High fluence parameters prove more effective in fractional laser scar management because they prioritize vertical penetration over horizontal coverage. By utilizing higher energy per point (such as 50 mJ), the laser bypasses superficial layers to deliver thermal stimulation directly to the deep reticular dermis, where the core structural issues of a scar reside.
The Core Reality While increasing density spreads energy across the skin's surface, increasing fluence drives energy down into the dermis. Effective scar remodeling requires the denaturation of deep collagen, a process that is triggered far more efficiently by deep, high-energy columns than by shallow, high-density coverage.
The Mechanics of Depth vs. Density
Targeting Deep Structures
Scar tissue is not merely a surface irregularity; it involves structural changes deep within the skin.
High density parameters increase the number of spots treated on the surface, but often at the cost of energy depth.
High fluence parameters allow the laser beam to punch through to the deeper layers of the dermis, directly impacting the root of the scar tissue.
Triggering Collagen Synthesis
The primary goal of fractional laser therapy is to remodel tissue.
To do this, you must trigger the denaturation (breaking down) and subsequent synthesis of collagen.
High fluence settings provide the thermal intensity required to stimulate this process deep within the tissue, leading to more significant structural changes.
The "Constant Energy" Principle
When the total energy delivered to the tissue remains constant, how you distribute that energy matters.
Studies indicate that concentrating that energy into fewer, deeper columns (high fluence) yields better results than spreading it out over many shallow columns (high density).
Specific improvements noted with high fluence include reductions in scar height, increased flexibility, and normalized vascularity.
Measuring the Impact
Vancouver Scar Scale (VSS) Improvements
The superiority of high fluence is quantifiable using the Vancouver Scar Scale.
Height: Deep thermal injury helps flatten elevated scars more effectively.
Pliability: Deep remodeling breaks up rigid scar tissue, restoring flexibility.
Vascularity: High energy treatments help normalize the blood flow and redness associated with scarring.
Understanding the Risks and Calibration
The Thermal Intensity Factor
It is critical to understand that fluence determines the peak temperature reached within the target tissue.
While high fluence is necessary for efficacy, it equates to higher thermal intensity.
The Risk of Over-Treatment
Just as energy density must be calibrated in other procedures to prevent burns, high fluence in scar management requires strict control.
If the energy density is too high for the patient's specific skin type, there is a risk of causing epidermal burns or triggering excessive inflammatory reactions.
The goal is to induce a controlled deep injury, not an uncontrolled surface burn.
Making the Right Choice for Your Goal
To select the appropriate parameters, you must balance the need for depth against the patient's tolerance and skin type.
- If your primary focus is structural remodeling: Prioritize high fluence settings (e.g., 50 mJ) to ensure energy penetrates the dermis to trigger deep collagen synthesis.
- If your primary focus is safety in sensitive skin: Reduce fluence to avoid excessive peak temperatures that could lead to burns, accepting that structural remodeling may be slower.
True scar management is defined by the depth of the repair, not the width of the treatment area.
Summary Table:
| Parameter Type | Focus Area | Tissue Impact | Primary Result |
|---|---|---|---|
| High Fluence | Vertical Depth | Deep Dermal Denaturation | Significant structural remodeling & flattening |
| High Density | Horizontal Coverage | Superficial Surface Treatment | Improved surface texture; limited deep change |
| Goal | Deep Scar Root | Collagen Synthesis | Reduced height, improved pliability & vascularity |
Elevate Your Clinical Outcomes with BELIS Advanced Laser Technology
At BELIS, we understand that true scar transformation requires precision-engineered equipment that balances high fluence with patient safety. Our professional-grade medical aesthetic portfolio—including CO2 Fractional Lasers, Nd:YAG, and Pico systems—is designed exclusively for clinics and premium salons seeking to provide deep dermal remodeling and superior skin rejuvenation.
From high-performance laser systems to specialized body sculpting solutions like EMSlim and Cryolipolysis, BELIS empowers your practice with the tools needed to deliver measurable results. Contact us today to discover how our advanced technology can enhance your service offerings and provide your clients with the next level of care.
References
- Hyung‐Sup Shim, Ho Kwon. Low versus High Fluence Parameters in the Treatment of Facial Laceration Scars with a 1,550 nm Fractional Erbium-Glass Laser. DOI: 10.1155/2015/825309
This article is also based on technical information from Belislaser Knowledge Base .
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