Fractional Laser in Ankara, Turkey

Fractional laser is an advanced skin resurfacing technology that provides controlled repair in both the epidermis and dermis layers of the skin by dividing high-energy laser beams into microscopic columns. Instead of damaging the entire skin surface, this method creates microthermal treatment areas by leaving islands of intact tissue in between, thus triggering the body’s natural healing mechanism in the strongest possible way. Accepted as the gold standard in the treatment of deep acne scars, stubborn sunspots, surgical scars, and wrinkles caused by aging, fractional laser treatment enables the skin to rapidly restructure itself from the inside out through the intense collagen and elastin production it initiates.

What Kind of Change Does Fractional Laser Technology Initiate in Our Skin?

In the consultations we have with our patients in our dermatology clinic, one of the most common questions we encounter is how a device can both eliminate deep acne scars, soften fine wrinkles, and tighten the skin at the same time. The secret of this versatile effect lies in the working principle of fractional laser technology, namely the mechanism of “fractional photothermolysis.” To understand this complex term, you can think of your skin like a digital photograph or a mosaic. In the classical laser technologies we used in the past, the entire skin was treated; in other words, the whole photograph was erased and recreated. Of course, this method was very effective, but the healing process was quite difficult, painful, and long for our patients. In fractional technology, however, the situation is completely different. The laser beam is sent to the skin not as a single block, but as thousands of microscopic, extremely fine columns of light.

These microbeams open tunnels so fine that they cannot be seen with the naked eye, reaching deep into the skin. We physicians call these areas “Microthermal Treatment Zones.” The most fascinating part of this and what makes the technology so safe is this: the tissue surrounding these columns of microdamage remains completely intact. The moment your skin perceives this controlled, microscopic damage, it activates the body’s natural wound-healing mechanism with an “emergency” code. The intact tissues rapidly begin to produce new cells to repair the damaged areas and, in a way, establish a bridge of support. Just as a gardener aerates the soil and plants new seeds, we also trigger the skin to shake off its sluggishness and start producing with the laser.

In this process, there is not only superficial improvement; the real magic happens deep within the skin. The thermal effect created by the laser, that is, heat, breaks down the collagen fibers responsible for the skin’s elasticity but which have loosened, broken, or lost their quality over time. The body replaces these broken fibers with much tighter, more organized, and fresh collagen and elastin fibers. This dermal remodeling process not only erases the spots on the surface of the skin, but also strengthens the skin’s skeleton.

The biological responses the skin gives during the treatment process are as follows:

• Intense collagen production
• Synthesis of elastin fibers
• Rapid cell renewal
• Increased blood circulation
• Shedding of dead skin
• Release of growth factors

Why Is There Not Just One Type of Laser, and How Do We Decide Which Device Is Suitable for You?

In dermatology, the approach of “one right treatment for every patient” is incorrect; instead, there is “the right treatment based on the patient.” Your skin structure, the depth of your problem, and most importantly the amount of time you can allocate for the healing process are the main factors that determine which type of laser we will choose. We basically examine fractional lasers in two main groups: ablative, meaning resurfacing lasers, and non-ablative, meaning non-resurfacing lasers.

Ablative fractional lasers are like the heavy industry of this business. Fractional Carbon Dioxide (CO2) and Er:YAG lasers especially belong to this group. While these devices create controlled resurfacing (ablation) in the upper layer of the skin, the epidermis, they also send powerful heat to the deeper layers at the same time. If you have deep acne scars, prominent scars, deep wrinkles, or serious skin sagging, our preference is usually in this direction. CO2 laser has been one of our most powerful tools in dermatology for years. We can achieve dramatic results even in one or two sessions. However, this power comes at a cost: the healing period. After this procedure, you experience a recovery period of about one week, including redness, flaking, and crusting on your skin.

On the other side are non-ablative lasers, such as Er-Glass systems. These systems act more “gently.” Without resurfacing the top surface of the skin, they deliver laser beams directly to the lower layers and create heat damage there. Since the upper skin remains intact, there is no frightening wound-like appearance from the outside. These systems are ideal for mild wrinkles, pore tightening, and general skin revitalization. They are closer to the applications we call a “lunchtime procedure.” If you say, “I do not have time to stay at home, I need to return to work immediately,” and your skin problems are not very deep, this group of lasers is tailor-made for you.

