Ablative laser treatments have long been considered the gold standard for the treatment of photoaging, scars, and wrinkles. However, the high efficacy of ablative treatments does not come without a price; the healing and downtime, up to two weeks, associated with complete cutaneous ablation and reepithelization are often prohibitive to patients. Thus patients and physicians have increasingly turned to nonablative therapies to achieve clinical improvement. These nonablative therapies have minimal associated downtime and limited side effects; however, they typically require multiple treatments to achieve clinical improvement. Thus physicians seek a device that combines the increased clinical efficacy of ablative resurfacing with the safety and minimal recovery associated with nonablative resurfacing. The development of fractional photothermolysis technology may ultimately allow for this ideal treatment.

Rather than treating the entire cutaneous surface uniformly, the overlying concept of fractional photothermolysis is treatment of the cutaneous surface in microbeams of diameter 100–250 μm; these microbeams create microscopic thermal zones of high energy fluences, while sparing the areas surrounding these zones. Thus the fractional therapies may achieve high efficacy due to the high energy in the microthermal zones, while limiting the potential for adverse reactions by decreasing the amount of skin subjected to these high-energy fluences.

Initially, fractional photothermolysis technology was applied to nonablative lasers. The microthermal zones treated with nonablative fractional devices result in homogenization and coagulation of the collagen in the dermis; additionally, the overlying epidermis is damaged with the formation and extrusion of necrotic epidermal debris.