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Commentary: Gene Profiling Analysis of the Early Effects of Ablative Fractional Carbon Dioxide Laser Treatment on Human Skin

Hantash and colleagues published the first study of carbon dioxide (CO2) ablative laser operating in fractional mode nearly 6 years ago. In that groundbreaking work, ex vivo human abdominal skin was treated using a prototype 30-W, 10.6-lm, CO2 laser with a 120-lm spot size and 0.7-ms pulse duration. Histologic studies using hematoxylin and eosin staining revealed that, at a pulse energy of approximately 23 mJ, a lesion 350 lm wide and 1 mm deep could be generated consistently across the microarray. Using lactate dehydrogenase staining, it was shown that the interlesional epidermis and dermis remained viable when cavities were 500 lm apart. In the accompanying study, Hantash and colleagues showed that increasing the pulse energy from 5 to 30 mJ resulted in a nonstoichiometric and asymmetric increase in lesion depth (triple) and width (double). Moreover, persistent expression of the collagen chaperone HSP47 was found, suggesting that wound healing continued for at least 3 months after treatment. These two studies provided the first qualitative evidence of long-term stimulation of neocollagenesis after fractional ablative resurfacing and were remarkable because they supported the hypothesis that a level of collagen synthesis similar to that of full surface resurfacing could be achieved fractionally but at substantially lower risk of side effects.