Fractional Lasers: What Are They Used For, and What Types Are There?

What is fractional laser?

Fractional laser is not the name of a single device or a single laser wavelength. The term "fractional" refers to the fact that instead of delivering laser energy continuously to the entire skin, it is applied in numerous microscopic treatment columns, leaving healthy tissue in between.

This approach aims to stimulate wound healing mechanisms and collagen remodeling by creating controlled tissue damage.

Fractional lasers are generally divided into two groups: ablative and non-ablative.

What is ablative fractional laser?

Ablative fractional lasers create true tissue ablation in the epidermis and dermis in microscopic areas. The best-known examples are the 10,600 nm carbon dioxide (CO₂) laser and the 2,940 nm Er:YAG laser.

They can provide strong resurfacing in cases such as deep atrophic acne scars, significant photoaging, and advanced skin texture irregularities. In return, this can lead to more pronounced redness, crusting, longer healing times, pain, and a risk of post-inflammatory hyperpigmentation (PIH).

What is a non-ablative fractional laser?

In non-ablative fractional lasers, controlled thermal microzones are created in the dermis while the epidermal surface is largely preserved.

The advantage of these systems is generally a shorter recovery time, less crusting, lower inflammatory load, and a faster return to daily life. However, some indications may require a greater number of sessions.

What are some non-ablative fractional lasers?

Different wavelengths can be used. Some of these are systems in the 1,440–1,550 nm range and 1,927 nm thulium lasers. Each wavelength has different water absorption, penetration depth, and clinical applications.

What is the place of the 1927 nm thulium laser?

The 1927 nm thulium laser belongs to the non-ablative fractional laser group. Because it is strongly absorbed by water, it can affect more superficial epidermal and dermal layers.

It can be used in areas such as pigmentation, photoaging, superficial skin texture irregularities, selected cases of melasma, and post-inflammatory hyperpigmentation.

What is BabyFace Ultra?

One of the devices we use for fractional laser treatments in our clinic is the Lutronic BabyFace Ultra, a 1927 nm thulium laser platform.

We use this device especially for problems such as pigmentation, sun damage, skin quality, and superficial tissue irregularities.

In our clinic, instead of classic ablative CO₂ or Er:YAG resurfacing, we prefer the non-ablative thulium approach in suitable patients, which offers shorter recovery times and better control in terms of pigmentation.

The detailed working mechanism, indications, and comparison of BabyFace Ultra with other lasers are also discussed in P56.

In which problems can fractional lasers be used?

It can be used for atrophic acne scars, some surgical or traumatic scars, photoaging, fine wrinkles, skin texture irregularities, some pigmentation problems, and the appearance of pores.

However, not every laser is equally suitable for all of these indications.

Is fractional laser effective for acne scars?

Yes, it's a particularly good option for atrophic acne scars. However, rolling, boxcar, and ice-pick scars have different morphologies.

A single laser cannot treat all scar types equally. Different methods may be needed, such as subcision for tethered rolling scars, trichloroacetic acid (TCA) CROSS for ice-pick scars, and fractional laser, microneedling, or radiofrequency microneedling for larger boxcar/rolling scars.

What is the difference between fractional laser and microneedling?

Microneedling creates mechanical microtrauma. Fractional lasers, on the other hand, create microthermal or ablative zones with controlled laser energy.

Both can stimulate collagen remodeling, but the energy source, recovery time, risk of pigmentation, pain, and targeted tissue level differ.

Are fractional laser and radiofrequency microneedling the same thing?

No. In radiofrequency microneedling, radiofrequency energy is delivered through needles. In fractional laser treatment, the energy source is a laser.

Can fractional laser treatment be used on dark skin types?

Yes, but careful planning is required. The risk of post-inflammatory hyperpigmentation is more significant in Fitzpatrick skin types III–VI.

Aggressive ablative resurfacing, in particular, can increase this risk. Non-ablative fractional systems can be used more controllably with appropriate protocols.

Why is the risk of PID important?

Post-inflammatory hyperpigmentation (PIH) is a significant complication after laser treatment, particularly in patients prone to pigmentation.

The risk is related to skin type, the laser used, energy intensity, treatment area, sun exposure, and post-treatment inflammation.

Can fractional laser be used for melasma?

Yes, in selected patients; however, laser treatment is not a routine first-line treatment for melasma. Melasma is a chronic, recurrent, and complex pigmentation disorder influenced by hormones and sun exposure.

Lasers should be considered only in selected and resistant cases, as part of a combination therapy.

Can fractional laser be used for skin rejuvenation?

Yes. Thanks to collagen remodeling, improvements can be achieved in fine wrinkles, superficial skin texture, photoaging, and pigment irregularities.

However, attempting to correct advanced facial sagging solely with fractional laser treatment is not realistic.

Why do ablative lasers cause more downtime?

Because actual ablation occurs on the skin's surface, healing involves processes such as erythema, edema, crusting, exudation, and epithelialization. In non-ablative systems, healing is generally faster because a large portion of the skin's surface is preserved.

Which laser is more powerful?

“Strong” alone is not a reliable selection criterion. Ablative CO₂ may provide stronger resurfacing in a deep scar; however, in a patient with a high tendency for pigmentation, this strength may mean a higher risk of complications.

Non-ablative systems like 1927 nm thulium may be a more controlled option for some pigmentation and skin quality problems.

The right question is: Which laser offers the best balance of efficacy and safety for this patient's specific problem?

Frequently Asked Questions

Is a fractional laser a single laser? No. The term fractional refers to the way the energy is applied.

Are CO₂ and Er:YAG fractional lasers? They can be used in fractional mode and belong to the group of ablative fractional lasers.

Is a thulium laser also a fractional laser? 1927 nm thulium systems can be used in a non-ablative fractional manner.

Which laser is best for acne scars? It depends on the type of scar. Some scars may require subcision or other surgical methods before laser treatment.

When is BabyFace Ultra used? It is a 1927 nm non-ablative thulium system that we use in our clinic especially for pigmentation, photoaging, and skin quality problems.

Dermatologist's Note

Fractional laser is not a device name, but rather the way the treatment is delivered to the skin.

Ablative CO₂ and Er:YAG systems can provide strong resurfacing; however, they may carry a longer downtime and a higher risk of PIH, especially in patients prone to pigmentation.

Therefore, at our clinic, we approach fractional laser treatment not by saying "we will use the most aggressive laser," but by selecting the most suitable system based on the patient's skin type, scarring or pigmentation problem, and the healing time they can tolerate.

In this context, the 1927 nm BabyFace Ultra thulium laser is one of the options we use; it does not represent the entire range of fractional lasers.