling. Three weeks is sufficient,      for different areas of the face where scarring is
as would be six. This flexibility of intervals is    more or less severe. The user can selectively
nice for both the patients and clinics.              deposit different amounts of energy. Depth and
                                                     density of spots can be customized to provide
For areas of mild acne, a shallow depth of           uniform color, texture and tone to the face—
approximately 100 µm at 4% coverage is               and can do so without heavy ablation, scabs,
effective. For more aggressive treatment, depth      crusting, and long downtime. The MLP treats
settings can be increased to 400 µm or even          the surface of the skin to put on a finishing
800 µm.                                              touch, especially around sensitive areas such as
Pre- and post-treatment care with Pro-               the eyelid.
Fractional is relatively universal. The procedure    RESULTS
is only slightly uncomfortable depending on
density settings used, and topical anesthetics       Acne scars have always been a treatment chal-
can make the patient more comfortable with           lenge, so managing expectations plays a key
aggressive treatment. Side effects at any setting    part in patient satisfaction. Whether for the
are minimal. No blisters or scabs have been          treatment of acne scars or traumatic scars, 50%
observed by us. Pinpoint bleeding may occur,         improvement in texture, tone, color, depth and
but chemical cautery swabs such as aluminum          size is the accepted standard with any treat-
hexahydrate will seal the tiny wounds. For           ment option. Photography is helpful in that
posttreatment care, any simple, water-based          both patients and clinicians can see improve-
moisturizers will effectively promote healing        ment by comparison. And happy patients will
and make the patient comfortable after treat-        come back for more treatments.
ment. Thermal mist sprays also help cool and
comfort the skin as the moisture evaporates.
Before Treatment                                     Four weeks after 1 treatment

Photos courtesy of                                   • Improved Tex t u re Tone – Radiance
B. Kent Remington, M.D., F.A.C., F.R.C.P.            • Acne Sca rs , Pits and Icepick A reas
Calgary, Canada                                        Softened-Flattened

Before Treatment                                     Four weeks after 1 treatment

Photos courtesy of                                   • Improved Tex t u re Tone – Radiance
B. Kent Remington, M.D., F.A.C., F.R.C.P.            • Acne Sca rs , Pits and Icepick A reas
Calgary, Canada                                        Softened-Flattened

Patient satisfaction has been very high because      their skin’s texture, tone and color. Dermal
both visible and tactile improvement is obvi-        fillers are being used after the third treatment
ous. Acne scars make the skin dull; after            by one author to help elevate the scars and
ProFractional treatment patients’ skin looks         bring more dramatic results on the face.
fresh, and they have the glow of a more youth-       Inflexible scars such as depressed pox scars
ful person. This device really improves the          require that the filler not be injected until after
overall quality of the skin.                         the third ProFractional treatment due to the
                                                     effects of collagen remodeling. But acne is a
CONCLUSION/FUTURE                                    management project, and such a combination is
Much of the focus with ProFractional has been        proving beneficial. Combination treatments,
for facial acne scarring, but successful treatment   such as with MLP or dermal fillers and others
of the neck and chest is also possible and has       involving laser- and light-based modalities,
been done in our clinics. Overall, patients          mean that the future for ProFractional looks
report satisfaction with the improvement in          bright.

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