Ablative Fractional Erbium
What ProFractional Is
ProFractional is Sciton’s ablative fractional 2940 nm erbium laser, drilling a grid of narrow, separated microchannels at a depth the operator sets from 25 microns to 1.5 mm, leaving the skin between channels untouched so it heals quickly while the dermis builds new collagen, making it the treatment for acne scars, deeper texture change, fine lines, and regional resurfacing of one zone. At Aesthetica by Ashley Howarth MD, conservative plans are performed by the physician-led team while deep plans, zone-specific resurfacing, and sessions stacked with a deep MicroLaserPeel are performed by Dr. Howarth herself, scheduled during laser season, October to April.
ProFractional is Sciton’s ablative fractional erbium laser. It uses the 2940 nm erbium:YAG wavelength to drill a grid of narrow, separated microchannels into the skin at a depth the operator sets, from 25 microns to 1.5 mm according to Sciton, while the skin between the channels is left untouched. The untouched skin heals the channels from the sides within days, and the dermis responds to the injury by building new collagen, which is why ProFractional is the treatment for acne scars, deeper texture change, fine lines, and regional resurfacing of one zone such as the mouth or the cheeks. Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery in Scottsdale, offers ProFractional across that depth range, and the depth decides who performs it: conservative plans are performed by the physician-led laser technicians under Dr. Howarth’s protocols, and deep plans, zone-specific regional resurfacing, and any session stacked with a deep MicroLaserPeel are performed by Dr. Howarth herself. In Arizona, where the summer UV index regularly reaches 11 or higher, ProFractional is scheduled during laser season, October to April, on untanned skin.
Fractional treatment trades coverage for depth. A full-field peel treats 100 percent of the surface to a shallow depth; ProFractional treats a fraction of it, typically 5 to 20 percent per pass, to a depth ten to fifty times greater, which is what a scar that sits in the dermis needs. Sciton’s version adds adjustable coagulation, a controlled band of heat around each channel that tightens tissue and reduces bleeding, and a published Dermatologic Surgery study of fractional erbium with coagulation showed improvement in atrophic acne scars in Asian skin with a low rate of pigment change. Most scar and texture plans use 1 to 3 treatments spaced 4 to 8 weeks apart, with 3 to 7 days of downtime depending on depth. The same laser runs MicroLaserPeel, and stacking the two in one session, the full-field peel for the surface and the channels for the dermis, is the combination Sciton designed the platform for. For pigment and redness, BBL goes first in the same visit; for etched wrinkles across a zone, the plan moves to Contour TRL. Compare Sciton lasers to see where each fits.
Why Patients Ask for ProFractional
What Patients Who Choose ProFractional Notice
Most people who ask Aesthetica by Ashley Howarth MD about ProFractional describe a problem that lives below the surface: scars from acne that ended twenty years ago, a texture that peels and facials brighten but never smooth, or lines around the mouth that a lighter laser did not reach. The common findings are these.
- Rolling or boxcar acne scars on the cheeks and temples
- Pitted, ice-pick scars that makeup cannot fill
- A raised or depressed surgical or injury scar
- Orange-peel texture and enlarged pores that a peel did not change
- Fine lines around the mouth or under the eyes
- Uneven texture that shows in raking light and photographs
These are dermal problems, and a fractional laser reaches the dermis without removing the surface. Separated channels at a chosen depth let the skin rebuild collagen where the scar or line sits while the untouched skin around each channel keeps recovery to days. The depth and coverage decide how much change and who performs the session.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs Fractional Resurfacing
Aesthetica by Ashley Howarth MD is the medical aesthetics practice of Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. A fractional erbium laser that can drill to 1.5 mm is a surgical instrument, and its two failure modes are judgment failures. The first is the wrong scar: a tethered rolling scar needs subcision before any laser will lift it, an ice-pick scar needs a different depth from a boxcar scar beside it, and a hypertrophic or keloid scar needs a different plan entirely; scar classification is a surgeon’s daily work. The second is the wrong depth for the skin: 1 mm channels at high density on Fitzpatrick IV skin in a tanned Arizona patient, or on the thin skin of the lower eyelid or neck, can leave grid marks or months of hyperpigmentation. Dr. Howarth sets the protocol that decides depth and density by scar type, skin type, and zone, and she draws the line herself: conservative-depth sessions are performed by the physician-led laser technicians under her written protocol, and every deep plan, every zone-specific regional resurfacing plan, every session stacked with a deep MicroLaserPeel, and every surgery-coordinated plan is performed by Dr. Howarth as physician-performed laser skin resurfacing. Your written plan names who performs each part before treatment.
