The traditional continuous mode acts as a high-precision sculpting tool. It is utilized primarily to perform localized laser dermabrasion, physically vaporizing protrusions and leveling the sharp edges of prominent scars. This step creates a smoother, uniform topographical foundation, allowing the subsequent fractional treatment to focus on deep tissue remodeling rather than surface irregularities.
Core Takeaway: Continuous mode provides the necessary "site preparation" by mechanically ablating severe surface defects. It transforms an uneven landscape into a leveled plane, ensuring the fractional laser can deliver consistent results across the entire treatment area.
The Function of Continuous Mode
Laser Dermabrasion and Leveling
The primary purpose of continuous CO2 mode is ablation. Unlike fractional modes that leave gaps of untreated skin, continuous mode removes 100% of the tissue in the targeted area.
By vaporizing distinct protrusions and high points, the clinician effectively "sands down" the skin. This levels the borders of the scar, reducing the visual shadow that makes acne scars appear deeper than they are.
Precision Targeting
Continuous mode is not intended for the entire face in this context; it is reserved for localized areas.
Clinicians use it to address specific, severe lesions that would not respond adequately to fractional spacing. This targeted approach allows for the correction of significant defects without subjecting surrounding healthy tissue to unnecessary full-surface ablation.
Why This Step Precedes Fractional Treatment
Creating a Foundation
The primary reference notes that leveling scar borders creates a "foundation" for the next step. If a scar has sharp, steep edges, fractional columns alone may not flatten the topography efficiently.
By removing these physical barriers first, the skin surface becomes more uniform. This enhances the efficacy of the fractional laser, which is designed to stimulate collagen in the deep dermis rather than remove large volumes of surface tissue.
Managing Thermal Damage
While continuous mode delivers high energy, using it only on localized spots minimizes the overall diffusion of thermal damage.
The clinician can apply intense energy exactly where the scar tissue is thickest. Once the "heavy lifting" of leveling is done, the fractional mode can take over to treat the broader area with a safety profile that allows for faster healing.
Understanding the Trade-offs
Recovery Implications
It is vital to recognize that the areas treated with continuous mode will heal differently than the rest of the skin. Because this mode fully ablates the epidermis, these specific spots lack the "bridges" of healthy tissue that facilitate the rapid healing seen in fractional treatments.
Risk of Aggression
Continuous mode is powerful and carries a higher risk profile than fractional mode. If used too broadly or deeply, it can lead to prolonged erythema (redness) or pigmentation changes. It requires expert judgment to limit its use strictly to the scar edges that require physical reduction.
Making the Right Choice for Your Goal
When designing a treatment plan for acne scars, understanding the synergy between these two modes is essential.
- If your primary focus is distinct, raised scar edges: The continuous mode is required first to physically plane the surface and reduce the scar's visible depth.
- If your primary focus is general skin texture and deep atrophy: The fractional mode will be the primary engine for collagen synthesis and dermal remodeling.
Summary: The most effective scar revision protocols often combine these methods, using continuous mode to mechanically sculpt surface defects and fractional mode to biologically remodel the underlying tissue.
Summary Table:
| Feature | Continuous Mode (Pre-treatment) | Fractional Mode (Main Treatment) |
|---|---|---|
| Primary Action | 100% Tissue Vaporization (Ablation) | Micro-thermal Treatment Zones (MTZs) |
| Main Goal | Leveling protrusions & sanding edges | Deep collagen remodeling & texture |
| Coverage | Localized (Targeted scars only) | Broad (Entire treatment area) |
| Healing Profile | Slower (Full epidermal removal) | Faster (Bridges of healthy tissue) |
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References
- Lüping Huang. A new modality for fractional CO2 laser resurfacing for acne scars in Asians. DOI: 10.1007/s10103-012-1120-5
This article is also based on technical information from Belislaser Knowledge Base .
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