Journal of the Laser and Health Academy

ISSN 1855-9913 Vol. 2012, No.1; www.laserandhealth.com

CASE REPORT
Clinical experience with FRAC3 Non-ablative Skin Tightening

Reinhard W. Gansel1
1Laser Medizin Zentrum Rhein-Ruhr, Essen, Germany

ABSTRACT repeated often.

The goal of skin tightening can be achieved by Next was the development of the so-called "no
various methods which, among others, include chemical downtime" procedures, which were carried out by
peels, radiofrequency therapy and laser therapy. The radiofrequency devices, IPL and infrared laser devices.
efficacy, downtime and potential side effects of these Essentially, these methods cause bulk heating of the
methods vary highly between "groups" of methods as skin (and also adjacent tissue to varied degrees).
well as within the same method group, depending on Efficacy varies between these methods. Split-face
treatment parameters used. A method which would studies comparing a radiofrequency device with long-
combine efficacy with no-downtime and minimize the pulsed Nd:YAG showed better outcomes in the case
chance of unwanted side effects is highly desirable. A of the Nd:YAG laser therapy [6, 7].
new FRAC3® Nd:YAG laser modality appears very
promising in this respect. Between 2010 and 2012, we Recently a novel self-induced, non-ablative, three-
performed the FRAC3® skin tightening procedure on dimensional fractional FRAC3® method for skin
over 100 patients. Procedure satisfaction rates of good to treatments was described [8]. The method utilizes the
excellent were reported by over 90% of the patients short pulse duration and high peak power density of
treated. Here we present six representative clinical cases Nd:YAG laser pulses. The pulses produce a three-
selected among the treatment data on over 100 patients. dimensional fractional pattern in the epidermis and
dermis, with damage islands that are predominantly
Key words: skin tightening, subsurfacing, located at the sites of skin imperfections. The
dermatoplastics, heat shock proteins, radiofrequency, measurements demonstrated the emergence of
Nd:YAG, removal of sun damage, bulk heating. isolated “fractional” hot islands within the skin. The
method appears promising with regard to being able
Article: J. LAHA, Vol. 2012, No.1; pp. 86-89. to fulfill the efficacy, safety and no-downtime
Received: April 18, 2012; Accepted: May 08, 2012. requirements of skin rejuvenation procedures with
clinical evidence supporting the theory [9, 10, 11]. We
© Laser and Health Academy. All rights reserved. used the novel FRAC3® method to perform over 300
Printed in Europe. www.laserandhealth.com skin tightening treatment sessions on over 100 patients.

I. INTRODUCTION II. CASE DESCRIPTION

Skin tightening can be achieved by various A representative sample of 6 cases among the
methods which focus on controlled traumatization of treatment data on over 100 patients (96% were
skin tissue. This, in turn, activates the skin's natural female) who underwent the FRAC3® skin tightening
repair mechanism, leading to collagen synthesis and procedure in our clinic between 2010 and 2012 was
the formation of elastic fibers. The final desired result selected. At least 3 treatment sessions in the first year
is "rejuvenated" skin tissue. were suggested to the patients. The first session was
offered as a test. After at least 2 weeks each patient
In the beginning, deep chemical peels were was asked to decide whether to proceed with further
performed [1-3]. While effective, such treatments were sessions or not (the shortest interval between two
connected with up to ten days downtime and had the sessions therefore being 2 weeks). Face and off-face
potential to cause serious side effects. Chemical peels treatments started in January 2010.
were followed by methods which caused punctual
trauma to the skin [4, 5] (e.g. mechanical skin Two Nd:YAG laser systems with FRAC3®
"needling" methods), which reduced the downtime capability (XP Max and SP Dynamis, Fotona,
period to four days. However, these methods also had Slovenia) were used. A fluence range between 15
relatively poor results and the treatments had to be J/cm2 and 35 J/cm2 was used for the therapies. The

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 Case Report: Clinical experience with FRAC3 Non-ablative Skin Tightening

energy was delivered either by a handpiece (R33) with

a 6 or 9 mm spot size or via a scanner with a 6 mm
spot size. The repetition rate was set from 5 – 9 Hz
and the pulsewidths ranged from 0.1 – 1.6 ms
(FRAC3® modality).

We used short FRAC3® laser pulses to target the

dermal skin layers with a heat pattern, which can be
described as "sparks of heat" within the tissue, creating
isolated "fractional" hot islands within the skin.
Through the use of a handheld infrared thermometer, we
aimed to achieve optimal heating conditions – e.g.
maintaining a skin surface temperature of 41°C for 2 –
10 minutes, depending on the treatment site.