Aesthetica by Ashley Howarth MD is the med spa of a plastic surgery practice, and that changes what can be offered. ProFractional is one mode on a Sciton platform that also runs MicroLaserPeel, Contour TRL, HALO, and BBL, and the practice also offers SkinPen, Ellacor micro-coring, subcision, and filler, so a scar plan can combine tools or skip the laser when it is not the right one. When the honest answer is that the skin is loose or the lines are etched, the same surgeon performs deep resurfacing and coordinates it with eyelid surgery, facelift, and neck lift. A surgeon directing the plan means more tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Where to Start
Who ProFractional Is For, and What Happens First
ProFractional at Aesthetica by Ashley Howarth MD is for adults with acne scars, surgical or injury scars, rough or pitted texture, enlarged pores, or fine lines on the face, neck, chest, or hands, whose acne is no longer active, who are untanned at the time of treatment, can take 3 to 7 days of visible recovery, and can protect the treated skin from sun for 2 to 4 weeks afterward. The skin assessment comes first. A member of the physician-led team examines the scars in raking light and classifies them, since ice-pick, boxcar, rolling, and tethered scars respond differently and tethered scars may need subcision or filler as well; records your Fitzpatrick skin type and recent sun exposure; asks about active acne, isotretinoin within the past year, cold sores, and keloids; and checks for any lesion that needs a dermatologist. Fair to medium skin with moderate scars or texture starts a conservative series performed by the team. Deep scars, a regional resurfacing plan for the mouth or cheeks, or a session stacked with a deep MicroLaserPeel is scheduled with Dr. Howarth. Fitzpatrick IV skin is treated at reduced density after pretreatment and a test area; Fitzpatrick V and VI skin is usually directed to SkinPen microneedling or MOXI. Active acne is referred to a dermatologist first. Skin with brown spots or redness adds BBL in the same visit.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Aesthetica by Ashley Howarth MD is the medical aesthetics brand of her practice, Howarth Plastic Surgery, at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
Depth, Density, and Coagulation
How ProFractional Is Used in Scottsdale
Acne Scars: Depth Matched to the Scar
Boxcar and rolling acne scars are treated with channels set to the depth of the scar base, often 500 microns to 1 mm, over a series of two to three sessions four to eight weeks apart.
Acne scars are the first use of ProFractional. Boxcar and rolling scars on the cheeks are treated with channels set to the depth of the scar base, often 500 microns to 1 mm, at 10 to 20 percent coverage, in a series of 2 to 3 sessions 4 to 8 weeks apart; the collagen built around each channel lifts the scar floor over 3 to 6 months. Ice-pick scars are treated deeper and more selectively. Tethered rolling scars are released with subcision or supported with filler as well. At Aesthetica by Ashley Howarth MD conservative-depth sessions are performed by the physician-led team; deep sessions are performed by Dr. Howarth.
Texture, Pores, and Fine Lines
For orange-peel texture, enlarged pores, and fine lines, ProFractional runs at a moderate depth of roughly 200 to 400 microns, with recovery of three to four days of pinpoint crusting.
For orange-peel texture, enlarged pores, and fine lines that a full-field peel did not reach, ProFractional runs at moderate depth, roughly 200 to 400 microns, with coagulation added to tighten the tissue around each channel. Recovery is 3 to 4 days of pinpoint crusting and pinkness. Most patients choose a series of 1 to 3 between October and April, performed by the physician-led team under Dr. Howarth’s protocol. When the concern is sun damage and pigment as much as texture, HALO is often the better single treatment, and the team explains which at the assessment.
