Long-term clinical improvement of facial and nonfacial photodamaged skin has been seen up to nine months after treatment with the 1550 nm Fraxel laser. Wanner et al. [23] examined fifty patients (skin types I-III) who underwent three treatments (8 mJ, 2000 MTZ/cm2 for facial areas; 8 mJ, 1,500-2000 MTZ/cm2 for nonfacial areas) three to four weeks apart. Nine months after treatment, 51-75% improvement in photodamage was observed in 73 and 55% of facial and nonfacial treated skin, respectively. Transient erythema and edema were seen in the majority of patients; however, no protracted pigmentary changes or scarring were observed [23].
In Asian patients with photodamaged skin, pigmentary problems are often more of a concern than rhytids [25,31]. Postinflammatory hyperpigmentation (PIH) is a common complication in these and other dark-skinned patients who attempt laser resurfacing [25,32-34]. Fractional resurfacing, however, can be effective in Asian patients when appropriate parameters are used, and caution is exercised to prevent complications such as hyperpigmentation. Initial studies have shown that there is a lower incidence of PIH when lower microthermal zone densities are used [24,25]. Chan et al. [25] found that Asian patients who received a high-energy, low-density treatment with the Fraxel (average fluence 16.3 mJ, total density 1000 MTZ/cm2) had a lower prevalence of PIH than those who received a low – energy, high-density treatment (average fluence 8.2 mJ, total density 2000 MTZ/cm 2). Similarly, Kono et al. [24] found that the use of higher densities (even with lower fluences) was associated with an increased risk of developing hyperpigmentation. Patients also experienced more pain, erythema, and swelling when higher densities and increased fluences were used. Overall, the clinical efficacy and patient satisfaction were significantly higher with high-fluence, low-density treatments.