Depending on the basal skin temperature (usually Fig. 2: Cheek; pre-treatment (top); post-treatment (bottom)
between 29 – 34°C) and skin type (including thickness, – after 2 treatment sessions; female patient, age 50.
microcirculation, pigmentation) at least 4 passes were
necessary. The goal was, as mentioned previously, to
obtain a temperature between 40 – 42°C on the skin
surface, which had to be maintained for at least 2
minutes. For the peri-orbital area the acceptable
temperature was up to 39°C.

The heating of the neck area over the thyroid gland

has to be avoided: in order to treat the overlying skin in
this area, we pulled the skin aside to treat it. In this way
only a small triangle of skin was left untreated. The
upper cheek and malar mound region was treated up to
1 cm below the orbital rim in order to protect the eye
cavity. Contraindications are considered to be
conditions such as excessive sun tan with melanin
content of more than 45 (Cortex DSM II), pregnancy,
age of under 20 years, heavy smokers, and no hair
removal desired in the treatment site (for male patients).
Fig. 3: Tear Troughs; pre-treatment (top); post-treatment
(bottom) - after 5 treatment sessions; female patient, age 50.
III. RESULTS

A majority of treatments were performed on the

face and neck region. Treatment results are shown in
Figs. 1 – 4.

Fig. 1: Mouth line; pre-treatment (top); post-treatment

(bottom) - after 3 treatment sessions; female patient, age 50. Fig. 4: Neck; pre-treatment (top); post-treatment (bottom) -
after 3 treatment sessions; female patient, age 40.

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 Case Report: Clinical experience with FRAC3 Non-ablative Skin Tightening

Other regions treated included, for example, the No serious side effects were observed, with the
abdominal area (Fig. 5) and upper arms (Fig. 6). exception of a single burn on the lower eyelid / malar
mound region in one patient, which healed without
scarring and complications.

IV. DISCUSSION

The demand for no-downtime procedures in skin

tightening led to different volumetric (bulk) heating
procedures. By evoking a bulk heating of the skin, a
relatively high portion of the energy is absorbed in
deeper structures, like fat tissue, for example. This was
confirmed in some cases where damage of the fat
tissue by radiofrequency devices had been observed.

Previous studies and our experience show a bright

future for the FRAC3® procedure. The treatment,
based on causing a three-dimensional fractional micro
damage pattern within the skin, appears to be safe and
effective. Clinical findings suggest that the dermal
Fig. 5: Abdominal area; pre-treatment (top); post-treatment layers are, in fact, targeted, and the result is a
(bottom) - after 5 treatment sessions; female patient, age 45. "rejuvenated" skin tissue due to new collagen and
elastic fiber formation.

An additional enhancement to the procedure

would be the integration of an active temperature
measurement/control system, which would lead to
even more effective treatments compared to simply
carrying out a certain number of passes, which is the
currently accepted “cook book recipe” nowadays..

In addition to skin tightening, a further positive

side effect for women was observed following
FRAC3® therapy – accidental hair removal. This, of
Fig. 6: Upper arm; pre-treatment (left); post-treatment course, has to be taken into consideration, as it can
(right) - after 2 treatment sessions; female patient, age 55.
also be regarded as an unwanted side effect in certain
anatomical regions for male patients, for example. We
When taking in to account reports from over 100 also observed a reduction of teleangiectatic vessels and
treated patients, the results were rated as good to skin sun damage.
excellent in over 90% of the cases, with less than 5%
describing the results as poor. For certain indications (e.g. wrinkles), a
combination of the FRAC3® method with an
Photographs, in general, show good results. In Er:YAG laser treatment can lead to additional
addition to the better complexion of the skin surface improvements in skin tightening.
there also appeared to be an improvement of various
forms of sun damage to the skin, as well as a reduction In the future, a split-face study comparing the
of teleangiectatic vessels. Pain management during the outcome of aesthetic treatments using radiofrequency
treatment was usually not necessary. Numbing and FRAC3® laser treatment is planned.
ointment can be used prior to the treatment for
patients with anxiety. V. CONCLUSIONS
It was not recommended to perform other FRAC3® is an effective non-ablative skin
treatments after the procedure. Treatments with rejuvenation procedure with no downtime, minimal
corticosteroids (at least) up to 14 days after the chance of minor side effects and with a high patient
procedure are not advised in order to prevent the satisfaction rate.
inhibition of new collagen production.

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exchange of information on the views, research results, and clinical experiences within
the medical laser community. The contents of this publication are the sole
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