The multi-round stacked passes method is utilized to achieve precise command over tissue interaction. By delivering laser energy in overlapping pulses on a single point, this technique allows operators to decouple surface-level tissue removal from deep tissue heating. This separation ensures that the depth of ablation and the extent of thermal coagulation can be independently managed to suit specific clinical requirements.
Core Takeaway: Instead of a "one-size-fits-all" pulse, stacked passes utilize a progressive strategy. This method clears the surface epidermis first to allow subsequent pulses to target the deeper dermis, maximizing collagen production while maintaining strict control over thermal damage.
Achieving Precision Through Layering
The primary utility of the stacked passes method lies in its ability to fine-tune the laser's impact. It transforms a static procedure into a dynamic one, responsive to the patient's unique skin architecture.
Controlling Ablation Depth
The physical depth of the laser channel is not fixed. By adjusting the number of pulse overlaps, an operator can dictate exactly how deep the laser penetrates the tissue.
This prevents unnecessary trauma to deeper layers when superficial treatment is sufficient, while allowing for greater depth when required for significant remodeling.
Managing Thermal Coagulation
Beyond simple tissue removal, this method regulates the zone of thermal injury (coagulation).
By stacking pulses, the operator controls how much heat accumulates in the surrounding tissue. This is critical for stimulating the body's healing response without causing excessive burns or unintended necrosis.
The Progressive Energy Delivery System
The most sophisticated aspect of this method is its staged approach to energy delivery. It treats the skin as a multi-layered structure rather than a homogenous block.
Stage One: Epidermal Vaporization
The initial pass in a stacked sequence serves a specific function: epidermal vaporization.
This first pulse effectively removes the outermost layer of skin, clearing the path for subsequent energy delivery.
Stage Two: Dermal Stimulation
Once the surface barrier is removed, the subsequent stacked passes can bypass the epidermis entirely.
These later pulses target the underlying dermis, delivering energy specifically for thermal stimulation.
Triggering Neocollagenesis
The ultimate goal of this staged heating is to induce collagen remodeling and neocollagenesis (the creation of new collagen).
Because the energy is delivered progressively, this biological trigger occurs within a controlled depth, optimizing clinical improvement while minimizing risks.
Critical Considerations and Trade-offs
While the multi-round stacked passes method offers superior control, it relies heavily on the operator's ability to assess clinical needs.
Reliance on Clinical Judgment
The flexibility of this method is also its main variable. The reference emphasizes that adjustments must be based on "clinical needs."
There is no automatic setting that works for every case; the operator must actively determine the correct number of overlaps to balance ablation with coagulation.
The Balance of Heat and Depth
Increasing the number of stacks increases the depth of thermal coagulation.
While this enhances collagen remodeling, it requires careful monitoring to ensure the "controlled depth" does not exceed the skin's safety threshold. The method is powerful, but it demands a precise understanding of tissue tolerance.
Applying This Method to Clinical Goals
To maximize the efficacy of ablative fractional laser processes, you must tailor the stacking strategy to the desired outcome.
- If your primary focus is Surface Resurfacing: Minimize the number of stacks to prioritize the initial epidermal vaporization pass, limiting deep thermal heat.
- If your primary focus is Deep Wrinkle or Scar Reduction: Increase the number of stacked passes to bypass the epidermis and drive thermal stimulation deep into the dermis for maximum collagen remodeling.
By mastering the ratio of vaporization to thermal stimulation, you transform the laser from a simple cutting tool into a precise instrument for tissue regeneration.
Summary Table:
| Feature | Single Pass Method | Multi-Round Stacked Passes |
|---|---|---|
| Energy Delivery | Single high-intensity pulse | Multiple progressive pulses |
| Tissue Interaction | Simultaneous ablation/heating | Decoupled ablation and coagulation |
| Depth Control | Fixed by pulse energy | Adjustable by number of overlaps |
| Primary Benefit | Faster procedure time | Superior precision & deep collagen stimulation |
| Clinical Focus | Uniform surface treatment | Targeted remodeling (scars, deep wrinkles) |
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References
- Moshe Lapidoth, Lilian Mayumi Odo. Novel Use of Erbium. DOI: 10.1097/00042728-200808000-00011
This article is also based on technical information from Belislaser Knowledge Base .
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