Regional Resurfacing: Perioral and Zone-Specific, Physician-Performed
For a problem confined to one zone (fine lines around the mouth, crepey under-eye texture, a single scar), Dr. Howarth performs zone-specific ProFractional resurfacing herself.
Some problems live in one zone: fine vertical lines around the mouth, crepey texture under the eyes, a scar across one cheek. ProFractional treats that zone deeply without resurfacing the whole face, and blending the treated zone into untreated skin is where a surgeon’s judgment shows. Every zone-specific and regional resurfacing plan at Aesthetica by Ashley Howarth MD is physician-performed laser skin resurfacing by Dr. Howarth, who sets depth by zone, uses local nerve blocks, and decides when the lines are etched enough that full-field Contour TRL is the better tool.
Combined With MicroLaserPeel in One Session
ProFractional and MicroLaserPeel run on the same laser and are often stacked in one session, adding about two to three days of recovery for a combined effect greater than either alone.
ProFractional and MicroLaserPeel run on the same 2940 nm erbium laser, and Sciton designed them to be stacked: the full-field peel removes 20 to 50 microns of the surface for smoothness and tone while the fractional channels reach the dermis for scars and collagen. The combination gives more change than either alone and adds about 2 to 3 days to recovery. Because the combined injury is deeper than either treatment on its own, every stacked session with a peel of 50 microns or deeper is performed by Dr. Howarth. For brown spots and redness on the same skin, BBL is added first in the same visit.
At a Glance
ProFractional at a Glance
How ProFractional is planned by concern at Aesthetica by Ashley Howarth MD, including depth and coverage, the number of treatments, days of recovery, and who performs it; every plan is set at the skin assessment and scheduled between October and April.
| Concern | Depth and coverage | Treatments | Downtime | Who performs it |
|---|---|---|---|---|
| Moderate acne scars | Conservative to moderate depth to the scar base, 10 to 20 percent coverage | 2 to 3, 4 to 8 weeks apart | 3 to 5 days, pink 1 to 2 weeks | Physician-led laser technician under Dr. Howarth's protocol |
| Deep ice-pick and boxcar scars | Deep channels approaching 1 mm or more, coagulation added; subcision for tethered scars | 1 to 2 deep sessions, 8 weeks apart | 5 to 7 days, pink 2 to 3 weeks | Dr. Howarth, physician-performed |
| Texture and pores | Moderate depth, about 200 to 400 microns, with coagulation | 1 to 3, 4 to 8 weeks apart | 3 to 4 days, pink 1 to 2 weeks | Physician-led laser technician under Dr. Howarth's protocol |
| Fine lines | Moderate depth across the zone; HALO considered when sun damage dominates | 1 to 3, 4 to 8 weeks apart | 3 to 5 days | Physician-led team; deeper plans by Dr. Howarth |
| Regional resurfacing (perioral, periorbital, one cheek) | Deep, zone-specific channels feathered into a light peel at the edges | Usually 1 | 5 to 7 days, pink 2 to 3 weeks | Dr. Howarth, physician-performed |
| Combined with MicroLaserPeel | Full-field peel of 20 to 50 microns plus fractional channels in one session | 1 to 2 | 5 to 10 days depending on peel depth | Team with a light peel; Dr. Howarth with a peel of 50 microns or deeper |
How It Compares
ProFractional vs HALO vs SkinPen
How the three collagen-building treatments at Aesthetica by Ashley Howarth MD compare for scars, texture, and fine lines; the team chooses at the skin assessment.
