The mechanism of Fractional CO2 laser systems relies on a synchronized dual action to repair atrophic scars. The vertical effect is driven by ablation, which creates deep channels in the skin to stimulate the deposition of new collagen fibers. Simultaneously, the horizontal effect occurs through thermal coagulation zones surrounding these channels, which triggers the remodeling of existing collagen networks.
By combining vertical ablation with horizontal thermal spread, this technology addresses the full architecture of a scar: filling deep depressions with new tissue while tightening and smoothing the surface texture.
The Vertical Effect: Building Volume and Depth
Mechanism of Ablation
The vertical component functions through high-precision ablation. The laser emits ultra-fine beams that vaporize tissue to create microscopic vertical channels, often referred to as Microthermal Zones (MTZs).
Targeting the Deep Dermis
These columns can penetrate deeply—up to 1,200μm—to reach the reticular dermis where atrophic scarring originates. By physically removing damaged tissue in these vertical columns, the laser creates space for healthy tissue regeneration.
Deposition of New Collagen
The primary biological result of this vertical trauma is the induction of new collagen deposition. As the body rushes to heal these microscopic injuries, it synthesizes fresh collagen fibers, effectively lifting the depression of the atrophic scar from the bottom up.
The Horizontal Effect: Surface Remodeling
The Zone of Coagulation
Surrounding each vertical ablative channel is a controlled area of thermal damage known as the coagulation zone. This is where the laser's heat dissipates laterally into the tissue without vaporizing it.
Triggering Remodeling
This horizontal thermal stress does not remove tissue but instead "shocks" the existing dermal structure. This initiates collagen remodeling, a process where disorganized scar tissue is broken down and reorganized into a smoother, more uniform pattern.
Contracting the Tissue
The horizontal delivery of heat causes immediate contraction of collagen fibers. This tightening effect helps to pull the edges of the scar closer together, reducing its visible surface area and smoothing the overall skin texture.
The Synergy of Dual Action
Fibroblast Stimulation
Both the vertical and horizontal effects work together to stimulate fibroblasts, the cells responsible for structural repair. The physical trauma of ablation and the thermal stress of coagulation trigger a potent healing response.
Rapid Recovery via Fractionation
Crucially, these effects occur in a "fractional" pattern, meaning healthy skin is left intact between the treatment zones. This untreated tissue acts as a reservoir for rapid healing, allowing the skin to recover quickly despite the intensity of the deep vertical penetration.
Understanding the Trade-offs
Depth vs. Recovery Time
There is a direct correlation between the intensity of the vertical effect and recovery time. Deeper ablation is necessary for profound scarring, but it increases the duration of the post-treatment healing phase.
Thermal Management
While horizontal coagulation is essential for remodeling, excessive lateral heat can pose risks. High-precision devices are required to ensure the thermal spread remains controlled, preventing unwanted damage to healthy surrounding tissue.
Making the Right Choice for Your Goal
To maximize results, the balance between vertical and horizontal effects should be adjusted based on the specific scar morphology.
- If your primary focus is deep, "ice pick" or "boxcar" scars: Prioritize the vertical effect to penetrate the deep dermis and induce significant new collagen deposition to fill the void.
- If your primary focus is uneven texture or rolling scars: Prioritize the horizontal effect to maximize surface contraction and collagen remodeling for smoother topography.
Effective treatment lies in the precise calibration of these two forces to rebuild the skin's structure while respecting its biological limits.
Summary Table:
| Mechanism Effect | Primary Action | Biological Result | Best For |
|---|---|---|---|
| Vertical Effect | Deep Micro-Ablation | New collagen deposition & tissue lifting | Ice pick & deep boxcar scars |
| Horizontal Effect | Thermal Coagulation | Collagen remodeling & tissue contraction | Rolling scars & skin texture |
| Synergy | Fractional Delivery | Accelerated healing & fibroblast activation | Comprehensive skin resurfacing |
Elevate Your Clinic's Results with BELIS Advanced Laser Technology
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- Advanced Laser Systems: From CO2 Fractional and Nd:YAG to Pico and Diode Hair Removal.
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References
- Amita Murali Babu, Hafsa Eram. A comparative study of efficacy and safety of platelet rich plasma versus fractional co2 laser in the treatment of post acne scars. DOI: 10.18203/issn.2455-4529.intjresdermatol20191760
This article is also based on technical information from Belislaser Knowledge Base .
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