The specific order of irradiation is dictated by the mechanics of skin penetration. The 10,600 nm laser must be applied first to create physical channels that break the skin's mechanical barrier. This prepares the tissue for the subsequent 1570 nm laser, which can then effectively deliver deep thermal energy around these pre-established pathways without causing further surface damage.
Core Takeaway This sequence functions as a "puncture then heat" strategy. By using the ablative laser (10,600 nm) to open the door and the non-ablative laser (1570 nm) to deliver therapeutic heat, you significantly expand the treatment volume (coagulation zone) without enlarging the open wound, thereby maximizing efficacy while limiting downtime.
The Mechanics of the Sequence
Step 1: Reducing the Mechanical Barrier
The 10,600 nm laser is an ablative technology. Its primary role in this sequence is to vaporize tissue and create microscopic physical channels.
By doing this first, you effectively reduce the mechanical resistance of the skin surface. These channels act as conduits that modify how the tissue accepts subsequent energy.
Step 2: Targeted Thermal Delivery
Once the barrier is breached, the 1570 nm laser is applied immediately. Because this laser is non-ablative, it does not cut or vaporize tissue.
Instead, it utilizes the pre-existing channels to penetrate the dermal layer. It selectively heats the tissue surrounding the initial ablative holes, delivering energy where it is needed most without having to fight an intact skin barrier.
Optimizing Tissue Morphology
Expanding the Coagulation Zone
The primary clinical goal of this sequence is to maximize the coagulation zone—the area of tissue heated enough to trigger remodeling.
The 1570 nm laser significantly expands this zone around the microscopic damage created by the first laser. This results in a larger volume of tissue being treated and stimulated for collagen remodeling than could be achieved by the ablative laser alone.
Preserving Channel Dimensions
Crucially, the 1570 nm laser adds this thermal value without altering the size of the original ablative channels.
If you attempted to get the same amount of heat into the tissue using only the 10,600 nm laser, you would likely have to create larger, more damaging wounds. The sequential approach allows for "deep heat" with a "small footprint."
Understanding the Trade-offs
Balancing Aggression and Safety
While this sequence optimizes results, it is a sophisticated balancing act. The 10,600 nm creates the necessary injury, and the 1570 nm amplifies the thermal stress.
The trade-off here is that while you avoid larger open wounds, you are still depositing significant thermal energy. This requires precise control to ensure the expanded coagulation zone does not lead to bulk heating that could overwhelm the tissue's cooling capacity.
Managing Recovery Expectations
This method is designed to control the post-operative recovery period. However, it relies strictly on the non-ablative nature of the second step.
Any deviation in the sequence that might disrupt the surface further would negate the benefits, leading to longer healing times similar to fully ablative resurfacing. The benefit lies entirely in the morphology of the coagulation zone remaining deep rather than wide.
Making the Right Choice for Your Goal
This sequential protocol is designed for scenarios where deep tissue remodeling is required but significant downtime is not an option.
- If your primary focus is Tissue Remodeling: This sequence is essential because the 1570 nm laser expands the coagulation zone, triggering a stronger collagen response than ablation alone.
- If your primary focus is Safety and Recovery: This sequence is critical because it restricts the physical wound size to the dimensions of the initial 10,600 nm channel, preventing the complications associated with larger ablative wounds.
By respecting this specific order, you achieve a synergy that delivers aggressive results with a conservative safety profile.
Summary Table:
| Laser Type | Wavelength | Primary Function | Role in Sequence |
|---|---|---|---|
| Ablative | 10,600 nm | Vaporizes tissue; creates physical channels | Step 1: Breaks the mechanical barrier & opens conduits |
| Non-Ablative | 1,570 nm | Delivers deep thermal energy; no vaporization | Step 2: Expands coagulation zone around existing channels |
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References
- Igor Snast, Assi Levi. Clinical and histological evaluation of a dual sequential application of fractional 10,600 nm and 1570 nm lasers, compared to single applications in a porcine model. DOI: 10.1007/s10103-021-03460-5
This article is also based on technical information from Belislaser Knowledge Base .
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