Cold Ablation Laser Resurfacing

Specialists who understand laser may argue that it is a very similar wavelength to Erbium YAG (2940nm) which is a cooler laser than CO2.

This is true. However it is the speed at which the microbeam vaporises the skin that allows for less energy to be used to achieve the same tissue ablation which in turn results in significantly less heating (of surrounding tissue).

Essentially the Acclaro fires a pulse of laser energy at 100 times the speed of a conventional Erbium YAG Ablative laser (5000Hz for the Acclaro Ultraclear micropulse train versus 50Hz for conventional Erbium YAG).

Even though the wavelength is the same the speed of delivery of the energy allows less energy to be created as heat for the same degree of ablation versus its closest competitor the Erbium YAG laser.

These unique thermodynamic properties make the Acclaro Ultraclear Erbium Fibre cold ablative laser capable of removing tissue without the need for the energy of the individual micropulse to be raised. This means virtually used in its pure form it will give minimal tissue heating around the area of tissue that is removed.

Ablative laser treatments (fractional or full ablation) are typically more aggressive laser resurfacing treatment that patients and doctors both understand yield excellent results in skin rejuvenation. Ablative laser treatments are gold standard skin rejuvenation methods but come at the cost of higher recovery times for the patient.

The next best method in laser skin rejuvenation in terms of overall degree of improvement is to move to non-ablative fractional lasers such as Sciton HALO or Fraxel (Fraxel Restore). These carry a much better downtime but the degree of improvement expected whilst very visible will not be as ablative laser especially in areas such as tightening, reduction of laxity, removal of wrinkles and removal of sun-damaged skin.

With the Acclaro Ultraclear Cold Ablation Laser we are able to perform much better treatment around the heavier wrinkles found around the eyes and the mouth because it is ablative. But as the remaining tissue is not heated for the same degree of ablation versus CO2 or Erbium YAG laser the resulting down time in a like for like treatment with conventional ablative lasers is about 50% less down time.

Essentially for patients this means comprehensive gold standard skin laser resurfacing with a much shorter recovery time and quicker return to work and social activities. Acclaro Ultraclear Cold Ablation in a younger patient of 30-45yrs requiring mild tightening around the eyelids and mild to moderate depth and density resurfacing around the face will recover to the point where they have mild residual redness but are able to return to work and normal social activities after 5-7 days.

Acclaro Ultraclear Cold Ablation in an older patient 45-65yrs requiring a deeper cold ablation resurfacing to reduce deeper wrinkles and remove greater quantities of sun damaged skin should be able to return to work and general social activities in 10-14 days (see video below).

Cold ablation has the same side effect profile as conventional fractional or full ablation laser. However the risk of developing any side effects is significantly reduced. Less heat and collateral thermal damage means quicker healing time and regeneration of the skin barrier.

This reduces the risk of infection during the recovery period significantly. Likewise reduced inflammatory trauma due to lower thermal injury to the underlying tissue significantly reduces the degree and duration of inflammation.

This means that the risk of developing post inflammatory hyperpigmentation is much less in a like for like ablation using Acclaro Ultraclear Cold Ablation Laser.

Hence cold ablation is a lower risk technique when it comes to treating darker skin types.

DrH is able to perform many advanced deep ablation techniques and skin laser surgery as day case procedures as he uses advanced anaesthetic techniques such as tumescent anaesthsia.

Due to the speed and minimal tissue heating of Acclaro Ultraclear Cold ablation 90% of procedures can be performed under topical (cream) anaesthetic without the need for anaesthetic injection.

The pain score under cream anaesthetic applied for 40mins before the procedure is typically from 3-5/10 (10 being unbearable and 0 being no pain).

At the end of the procedure patients will feel a sunburn like discomfort but this settles within a few hours of treatment.

Facewashing will sting a little during the next 2-3 days before settling.

Interestingly and perhaps counterintuitively the facial skin is the most resistant and faster recovering area when it comes to ablation. The neck chest and forearms / back of hands are common areas that are sun exposed but often unprotected.