The problems targeted by laser types are as follows:

• Deep acne scars
• Surgical scars
• Fine lines
• Skin laxity
• Enlarged pores
• Sunspots
• Uneven skin tone

How Does Radiofrequency Technology Differ from Laser Systems, and In Which Cases Do We Prefer It?

As technology has advanced, the tools in our hands have also diversified. We can use not only light energy, meaning laser, but also electrical energy, meaning radiofrequency, with a fractional logic. Fractional radiofrequency systems have principles similar to technologies popularly known as “golden needle,” but here the energy source is different.

In these systems, radiofrequency energy is sent under the skin through micro-needles or special applicators. The goal is again the same: to raise the temperature under the skin, especially at a certain depth, to a critical level. Scientific studies have shown that a temperature between 55 and 60 degrees is the “magic” range for collagen production. At this temperature, old and worn collagen is destroyed and fresh production begins in its place.

So why should we prefer radiofrequency instead of laser? One of the most critical factors here is the patient’s skin color. Laser light can be excessively absorbed by melanin pigment in dark skin, which may lead to unwanted burns or spots. However, radiofrequency energy works independently of pigment, that is, color. For this reason, in our dark-skinned patients or in sensitive skin with a high risk of pigmentation, we can safely use fractional radiofrequency systems instead of lasers or alternately with lasers to provide deep dermal renewal. This gives us the flexibility to create a treatment plan suitable for every skin type.

The situations in which this method is advantageous are as follows:

• Dark-skinned patients
• Summer months
• Neck area
• Skin prone to active acne
• People with a high risk of pigmentation

Do Laser Applications Really Provide Definite Results in the Treatment of Acne Scars and Scars?

Acne scars left over from adolescence, that is, acne scars, are one of the most common reasons for applying to our clinic, affecting our patients’ psychology the most, damaging their self-confidence. To speak openly and honestly, it is biologically impossible to eliminate deepened, pitted acne scars with only creams, serums, or home devices. Because there is tissue loss in those areas, or the tissue has healed incorrectly and pulled the skin downward. This is exactly where fractional lasers come into play.

Fractional CO2 and Er:YAG lasers in particular continue to be the “gold standard” in acne scar treatment all over the world. In our clinical studies and daily practice, we see that these treatments provide more than 50% improvement in acne scars, and in some suitable cases, at much higher levels. The laser softens the edges of those pitted areas by resurfacing them, and most importantly, it stimulates the collagen at the base of the depression, allowing the skin to “lift upward.”

And not only acne scars; a similar mechanism also works in surgical scars, burn scars, razor scars, or scars resulting from accidents. Scar tissue is a hard and irregular mass of collagen, different from normal skin. The laser breaks up this irregular mass and enables the skin to weave a more organized structure more similar to normal tissue. However, we always tell our patients to be realistic: scars may not disappear completely as if erased with an eraser. But their prominence can decrease so much that they can be easily covered with makeup or become unnoticeable from social distance.

The types of scars treated are as follows:

• Icepick scars
• Boxcar scars
• Rolling scars
• Keloids
• Hypertrophic scars
• Stretch marks
• Burn scars
• Surgical incision scars

What Should Our Expectations Be in Skin Rejuvenation and Tightening?

The aging process is not just the skin wrinkling; it is also the skin succumbing to gravity, pores enlarging, and the skin losing its “vibrant” radiance. Fractional laser should not be thought of only as an “iron” that smooths wrinkles. Yes, it softens fine wrinkles, but its main effect is improving the overall quality of the skin.

The laser heat shortens and tightens the elastin fibers responsible for the skin’s elasticity. Although this does not create a surgical lifting effect across the whole face, it does create a noticeable “lifting” and firming effect. Our patients often tell us that a few months after the procedure, people around them ask questions such as “Your face looks so rested” or “What did you do to your skin?” Enlarged pores are also related to the loss of the skin’s elasticity and the disruption of oil balance. The renewal created by the laser tightens the tissue around the pores, making them appear much smaller and less noticeable.

