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AT-A-GLANCE

AT-A-GLANCE

  • Nonablative treatments produce no clinical wounds.

  • Nonablative procedures are associated with minimal social downtime and a low risk of complications.

  • Several visible light and infrared wavelengths may be used for nonablative applications.

  • Nonablative devices may be used for a variety of conditions including benign pigmented lesions, vascular lesions, hair removal, tattoo removal, scarring, and wrinkles.

BACKGROUND

Much of modern laser therapy is based on the principle of selective photothermolysis, first detailed by Anderson and Parrish in 1983.1 In short, this principle states that with the use of a wavelength of light that is preferentially absorbed by a cutaneous target applied over an appropriate pulse duration, a skin structure may be selectively destroyed if adequate energy is delivered. This principle opened the door to a revolution in laser and light-based therapy for a wide variety of both medical and cosmetic applications.

Laser and light-based therapy may be categorized as nonablative when a biologic change is produced without the creation of a clinically relevant wound. Thus, as opposed to ablative laser techniques, nonablative treatments tend to necessitate minimal postprocedure wound care and are associated with a highly favorable risk profile. Although nonablative devices in general may produce results that are sometimes less dramatic than ablative techniques for some indications, they are the clear treatment of choice for a number of aesthetic and medical conditions. For some indications, serial nonablative procedures may produce results that approach or even surpass those that may be obtained from more invasive procedures.

Nonablative lasers may be further categorized as those utilizing visible light or infrared light. In addition, light-based devices that involve a broad band of wavelengths are often referred to as intense pulsed light (IPL) systems. Other energy-based devices that are used in a nonablative fashion such as radiofrequency devices and focused ultrasound systems may also have a variety of aesthetically oriented applications, and these will be reviewed in greater detail elsewhere in the text (Chap. 211). Another increasingly critical subcategory of energy-based systems is that of fractionated or fractional devices. Based on the principle of fractional photothermolysis first reported by Manstein and colleagues in 2004, a fractionated application of laser energy involves numerous microscopically small laser beams applied to the skin with sparing of a percentage of intervening skin surface area.2 The resulting columns of thermally altered tissue are called microscopic treatment zones (MTZs).3 These MTZs form the basis of clinical changes while the intervening untreated skin facilitates relatively rapid healing. In this way, patient safety is enhanced while social downtime is minimized.

PERIOPERATIVE CONSIDERATIONS

PATIENT SELECTION

There has been a significant trend in aesthetic medicine toward treatments that produce clear results but minimize interruptions in patients’ lives. Nonablative laser therapy is generally associated with the need for rather brief social downtime, but patients must be counseled ...

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