Well, its been about 6 months in search of the Holy Grail of fractional lasers for the removal of wrinkles and discolorations of the face and neck. The laser story starts in 1995. At that time, CO2 laser was the rage and I embarked on a course of lasering quite a few people with weathered and wrinkled skin. There was tremendous healing times attendant to this treatment with a pink hue to the skin that could last several months. We also noticed that sometime later, the skin could be lighter in color and there would be a line of demarcation at the jawline. The Fraxel® laser was introduced with the hope of less downtime but similar results to CO2. We tried the first version of Fraxel® when it was first introduced several years ago. We found that it hurt too much and wasn’t all that effective. I introduced fractional lasers to our office with the Affirm® laser. This laser uses a combination of laser wavelengths that we call non-ablative. By that we mean that the skin is not removed only “injured” by the laser so the downtime consists of only redness for a few hours. Like everything in life, you get what you pay for. With limited downtime’s, multiple treatments are necessary and the results are more subtle. For mild wrinkles and coarse facial texture the Affirm® laser is great. Some patients wanted more results for deeper wrinkles and were OK with more downtime. In the search for a new laser, most companies were using CO2 but in a fractional mode. I tried several of these and found that CO2, because of the heat it produces can still have some of the unwanted healing characteristics from the early CO2 lasers of the mid 1990’s. Along comes the Sciton Joule® using a different Erbium wavelength. Erbium it turns out is more gentle than CO2 and heals more quickly. However, it is the heat of the CO2 that may tighten the skin and lead to a better result. With the Joule®, we can actually dial in as much or as little heat as we need and customize for each patient the downtime and the result. We can mimic the characteristics of three different lasers in one machine. For instance, the Pearl® settings can be simulated on this new laser. It’s been a few weeks now and our patients have been thrilled with the results. We can even combine IPL treatments for color with this fractional laser in one session. We also have combined the effects of both the Affirm® and the Joule® into one treatment package to maximize the benefits of each laser. Slow or fast results, little or minimal downtimes: we have all the choices to make our patient’s skin look its best.