In anti-aging applications, we usually determine special protocols according to the patient’s age and skin condition. While protective and revitalizing non-ablative methods may be selected in younger patients, more aggressive ablative lasers may be preferred in older age groups and in patients with marked loss of elasticity. It should not be forgotten that these procedures not only repair existing damage but also slow the rate of skin aging.

The effects of laser on signs of aging are as follows:

• Reduction of wrinkles
• Skin tightening
• Reduction of pores
• Evening of skin tone
• A more vibrant appearance
• Improvement in skin quality

What Is the Role of Laser in Spot Treatment, and Especially in Melasma?

Spot treatment is one of the most challenging and patience-requiring areas of dermatology. Especially “melasma,” the widespread map-like spots on the face generally triggered by hormonal changes, pregnancy, and the sun, is one of the most delicate conditions to treat. Fractional lasers are a very powerful weapon in spot treatment, but they must be used very carefully and consciously.

Our work is relatively easier with sunspots and age spots. The laser beam targets pigment-loaded cells and breaks them apart, and as these fragmented pigments are eliminated by the body, skin tone becomes more even. In addition, the increase in skin renewal, that is, turnover speed, allows the spotted upper skin to shed and be replaced by fresh, spotless skin.

However, in sensitive conditions such as melasma, uncontrolled high heat can sometimes trigger the pigmentation. Therefore, in melasma patients, we generally apply lower-energy “baby face” protocols or treatments combined with pigment-lightening mesotherapies in addition to the laser. Here, the goal is not to scrape the pigmentation aggressively, but to gradually lighten it by repairing the skin without suppressing it.

The types of spots treated with laser are as follows:

• Sunspots
• Age spots
• Melasma
• Post-inflammatory hyperpigmentation
• Freckles
• Comedone marks

Will I Feel Pain During the Treatment, and How Long Does the Procedure Take?

Naturally, one of the biggest concerns and fears of our patients while sitting in the chair is the question, “Will it hurt?” We cannot say that fractional laser procedures are completely sensation-free, but they are definitely not unbearable or frighteningly painful. About half an hour or forty-five minutes before the procedure, we apply strong local anesthetic creams to the treatment area. These creams numb the skin and greatly reduce the sensation.

During the procedure, our patients generally feel an increase in skin temperature and mild pricking sensations similar to the snap of a rubber band. With the development of technology, most new-generation devices have special cooling applicators integrated into them that blow cold air onto the skin during the procedure. This cooling both protects the skin and almost eliminates the sensation of pain. The procedure itself takes between 20 and 45 minutes, depending on the size of the area to be treated. After the procedure, there is a burning sensation as if you had stayed a little too long under the sun at the beach in summer. This sensation is not permanent; it usually subsides within one or two hours with the cold compress applications we perform.

The factors that increase the comfort of the procedure are as follows:

• Anesthetic creams
• Cold air blowing devices
• Cold compresses
• Post-procedure soothing masks
• Thermal water sprays

What Is the Recovery Process Like After the Treatment, and When Can I Return to Social Life?

The recovery process varies entirely depending on which laser was applied and with what intensity. If we performed a mild, non-ablative procedure, you can comfortably go to work the next day. There may be slight pinkness on your face and perhaps a little edema, but this definitely does not interfere with your daily life.

However, if we used an ablative laser for deep scars or serious rejuvenation, the process progresses a bit differently. On the first day, there is noticeable redness and edema on your face. On the second and third days, tiny brown dots the size of pinheads begin to form on the skin. This is the clearest sign that the procedure has worked and that damaged tissue is being shed from beneath the skin. Your skin may take on a darker appearance as if tanned. On the fourth and fifth days, fine peeling begins on the skin. During this period, moisturizing the skin is critically important. Usually within a week, the peeling is completed and a pink, fresh, baby-like skin emerges from underneath.

During this process, we generally recommend our patients plan a “social distancing” period. For many patients, having the procedure on Friday, spending the weekend at home, and returning to work at the beginning of the week is a suitable scenario. However, it should be known that this period may be longer in very aggressive treatments.

