ORIGINAL ARTICLES Fractional Photothermolysis: Treatment of Facial and Nonfacial Cutaneous Photodamage with a 1,550-nm Erbium-Doped Fiber Laser MOLLY WANNER, MD, ELIZABETH L. TANZI, MD, AND TINA S. ALSTER, MD Ã PURPOSE To evaluate the safety and effectiveness of a novel nonablative 1,550 nm erbium-doped fiber laser in the treatment of facial and non-facial photodamaged skin. METHODS 50 patients with mild to moderate cutaneous photodamage, rhytides, and dyspigmentation received 3 successive treatments at 3–4 week intervals with a 1,550 nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc., San Diego, CA). Clinical improvement of treatment areas was independently determined by two masked assessors’ evaluations of comparative photographs at baseline and 3, 6, and 9 months post-treatment using a quartile grading scale. Patient satisfaction surveys were also obtained at each follow-up visit. RESULTS Mean clinical improvement at 3 months for the face was 2.23 and 1.85 for non-facial skin (po 0.001). Mean improvement at 6 months was 2.10 for the face and 1.81 for non-facial skin (po0.001). Mean improvement at 9 months was 1.96 for the face and 1.70 for non-facial skin (po0.001). At least 51% to 75% improvement in photodamage at the 9-month follow-up was achieved in 73 and 55% of facial and non-facial treated skin, respectively. Side effects were limited to transient erythema and edema in the majority of patients. No prolonged pigmentary changes or scarring were observed. Patient satisfaction surveys mirrored the observed clinical effects. CONCLUSION The nonablative 1,550 nm erbium-doped fiber laser is an effective treatment for facial and non-facial photodamage, rhytides, and dyspigmentation with a favorable recovery and side effect profile. Molly Wanner, MD, Elizabeth L. Tanzi, MD, and Tina S. Alster, MD, have indicated no significant interest with commercial supporters. A s the first of the ‘‘baby boomer’’ generation hits 60, the demand for safe and effective treatment of photodamaged skin is expected to increase. Ab- lative laser skin resurfacing with either carbon di- oxide (CO 2 ) or erbium:yttrium-aluminum-garnet (Er:YAG) laser systems is a well-accepted treatment modality for facial rejuvenation, predictably im- proving the appearance of photoinduced rhytides and dyschromia. 1 Complete epidermal ablation ef- fected by these systems results in loss of barrier function and an extended postoperative recovery period. Untoward side effects may include prolonged erythema, pigmentary alteration, infection, and, in rare cases, fibrosis. Furthermore, the use of ablative laser skin treatment is limited to facial areas due to the high risk of scarring in nonfacial skin with rela- tively few pilosebaceous units. As a result of these risks, interest for less invasive methods to treat photodamaged skin effectively has grown. Nonablative laser or light-based systems combine epidermal surface cooling with infrared or near-infrared wavelengths that create a controlled dermal thermal injury and effect subsequent neocollagenesis. In studies using various nonablative devices, including 1,064- and 1,320-nm Nd:YAG, & 2007 by the American Society for Dermatologic Surgery, Inc.  Published by Blackwell Publishing  ISSN: 1076-0512  Dermatol Surg 2007;33:23–28  DOI: 10.1111/j.1524-4725.2007.33003.x 23 Ã All authors are affiliated with the Washington Institute of Dermatologic Laser Surgery, Washington, DC