From ASLMS: E. Victor Ross, MD, Talks Landscape of Fractional Laser Treatments

Pictured: E. Victor Ross, MD, gives a lecture at ASLMS 2025 in Orlando. 

At the 2025 American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting in Orlando, E. Victor Ross, MD, shared insights on the evolving role of fractional lasers in dermatologic practice, highlighting both their advantages and limitations.

Risk, Recovery, and Pigmentation

“Why do we even do fractional lasers versus non-fractional lasers?” Dr. Ross, a dermatologist at Scripps Hospital in San Diego and a leading expert in fractional laser technology posed to the attendees. “In the end, we're trying to decrease the infection risk, speed up the recovery time, and reduce the risk of  long-term hyperpigmentation, which we all started seeing about 30 years ago aggressive nonfractional resurfacing.”

In his talk, which was part of a panel of experts exploring all facets of fractional laser treatment for a variety of dermatological conditions, emphasized the core challenge of fractional laser treatment: the lack of clear clinical endpoints.

“You're treating by recipe completely,” he said, adding that clinicians must strictly adhere to established parameter sets. “You can get distracted with a fractionalprocedure , you have to keep up with the number of passes you have made over any particular area ,” he warned, likening over-treatment to a "Clint Eastwood" gamble: 'You feel lucky sometimes, but you’ve got to not talk too much.'"

Although Dr. Ross said that fractional lasers dramatically speed recovery and lower infection risk, he cautioned that there are limitations, particularly for deeper rhytides around the mouth.

“I have not found a fractional way to do this very well,” he said while sharing one patient’s case results, opting instead for non-fractional CO₂ laser treatments, which he said yielded better outcomes for deep perioral lines.

Wound Geometry and Healing Outcomes

Dr. Ross also discussed the use of fractional picosecond and nanosecond lasers on the arms and legs, adding a personal cautionary tale about the destructive effects of these lasers on iPhone CCD cameras. 

“Never use a short-pulse green light laser near your cellphone,” he joked, sharing a video taking with a camera destroyed mid-treatment.

He also stressed the importance of wound size and said that wounds larger than 500 microns in diameter, in his experience, significantly increases the risk of scarring and hypopigmentation.

"Smaller wounds are typically better than larger wounds," he said. “When your wounds get bigger, your surface-to-volume ratio goes down, and it compromises the healing.”

Parameters and Combo Therapy

Dr. Ross also addressed ablative vs. non-ablative fractional lasers, and said that in general, ablative lasers outperform non-ablative options (with the possible exception in the treatment of acne scars, where non-ablative devices can be equally effective).

“Deeper tends to work better for acne scars and more superficial treatments for superficial wrinkles," he added

Dr. Ross also mentioned the clinical importance of parameters like density and depth. He said that clinicians need to come up with precise treatment recipes for the most effective treatment.

“You have to know the recipe, and you have to stick to the recipe,” he said.

Dr. Ross concluded by illustrating the importance of combining technologies, showing examples where fractional radiofrequency devices were used alongside fractional 1927 lasers to target both epidermal pigment and deeper dermal structures.

“You can address both the paint of the house, which is the pigment, and the foundation of the house, which is the deeper wrinkles and folds,” he said.

Source: Ross EV. This is What Really Works: Fractional Truths. Presented at: American Society for Laser Medicine and Surgery Annual Meeting; April 2025; Orlando, FL.