Sun damage and sun related skin cancers can develop such as basal cell or squamous cell carcinoma (BCC & SCC). A seminal paper was published last year by Avram and his US team showing that fractional ablation and indeed full ablation by extension (which has long been known by clinician) removes replaces damaged cell populations and reduces overall skin cancer risk significantly.

The need to use ablative laser off the body is great however due to the skin structure and its healing potential of non-facial skin side effects from conventional ‘hot’ ablative lasers are a significant issue and the risk of delayed healing, scarring and infection increase.

Acclaro Ultraclear is the first of its kind laser that can overcome this problem due to its true cold ablative potential. This is why it is now DrH go to laser for sun damaged skin on neck, chest and forearms.

It is safe and quick healing in these areas.

Heat in ablation is not always the enemy in ablative laser resurfacing. Heat is sometimes necessary depending on the procedure.

In deeper ablation heat prevents bleeding so this is essential if accurate laser surgery is to be performed as blood will obscure the vision and impair the judgement of the doctor performing the procdure. When it comes to significant tissue removal control of bleeding becomes essential for procedural safety. In this case we need heat to coagulate therefore CO2 and Erbium YAG ablative lasers are still essential tools in DrH’s practice.

Heat allows for greater tightening and tissue remodelling. When it comes to skin laxity and loss of elasticity hot ablation with CO2 lasers and Erbium YAG are much more tightening but at the expense of a greater downtime and elevated risk of side effects.

Therefore the overall end result will be better for acne scar patients and older patients that require deeper wrinkle reduction with CO2 ablation and Erbium YAG ablation versus Acclaro Ultraclear Cold Ablation in like for like treatment depth and density. Sometimes younger patients may show signs of laxity and lines earlier particularly around the mouth and eyes.

DrH may elect to combine lasers in these cases and use Lumenis Ultrapulse CO2 ablation around the eyes and/or mouth and Acclaro Ultraclear cold ablation on the rest of the face.

Interestingly the Acclaro Ultraclear Cold Ablation laser allows tuning of the device to allow heat to be produced. This gives the operator the ability to make the laser hotter and mimic the CO2 or Erbium YAG. But effectively these features then mean you are effectively performing ablation that is conventional CO2 or Erbium YAG ablation in which case the downtime risk scenario rises to match.

DrH will always consult and examine you before the procedure. He will choose which treatment is appropriate depending on the indication or expected outcomes. It is important to understand that he has more laser surgical experience than any other UK dermatologist in ablative laser experience due to the number of cases he performs.

His opinion maybe that you do not require treatment. It may differ from what you were expecting and he will explain why. He is recognised around the world as a leading dermatologist in laser surgery and he contributes to international expert consensus publications on ablative laser.

As he has access to all the recognised leading devices by category he does not need to use any device that is less than ideal for purpose.

His readily visible results and outcomes show the degree of efficacy of his procedures.

• Dr Hussein is the UK’s leading ablative laser surgeon by case volume
• Dr Hussein routinely performs laser xanthelasma treatment and therefore has sufficient caseload and experience in treatment.
• Dr Hussein He has been using ablative lasers in skin surgery for over a decade and is internationally renowned for his laser skin resurfacing work
• Dr Hussein is the only UK dermatologist with extensive experience in the use of ablative lasers in darker skin types. This means he is comprehensively understands applications of all resurfacing lasers in all skin types.
• Other Clinics will use the Acclaro Ultraclear Laser but generally for much lighter and lower downtime procedures such as 3D MIRACLE or Clear Plus. DrH is renowned for much more effective laser resurfacing that may carry greater downtime and risk but will give a more effective result. Due to his caseload and experience he is also prepared to handle and mitigate any potential complications of cold ablation.
• If lighter 3D MIRACLE and Clear plus Ultraclear procedures are required please consult our cosmetic dermatologist Dr Simon Zokaie.