The primary function of stack mode in fractional CO2 laser therapy is to increase the depth of thermal penetration without causing excessive collateral damage to the skin's surface. By delivering a rapid sequence of multiple pulses to a single microscopic treatment zone, the laser progressively "drills" deeper into the dermis, reaching layers that a single pulse cannot safely access.
By effectively breaking a single high-energy shot into smaller, consecutive pulses, stack mode allows practitioners to treat deep pathologies like stubborn scar tissue while maintaining precise control over epidermal safety.
The Mechanics of Vertical Stacking
Sequential Pulse Delivery
In standard operation, a fractional laser might fire one pulse per spot before moving to the next. Stack mode changes this by firing multiple consecutive pulses into the exact same coordinate.
This happens rapidly, ensuring the pulses stack on top of one another.
Cumulative Depth Penetration
Each individual pulse in the "stack" removes or heats a specific amount of tissue.
Because the subsequent pulses follow the path of the first, the thermal energy travels vertically deeper into the dermal tissue rather than spreading horizontally across the surface.
Advantages Over Single-Pulse Treatments
The Limitation of Single High-Energy Pulses
To reach deep dermis layers with a single pulse, you would typically need to crank up the energy significantly.
However, a single high-energy pulse often creates a wider zone of ablation. This increases the risk of damaging the superficial epidermis (the top layer of skin) and can lead to longer downtime or adverse effects.
Precision Through Incremental Stacking
Stack mode solves the single-pulse problem via incremental stacking.
By delivering the energy in packets, the laser allows for precise control over the depth of the treatment column (Microscopic Treatment Zone). This ensures the energy is focused exactly where it is needed—deep in the tissue—rather than dissipating at the surface.
Understanding the Clinical Application
Targeting Deep Pathology
The architecture of this mode is specifically designed for deep-seated skin issues.
The primary reference highlights its efficacy on deep, stubborn scar tissue. These conditions require thermal remodeling in the lower layers of the skin, which superficial treatments often miss.
Safety Profile
Despite the increased depth, the safety profile regarding surface burns remains favorable.
Because the energy is fractionated over time (even milliseconds), the epidermis is spared the trauma of a single, massive explosion of energy, reducing the likelihood of superficial scarring.
Making the Right Choice for Your Goal
When configuring your laser parameters, understanding the target tissue depth is essential.
- If your primary focus is treating deep acne scars or surgical scars: Utilize stack mode to maximize vertical penetration and remodel the underlying tissue structure.
- If your primary focus is superficial resurfacing or texture: A standard single-pulse mode is likely sufficient, as deep penetration is not required and may be overkill.
Stack mode transforms the CO2 laser from a surface resurfacing tool into a precise instrument for deep dermal remodeling.
Summary Table:
| Feature | Single-Pulse Mode | Stack Mode (Multiple Pulses) |
|---|---|---|
| Energy Delivery | Single high-energy shot per spot | Rapid sequence of smaller pulses |
| Penetration Depth | Moderate / Superficial | Deep (Progressive vertical drilling) |
| Thermal Spread | Wider horizontal spread | Controlled vertical penetration |
| Epidermal Risk | Higher risk of surface burns at high energy | Lower risk; spares the surface layer |
| Best Used For | Texture, tone, and fine lines | Deep acne scars, surgical scars, and thick tissue |
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References
- Tokuya Omi, Zenya Naito. Fractional CO2 laser for the treatment of acne scars. DOI: 10.1111/j.1473-2165.2011.00587.x
This article is also based on technical information from Belislaser Knowledge Base .
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