We get calls regularly from patients that are frustrated with the results of their fractional laser resurfacing treatment at another office. In over 90% of the cases, we can trace the reason for their disappointment back to the depth of the resurfacing treatment.
Fractional laser resurfacing is not the same everywhere. The depth of the resurfacing matters, coagulation matters (heating of the tissue) and how large the fractional holes are matters. There are a lot of determinants to set when performing a fractional laser treatment and how well your practitioner knows these determinants and how they will affect your case will determine your results.
Most patients are not told (nor do they ask) how deep their resurfacing will be. This is important because for acne scars, fine lines and sun damage, the deeper the resurfacing, the easier it is to resolve the concern. But with deeper resurfacing, patients feel more pain and thus need more comfort measures. We always know when a patient has had a very simple fractional resurfacing because they tell us that all they had for numbing is the triple numbing cream that is placed directly on the face. Using this method alone ensures that the resurfacing must be very superficial, otherwise it would be too painful.
At our practice, we resurface down to 1000 microns (1 millimeter). In most practices, they limit the depth to 200 microns. We know this because when we askpatients that have come from other practices whether they experienced heavy bleening or not, the answer is almost always no. Once you get past 150-200 microns the bleeding becomes more profound, but so do the results. To resurface deep acne scars, the treatment needs to go much deeper than 200 microns.
Take a look at the picture below of a typical 7 day recovery process. You will note that there is much bleeding right after the procedure ends (first photo) and this is indicative of a good, deep, fractional resurfacing procedure. A procedure that's a little more difficult to recover from, but one that delivers much better outcomes.