The conditions seen during the recovery process are as follows:

• Redness
• Edema
• Mild burning sensation
• Brown pinpointing
• Tightness in the skin
• Flaking
• Peeling
• Temporary darkening of color

When Will I Start Seeing Results, and How Many Sessions Are Required?

Fractional laser is a long-term investment that greatly rewards those who are patient. Immediately after the procedure, the skin looks tight and bright due to the effect of edema. After peeling ends, that is, at the end of the first week, the skin is smoother and more vibrant, and superficial spots are gone. This quick effect makes our patients very happy. However, the real permanent and deep results, that is, the completion of collagen production, take biological time.

The renewal process under the tissue continues increasingly for 3 months after the application. In other words, your skin looks good one month after the treatment, but it looks much better three months later. The filling of scars and the softening of deep wrinkles occur during this process. Generally, even a single session makes a difference, but for ideal results, we recommend an average of 3 to 5 sessions depending on the severity of the problem. We determine the intervals between sessions as approximately one month in order to allow the skin time to recover.

The duration of permanence varies according to the purpose of the treatment:

• Acne scars
• Scars
• Surgical scars
• Stretch marks

The results obtained for the above conditions are permanent. However, yearly maintenance sessions are recommended for anti-aging procedures.

What Are the Combination Methods That Increase Treatment Success?

In modern dermatology, we are no longer blindly attached to a single method; we combine strengths. If fractional laser is like “plowing the field” of the skin, it is also necessary to provide “fertilizer and water” to that field in order to get a yield. This is where biological supports such as PRP and Mesotherapy come into play.

Especially in deep acne scars and skin rejuvenation, we really like to apply PRP immediately after the laser application or in the same session. PRP is a reparative plasma obtained from your own blood and filled with growth factors. When we deliver PRP into the skin through the thousands of microtunnels opened by the laser, the healing speed increases tremendously and collagen production multiplies. This combination both shortens the healing process and strengthens clinical results.

In addition, in spot treatment, by adding special chemical peels or spot-lightening mesotherapies between laser sessions, we can attack the pigmentation simultaneously through different mechanisms. In acne scars, we can sometimes combine the laser with microneedle radiofrequency and progress much faster by stimulating both the top and bottom of the skin with different energies.

The frequently used combinations are as follows:

• Laser and PRP
• Laser and Mesotherapy
• Laser and Golden Needle
• Laser and Chemical Peeling
• Laser and Youth Vaccine

Who Is Not Suitable for Fractional Laser Treatment?

Although it is an extremely safe technology, there are some medical conditions in which we cannot perform laser treatment or need to postpone it. Our most important red line is isotretinoin-group medications used in acne treatment. If the patient is using this medication or has used it recently, laser is definitely not performed. Because this medication changes the skin’s wound-healing capacity and creates a serious risk of scarring after laser.

In addition, if there is an active infection in the treatment area, the procedure is postponed. During pregnancy, we also prefer not to perform laser applications for ethical and safety reasons; we wait until this special period is over.

The situations in which the procedure is not performed are as follows:

• Pregnant women
• Those with an active herpes infection
• Those undergoing cancer treatment
• Those with light sensitivity
• Recently tanned individuals

What Do You Need to Pay Attention to at Home After the Procedure?

After getting up from the treatment chair, a large part of the responsibility falls to you, that is, the patient. The success and safety of the treatment directly depend on the care you apply at home. The first and most important rule is protection from the sun. After the laser, your skin is vulnerable and prone to pigmentation.

The second rule is moisturizing. Your skin needs water while healing. You need to frequently apply the special skin-repairing and soothing creams we recommend to you. You should never pick off the crusts that form on the skin with your hands; let them fall off on their own.

The things that must be avoided are as follows:

• Sunbathing
• Tanning beds
• Scrubbing mitts
• Peeling
• Retinol creams
• Acidic toners
• Hot showers
• Sauna
• Turkish bath
• Makeup (First few days)

When the triangle of the right patient, the right device, and the right care is established, fractional laser treatments are one of the best investments you can make for your skin. This process is not magic, but a biologically reparative process based on scientific foundations.