The core function of the Fractional Ablative CO2 Laser in Laser-Assisted Drug Delivery (LADD) is to act as a high-precision barrier breaker. By emitting high-energy light beams, the laser creates Microthermal Zones (MTZs) that physically vaporize microscopic vertical channels into the skin. These channels bypass the skin's natural defense layer—the stratum corneum—allowing therapeutic drugs to penetrate directly into the deep dermis.
The skin is biologically engineered to keep foreign substances out. The Fractional CO2 Laser overcomes this by drilling temporary, physical "tunnels" through the outer barrier, enabling large-molecule drugs to reach deep tissue targets that topical application alone could never access.
The Mechanics of Barrier Bypass
To understand how this technology enhances drug delivery, one must understand how it physically alters the skin's architecture.
Creating Microthermal Zones (MTZs)
The laser does not treat the entire skin surface at once. Instead, it utilizes a fractional approach to generate Microthermal Zones.
These are precise, spaced-out columns of thermal activity. By leaving the surrounding tissue intact, the laser concentrates high energy into specific microscopic points to maximize penetration without causing widespread surface trauma.
Vaporization of Vertical Channels
Within these zones, the laser energy is intense enough to cause instantaneous vaporization of the tissue.
This creates open, vertical channels (micropores) that extend from the surface down into the dermis. Unlike non-ablative lasers that merely heat the tissue, ablative CO2 lasers physically remove microscopic columns of tissue to create empty space.
Coagulation and Channel Stability
As the laser forms these pores, it produces a localized coagulation effect around the channel walls.
This thermal coagulation is critical because it keeps the channels open for an extended period. This structural stability ensures that the pathway remains clear long enough for the applied medication to permeate the tissue effectively.
Enhancing Drug Bioavailability
The primary goal of creating these channels is to solve the problem of absorption.
Defeating the Stratum Corneum
The stratum corneum is the skin's outermost layer and its primary barrier against absorption.
By vaporizing channels that penetrate this layer, the laser provides a direct physical pathway to the dermis. This allows medication to bypass the "gatekeeper" layer entirely, rather than relying on passive diffusion.
Enabling Large-Molecule Penetration
Many potent therapeutic agents, such as stem cell metabolites or corticosteroids, consist of large molecules that are too heavy to penetrate intact skin.
The micro-channels created by the CO2 laser are large enough to accommodate these macromolecules. This ensures that the drug is distributed evenly and absorbed deeply, significantly increasing its bioavailability and therapeutic efficiency.
Understanding the Trade-offs
While LADD is highly effective, it involves controlled physical alteration of the tissue.
Depth Control and Safety
The depth of the channels—often between 200 and 600 micrometers—must be precisely calibrated.
If the channels are too shallow, they may not breach the barrier effectively; if they are too deep, they risk unnecessary injury. The success of LADD relies on hitting the exact depth required for the specific drug to reach its target within the dermis or scar tissue.
The Necessity of Controlled Injury
It is important to recognize that this process is fundamentally a controlled injury.
The laser creates a wound to facilitate healing and delivery. While the fractional nature of the laser minimizes recovery time compared to fully ablative procedures, it still triggers a wound-healing response that must be managed alongside the drug therapy.
Making the Right Choice for Your Goal
When implementing LADD protocols, your specific objective should dictate the laser settings and drug choice.
- If your primary focus is Scar Remodeling: Utilize the laser to penetrate deep into the fibrous tissue, ensuring drugs like corticosteroids reach the core of the scar to reduce thickness.
- If your primary focus is Skin Rejuvenation: Focus on creating a high density of superficial channels to maximize the uniform absorption of large-molecule metabolites or vitamins across the dermis.
By transforming the skin from a barrier into a gateway, the Fractional Ablative CO2 Laser turns topical application into deep-tissue therapy.
Summary Table:
| Feature | Mechanism of Action | Clinical Benefit |
|---|---|---|
| Channel Creation | Vaporizes microscopic vertical tunnels (MTZs) | Bypasses the stratum corneum barrier |
| Tissue Ablation | Instantaneous removal of tissue columns | Creates a direct physical pathway to the dermis |
| Thermal Coagulation | Seals and stabilizes channel walls | Keeps pathways open for sustained drug absorption |
| Macromolecule Delivery | Accommodates large-molecule therapeutic agents | Enables delivery of stem cells and corticosteroids |
| Depth Control | Adjustable penetration (200-600 micrometers) | Targets specific tissue layers for scars or rejuvenation |
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References
- Bassam Younes, Tarek Shoukr. Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article. DOI: 10.21608/ejprs.2025.444136
This article is also based on technical information from Belislaser Knowledge Base .
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