Fractional technology utilizes a precision scanning system to divide a single laser beam into thousands of micron-sized thermal injury columns. This mechanism allows the laser to penetrate the stratum corneum and treat specific depths of the eyelid without ablating the entire skin surface.
By creating microscopic channels of thermal injury while leaving surrounding tissue intact, fractional technology enables deep treatment of Milia En Plaque while leveraging the skin's natural healing capacity for rapid repair.
The Mechanism of Selective Photothermolysis
Creating Micro-Thermal Zones
The core technical function of this technology is the creation of Microscopic Treatment Zones (MTZs).
The scanner delivers energy in a pixelated pattern, drilling narrow, vertical columns of thermal injury into the skin.
This allows the laser to bypass the epidermis in specific spots to reach the deep dermis where the plaque resides.
The Role of Intact Tissue Bridges
Crucially, the technology leaves the skin tissue surrounding each micro-column untouched.
These bridges of healthy, undamaged tissue act as a biological reservoir for repair cells.
Because the majority of the skin surface remains intact, re-epithelialization occurs rapidly, significantly reducing downtime compared to fully ablative lasers.
Precision Control for Eyelid Anatomy
Preventing Heat Accumulation
The eyelid skin is exceptionally thin and fragile, making it susceptible to thermal injury.
The scanning system prevents excessive heat accumulation by precisely distributing energy across micro-zones rather than a continuous field.
By controlling scanning density—such as maintaining specific spacing (e.g., 500 microns)—the device ensures a safe ratio between thermal injury zones and normal tissue.
Targeting Variable Depths
Milia En Plaque lesions often attach to the orbicularis oculi muscle at varying depths.
Advanced CO2 fractional systems utilize multiple pulse shape adjustment functions to modulate energy release.
This allows the operator to achieve superficial epidermal ablation while simultaneously delivering localized heat to the deep dermis to clear infiltration.
Understanding the Trade-offs
The Risk of Excessive Density
While fractional technology is safer than traditional ablation, parameter control is critical.
If the spot density is set too high, the bridges of healthy tissue become too narrow to support rapid healing.
This can lead to "bulk heating," effectively turning a fractional treatment into a fully ablative one, increasing the risk of scarring on the eyelid.
Balancing Depth and Safety
Deeper micro-channels are required to reach the root of the Milia En Plaque.
However, increasing the pulse energy to achieve this depth also increases the diameter of the thermal damage.
Operators must carefully balance pulse energy against spot density to ensure the channels are deep enough for efficacy without merging laterally.
Making the Right Choice for Your Goal
When configuring a medical-grade CO2 fractional laser for treating Milia En Plaque on the eyelid, the technical priority shifts based on the specific clinical presentation.
- If your primary focus is Safety and Recovery: Prioritize a lower scanning density (wider spacing) to maximize the amount of intact tissue bridges, ensuring the fastest possible re-epithelialization of the fragile eyelid skin.
- If your primary focus is Clearance Rate: Prioritize pulse shape modulation to deliver higher energy to the deep dermis, ensuring the heat reaches the orbicularis oculi muscle attachments where the lesions are rooted.
Mastering fractional technology requires balancing the depth of the injury column with the preservation of the surface integrity.
Summary Table:
| Feature | Technical Function | Clinical Benefit for MEP |
|---|---|---|
| Microscopic Treatment Zones (MTZs) | Creates pixelated vertical thermal columns | Targets deep plaque while preserving surface integrity |
| Intact Tissue Bridges | Leaves surrounding skin undamaged | Acts as a biological reservoir for rapid healing/re-epithelialization |
| Precision Scanning System | Distributes energy across micro-zones | Prevents excessive heat accumulation on fragile eyelid skin |
| Pulse Shape Modulation | Adjusts energy release depth and intensity | Reaches lesions attached to the orbicularis oculi muscle |
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References
- Stefania Tenna, Paolo Persichetti. Eyelid milia en plaque: a treatment challenge with a new CO<sub>2</sub>fractional laser. DOI: 10.1111/dth.12049
This article is also based on technical information from Belislaser Knowledge Base .
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