Key messages

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  The development of fractionated laser technology, which creates a pixilated pattern of microscopic treatment zones and adjacent areas of sparing, is a milestone in the history of light-based rejuvenation.

  
  
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  Treatment with the fractional ablative devices can approach results seen with the traditional carbon dioxide laser, with significantly less downtime and discomfort, and fewer complications.

  
  
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  Although complications with fractionated lasers are rare, diligent patient management throughout the procedure and postoperative period remains critical in achieving optimal results.

  
  
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  There are numerous fractional devices that use either ablative or nonablative treatment characteristics. These devices are not all made equal, and those who purchase such systems should make a careful determination about the relative efficacy of their proposed acquisition.

First used by Manstein and colleagues in 2004, fractionated laser energy has quickly become an essential component of laser-based medical and aesthetic treatments. Although traditional full-face ablative laser resurfacing treats 100% of the skin, fractionated laser devices treat only a fraction of the skin and generally have the shape of vertically oriented cylinders of thermally damaged tissue. This design is unique in that each of these treatment areas is surrounded by normal, unaffected skin. Fractionated devices, with either thermal or ablative characteristics, are now produced by many laser companies. They are not all equal in their engineering or delivery capabilities, and thus potential buyers need to be cautious when choosing such a device for their practice. Although the gold standard remains the traditional CO ₂ laser, these devices have approached this standard with much less downtime, and fewer side effects and complications.