The primary purpose is to achieve near-total tissue ablation. While a single fractional scan covers only a small percentage of the skin, performing 16 to 18 passes layers the treatment to achieve an effective coverage density of 90% to 92%. This technique allows the practitioner to simulate the aggressive tissue removal capability of traditional fully ablative lasers.
By stacking multiple fractional scans, the procedure bridges the gap between gentle resurfacing and deep surgical ablation. It enables the significant bulk removal required for Rhinophyma while maintaining the rapid healing and safety profile characteristic of fractional technology.
Bridging the Gap Between Fractional and Full Ablation
Overcoming Single-Scan Limitations
A standard fractional laser leaves "bridges" of untreated skin to speed up healing. However, this limited density is insufficient for the heavy lifting required in Rhinophyma cases.
By repeating the scan 16 to 18 times, the practitioner systematically fills in the gaps. This increases the total surface area treated to approximately 90% to 92%.
Simulating Full-Field Power
Rhinophyma involves excess hyperplastic tissue that must be physically removed.
The high number of passes allows the fractional laser to mimic the high tissue removal capacity of a traditional full-field ablative laser. This provides the necessary power to debulk the nose effectively without switching to riskier, older technologies.
Preserving Safety Mechanisms
Despite the high coverage, the laser remains in "fractional" mode.
This retains the inherent benefits of the technology, such as rapid healing and low rates of adverse reactions. The goal is to be as aggressive as possible with tissue removal while keeping the side-effect profile manageable.
The Mechanics of Deep Tissue Sculpting
Vaporization and Lysis
The mechanism relies on the rapid absorption of laser energy by intracellular water molecules.
This causes swift vaporization of moisture, leading to tissue lysis (breakdown). This process is essential for the precise removal of the excess tissue responsible for the distorted nasal contour.
Reaching the Necessary Depth
Surface abrasion is not enough for Rhinophyma; the problem lies deep in the dermis.
Practitioners set high single-pulse energy to ensure an ablation depth exceeding 1.5 mm. This depth is critical to reach and debulk the hypertrophic sebaceous glands and connective tissue that define the condition.
Dual Action: Removal and Regeneration
The procedure does not simply remove tissue; it utilizes thermal effects to benefit the remaining skin.
The heat generated during the 16-18 passes stimulates collagen regeneration in the dermis. This helps rebuild a healthy, structured skin framework once the excess bulk is removed.
Understanding the Trade-offs
Balancing Density with Recovery
While 16-18 passes mimic full ablation, they also push the limits of the skin's recovery capacity.
Detailed observation is required because as coverage approaches 92%, the reservoir of healthy cells needed for rapid re-epithelialization shrinks. This technique requires a skilled hand to ensure the threshold for scarring is not crossed.
Heat Accumulation
Performing this many passes generates significant thermal buildup.
While this heat is beneficial for collagen remodeling, excessive thermal stacking can lead to unintended damage. The "fractional" nature helps mitigate this, but it does not eliminate the risk entirely compared to a single pass.
Approaches for Optimal Restoration
To effectively treat Rhinophyma using this high-density technique, consider your specific clinical end-goals:
- If your primary focus is Debulking and Reshaping: Prioritize high single-pulse energy to ensure penetration exceeds 1.5 mm, targeting the deep sebaceous hyperplasia.
- If your primary focus is Safety and Recovery: Rely on the fractional nature of the 16-18 passes to maintain a lower adverse reaction rate compared to traditional full-field ablation tools.
The success of this procedure lies in using the repetition of fractional pulses to achieve surgical-grade removal with non-surgical precision.
Summary Table:
| Feature | Single Fractional Pass | 16-18 Passes (Rhinophyma Protocol) |
|---|---|---|
| Effective Coverage | ~5% - 20% | 90% - 92% |
| Clinical Objective | Gentle Resurfacing | Bulk Tissue Removal / Debulking |
| Ablation Depth | Superficial | Deep (Exceeding 1.5 mm) |
| Tissue Effect | Micro-thermal zones | Near-total tissue lysis/vaporization |
| Primary Benefit | Minimal downtime | Surgical precision with fractional safety |
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References
- Kathryn Serowka, Christopher B. Zachary. Fractionated ablative carbon dioxide laser for the treatment of rhinophyma. DOI: 10.1002/lsm.22184
This article is also based on technical information from Belislaser Knowledge Base .
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