Thulium laser: focus on this fractional laser peel to smooth skin.

The thulium laser is a technology used in dermatology to improve visible signs of ageing and smooth the wrinkles and improve skin texture. It operates on the principle of fractional photothermolysis with a wavelength of 1927 nm. When excited, thulium emits light that is absorbed by water in skin cells and generates heat causing controlled microperforations, which in turn trigger a natural cellular repair process and the production of collagen. The stimulation of collagen and elastin production makes the skin smoother and firmer. Indeed, collagen forms a network of solid fibres which supports the skin like a framework. Stimulating its production makes the skin denser and firmer. Elastin is a protein that provides suppleness and elasticity to the skin.

The thulium laser is designed for minimal impact on the skin’s superficial layers, the epidermis and superficial dermis, while also reaching the deeper dermis. It is considered less aggressive than ablative lasers as it preserves the skin’s surface layer almost intact while reaching the mid-dermal layers as this wavelength is absorbed to a moderate extent by water reducing the risk of side effects.

This peel is suitable for all patients, male or female, who wish to smooth the skin of the face, décolletage, and neck. It is a treatment designed to act deeply on the dermis. It treats spots and irregularities caused by skin ageing. By reaching the mid-dermis, the laser targets melanocytes and melanin deposits responsible for hyperpigmentation by fragmenting them. It also stimulates surface cell turnover, improving skin-tone uniformity.

To achieve this, the device emits fractional laser beams. The density and intensity of the spots are set according to the depth of scarring or of wrinkles to be treated. Based on a vascular mechanism, this mechanical peeling technique is valued for its gentleness. In addition, the risks of scarring complications, infectious or pigmentary complications are relatively low. It acts intermittently on the skin, which means the laser does not treat the entire skin surface at once. It emits targeted microbeams that create tiny thermal impact zones, spaced by areas of intact skin. That is why two or three sessions are required to cover all targeted areas. After this, the skin surface is firm, elastic, luminous and smooth, with an even, radiant complexion.

The session of peeling with a fractional laser lasts about one hour. A topical anaesthetic cream is applied to the treatment area one to two hours before the procedure. This preparation reduces heat and tingling sensations during the session. Note that this treatment causes skin flaking and the appearance of redness, even oedema, on the treated area. These effects resolve three days after the procedure. A social downtime of two to three days is recommended, especially for those wishing to preserve skin integrity during its regeneration phase.

Basic rules must be followed to achieve satisfactory results. At the end of the session, the treated area is exposed to LEDs to reduce healing time. Tanning beds must be avoided in the month before a laser peel. Sun exposure must be avoided and SPF 50 sunscreen applied.

Side effects of fractional thulium laser are generally moderate and temporary, as it is a nonablative laser operating at intermediate depth in the dermis, but they may vary according to factors such as skin phototype, individual sensitivity and treatment intensity.

Among common side effects of thulium laser, mild and transient reactions include a erythema and redness, lasting 24 to 72 hours, a sensation of warmth or mild burning after treatment, moderate oedema around the eyes, and a fine peeling after two to four days. The skin may also feel tightness or transient dryness. Less frequent side effects include a post-inflammatory hyperpigmentation in darker skin types or with early sun exposure, localized hypopigmentation, crusting, or transient micro-craters when high settings are used.

In a study of 71 patients with an average age of 56 who underwent a thulium laser session, it was observed that more than 50% of patients experienced tightness, swelling, tenderness, discomfort and a burning sensation at the start of recovery, which subsided over time.

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