The Fractional Mode facilitates tissue repair by decomposing the laser beam into a microscopic pixel array, delivering energy in a precise grid pattern. This method creates controlled micro-injuries in the dermis while preserving the surrounding healthy tissue. By strictly limiting the scope of thermal damage, it prevents excessive heat accumulation and triggers the body's natural healing mechanisms to remodel skin structure.
Core Takeaway Fractional CO2 technology works on a dual mechanism of physical ablation and biological stimulation. It physically removes pathological tissue in hypertrophic scars while simultaneously stimulating fibroblasts to regenerate healthy collagen and elastin in atrophic conditions, bridging the gap between aggressive surgery and non-invasive surface treatments.
The Mechanism of the Microscopic Pixel Array
Controlled Energy Delivery
The system emits high-energy light beams (typically 10600 nm wavelength) that are absorbed efficiently by water in the skin tissue.
Instead of a solid beam, the Fractional Mode splits this energy into thousands of tiny shafts.
Microscopic Ablative Zones (MAZs)
These beams create specific zones of thermal injury, known as Microscopic Ablative Zones (MAZs).
Because these zones are spaced out in a grid, bridges of healthy, untreated tissue remain between them. This preserved tissue acts as a reservoir for rapid healing, significantly accelerating epithelial repair compared to full-field ablation.
Treating Hypertrophic Lesions (Keloids)
Physical Ablation of Excess Tissue
Keloids are characterized by an overgrowth of dense collagen bundles. The CO2 laser acts as an ablative tool, using the fractional grid to physically cut through and gasify this excess scar tissue.
This results in an immediate reduction in scar volume and a visible flattening of the lesion.
Enhanced Therapeutic Delivery
One of the most critical functions for keloid treatment is the creation of micro-channels deep into the tissue.
Keloids often have dense barriers that prevent topical or injected medications from working effectively. The laser perforates these barriers, allowing for deeper and more uniform penetration of intralesional steroids.
Pulse Stacking for Depth Control
Advanced systems utilize pulse stacking technology, which delivers multiple consecutive pulses into a single microscopic hole (DOT).
This allows the practitioner to reach the deep dermal layers required for treating thick keloids without expanding the width of the injury, thereby minimizing damage to surrounding tissue.
Treating Atrophic Lesions (Striae)
Stimulating the Fibroblast Response
Unlike keloids, striae (stretch marks) represent a loss of substance or atrophy. Here, the goal is not removal, but regeneration.
The controlled thermal stress induces fibroblasts—the cells responsible for making connective tissue—to synthesize new collagen.
Structural Remodeling
The process triggers the production of new elastic fibers, which are often damaged or missing in striae.
This results in a structural remodeling of the skin, leading to increased firmness, reduced wrinkle depth, and improved pigment uniformity.
Understanding the Trade-offs
The Necessity of Precision
While the fractional approach reduces risks, it still relies on creating thermal damage.
If the density, width, or depth of the micro-zones is not precisely controlled, there is a risk of heat accumulation. This can negate the benefits of the "fractional" approach and lead to complications similar to full ablation.
Recovery vs. Results
The creation of MAZs guides pathological tissue toward a normal wound healing trajectory, offering rapid recovery.
However, because the treatment relies on the body's biological response (modulating cytokines and growth factors), results are cumulative rather than instant. The remodeling process continues for weeks after the physical procedure.
Making the Right Choice for Your Goal
To maximize the efficacy of Fractional CO2 treatment, align your protocol with the specific pathology of the tissue.
- If your primary focus is Volume Reduction (Keloids): Utilize the laser to create micro-channels immediately prior to drug injection to break tissue barriers and enhance steroid penetration.
- If your primary focus is Structural Repair (Striae): Focus on parameters that optimize fibroblast stimulation to encourage the synthesis of new collagen and elastic fibers.
- If your primary focus is Deep Tissue Remodeling: Leverage pulse stacking capabilities to achieve necessary depth without causing lateral thermal damage to healthy skin.
Ultimately, the Fractional Mode succeeds by converting a chaotic injury into a controlled, microscopic wound healing environment that forces the skin to rebuild itself correctly.
Summary Table:
| Feature | Hypertrophic Scars (Keloids) | Atrophic Scars (Striae) |
|---|---|---|
| Primary Goal | Volume reduction & flattening | Structural regeneration & thickening |
| Mechanism | Physical ablation of dense collagen | Fibroblast stimulation & collagen synthesis |
| Key Technique | Micro-channels for drug delivery | Controlled thermal stress for remodeling |
| Laser Depth | Deep dermal penetration (Pulse Stacking) | Mid-dermal remodeling |
| Benefit | Breaks tissue barriers for steroids | Restores elasticity and skin firmness |
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References
- Riezky Januar Pramitha, M. Yulianto Listiawan. Efficacy and Side Effects of Fractional Carbon Dioxide Laser for Acne Scars, Keloids, and Striae Albae in the Dermatovenereology Clinic of Tertiary Hospital: A Retrospective Study. DOI: 10.20473/bikk.v33.1.2021.19-27
This article is also based on technical information from Belislaser Knowledge Base .
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