From ASLMS 2025: Dr. Joel Cohen Highlights New Fractional Laser Techniques for Scars

Pictured: Joel Cohen, MD, gives a talk during the "Fun with Fractionals" session at ASLMS 2025.

At the 2025 American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting in Orlando, board-certified dermatologist, Mohs surgeon, and laser expert Joel L. Cohen, MD, FAAD, FACMS, presented clinical insights into fractional laser use, emphasizing earlier scar intervention and combination therapies to enhance outcomes.

Laser-enabled Tissue Coring and Combo Approaches

Turning to newer technologies, Dr. Cohen, who is Director of AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado, and an associate clinical professor of dermatology at the University of California Irvine, highlighted laser-enabled tissue coring using a 2910 nm fiber laser, referencing work by Drs. Taryn Murray and Paul Friedman.

"This specific ablative fractional laser also has the ability to vaporize larger holes in the skin, to help see improvement in laxity – and this has made a difference in my practice," he said.

In addition, he shared early personal experiences using the device on family members starting a few years ago, and how there is now a choice in the actual size of the holes that are vaporized. He showed examples of improving laxity in the secondary smile lines, the jowls as well as the upper eyelids after a series of treatment sessions, with patients typically healing in about a week.

He also described integrating laser enabled tissue coring along with the 2910 fractional ablative treatments for scars and acne scars.

"We can core out those acne scars while at the same time doing fractional ablative resurfacing," he explained.

Dr. Cohen also talked about using a hybrid approach, combining non-ablative and ablative fractional devices to address different skin concerns simultaneously. Adding broadband light, he pointed out, enhances the improvement in lentigines particularly in older patients with chronic sun exposure.

He said he also tends to combine Q-switched or Pico lasers with ablative fractional for road rash scars, sharing a case he published earlier this year in the Journal ofDermatologic Surgery.

"It wasn't until I added specifically the ablative fractional that I was able to see more significant improvements," Dr. Cohen said.

He also referenced laser-assisted drug delivery. He highlighted topical tranexamic acid applied post-fractional treatment as a promising strategy for pigmentation, as well as Kenalog and 5-FU immediately drizzled over fractional laser treated scars.

Early Scar Treatment with Fractional Ablative Lasers

Dr. Cohen also spent time distinguishing non-ablative from ablative fractional laser therapies, noting that while non-ablative fractional lasers can be effective, they often require patience and many treatments.

"It can take a while to see improvement," he said in his presentation, noting that he often adds another type of laser at the same time to help patients stay engaged by providing visible changes early in the course of treatment. Ablative types of fractional lasers provide more immediate improvements, Dr. Cohen noted.

"We can see more significant changes early on," he added, crediting the work of colleagues including Drs. Rox Anderson and Jill Waibel, for influencing his shift toward initiating scar treatment sooner.

Dr. Cohen also shared examples from his practice, including a melanoma in situ patient’s scar that he treated with fractional ablative resurfacing two months after flap reconstruction. Another patient, who was the victim of a late-night assault, saw significant cosmetic improvement with similar intervention in a period of weeks.

Fractional Radiofrequency for Laxity and Acne Scars

Closing his talk, Dr. Cohen discussed using fractional radiofrequency devices for treating acne scars and addressing early skin laxity, noting he often treats multiple areas at once.

Referring to his wife’s treatments, he pointed out that he will " “often treat her above knee laxity on the same session as I am treated her neck as it’s the same tip and the same downtime

He also pointed out that creping skin type of laxity is quite shallow, and he favors more superficial treatments.

he said, emphasizing newer micro-ablative radiofrequency techniques to target skin quality as well as redness and scarring at shallower depths using a new microablative technology that he just finished a clinical trial on. -by Eric Raible

Source: Cohen JL. Presentation on Fractional Lasers for Scar Management. 2025 American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting, April 2025, Orlando, FL.