http://www.ellipseklinikken.no/docs/Fra ... 20face.pdf
This “remodeling effect” was eagerly sought after, but without loss of epithelium and significant recovery time that occurred with laser resufacing. Strategies to heat the mid-dermis while cooling the epidermis with cryogen spray or contact cooling devices became known as nonablative laser remodeling, marketed as CoolTouch (CoolTouch, Roseville, CA) and Smoothbeam (Candela, Wayland, MA) among others.7,8 The thermally damaged collagen stimulated a healing response and deposition of new collagen, with a remodeling effect on rhytids. This process required 1 or more treatments and a delay of several months before the clinical effect became apparent. It avoided downtime, there was no loss of epithelium (only mild erythema), and patients were able to immediately return to normal activities.
Nonablative remodeling was a triumph in that it avoided recovery time and the complications associated with laser resurfacing. Unfortunately, the degree of clinical improvement was modest and much less predictable than with laser resurfacing. The reason for this is not difficult to understand. Laser resurfacing or other peeling techniques have 2 components that contribute to clinical improvement: (1) tissue removal that occurs at the time of the treatment, and (2) the remodeling effect of the body’s response to the wound. Tissue removal is predictable, with only minor variation from person to person, producing a clinical improvement that can be consistently generated with the same laser parameters. The remodeling response is not at all like this. A high degree of variation can be expected, depending on age, skin type, degree of pre-existing photodamage, and genetics. The delay in seeing the results of the treatment adds to the uncertainty, frustration, and difficulty in studying and refining these therapies. In addition, because tissue is not removed, epidermal pigment problems are not treated at all. Attempts to improve the degree and consistency of clinical response by increasing the amount of energy transferred into the skin did not amplify the clinical remodeling effect, but produced a higher incidence of complications.