| ProFractional | HALO | SkinPen microneedling | |
|---|---|---|---|
| Technology | Ablative fractional 2940 nm erbium laser with adjustable coagulation | Hybrid fractional laser, 1470 nm non-ablative plus 2940 nm ablative in one pass | Mechanical microneedles, no laser and no heat |
| Depth | 25 microns to 1.5 mm per Sciton, set by the operator | Ablative channels shallow, non-ablative channels deeper, set separately | Up to about 2.5 mm mechanically, without ablation |
| Best for | Acne scars, deep texture, surgical scars, one-zone resurfacing | Sun damage, tone, pores, texture, and fine lines together | Mild scars and texture, darker skin types, summer months |
| Downtime | 3 to 7 days depending on depth | 5 to 7 days of sandpaper texture and peeling | 1 to 3 days of redness |
| Sessions | 1 to 3, 4 to 8 weeks apart | 1 to 2 | 3 to 6, 4 weeks apart |
| Skin types and who performs it | I to III routinely; IV at reduced density; team at conservative depth, Dr. Howarth for deep and zone-specific plans; October to April | I to IV routinely, V with care; team under protocol, deeper plans by Dr. Howarth; October to April | All skin types; aesthetician or team; year-round with sun avoidance |
A Visit Built Around Depth
What to Expect at a ProFractional Visit at Aesthetica by Ashley Howarth MD
A ProFractional visit at Aesthetica by Ashley Howarth MD has three parts: an examination that classifies the scars or texture and decides depth, density, and who performs the session; the laser pass itself; and a written healing and sun plan. The depth decision is the part that separates a medical practice from a spa, because it decides both the result and the risk.
Scar type, skin type, and the depth decision
The team examines the scars or texture in raking light and classifies them, records your Fitzpatrick skin type and recent sun exposure, asks about active acne and isotretinoin, flags any lesion that needs a dermatologist first, and sets depth and density. Deep, zone-specific, and stacked plans are scheduled with Dr. Howarth. Tanned skin postpones treatment.
Numbing, protective eyewear, and a grid of pinpoint channels
Numbing cream stays on for 45 to 60 minutes. You wear protective eyewear and the handpiece places a grid of microchannels pass by pass, which feels like hot pinpricks. The face takes about 20 to 40 minutes. Deep plans add local nerve blocks and are performed by Dr. Howarth; a MicroLaserPeel pass, when stacked, comes first.
A healing and sun plan in writing
You leave with a bland occlusive ointment for the first 2 to 3 days, a gentle cleansing routine, instructions not to pick at the pinpoint crusts, mineral SPF 30 or higher once the surface has closed, a hat-and-shade plan for 2 to 4 weeks, and the date of your next session 4 to 8 weeks out.
Clear Information. Informed Choices.
Safety and Limitations of ProFractional
ProFractional is safe when depth and density match the skin type and the skin is untanned, and fractional treatment still creates thousands of small wounds. Most side effects are expected and short-lived. The one that matters most in Arizona is post-inflammatory hyperpigmentation, more likely on tanned skin, on Fitzpatrick IV to VI skin, at high density, and on skin exposed to sun while healing. That risk is why the team screens skin type, schedules treatment between October and April, lowers density and test-spots Fitzpatrick IV skin, directs Fitzpatrick V and VI skin to SkinPen or MOXI, and reserves deep and zone-specific plans for Dr. Howarth, who manages any complication personally.
Possible Side Effects Include
- Redness, swelling, and pinpoint bleeding for 1 to 3 days
- A grid of fine crusts that sheds over 3 to 7 days
- Post-inflammatory hyperpigmentation, especially with sun or tanned skin
- Cold sore reactivation without antiviral prophylaxis
- Rarely, infection, prolonged redness, grid-pattern marks, or scarring
What Treatment Cannot Guarantee
- Complete removal of acne scars
- A result from a single session for deep scars
- Release of tethered scars without subcision
- Safe treatment of Fitzpatrick V and VI skin at full settings
- Improvement of loose skin or deep etched wrinkles
What Happens After ProFractional
Recovery After ProFractional
Recovery from ProFractional is measured in days and scales with depth and density: 3 to 4 days at conservative settings, 5 to 7 days at deep settings, and 7 to 10 days when stacked with a deep MicroLaserPeel. Because the skin between channels is untouched, the surface closes far faster than after full-field resurfacing at the same depth. The timeline below describes a moderate-depth session; deep and zone-specific plans performed by Dr. Howarth follow the same stages over more days.
The skin feels hot and tight like a strong sunburn for several hours and shows a fine grid of pinpoint red dots, some of which ooze slightly. A bland occlusive ointment goes on before you leave and stays on; cool compresses help. No makeup, no active skin care, and no sun. Sleep with your head elevated to limit swelling, which peaks the next morning.
The channels crust into fine dark dots that feel like sandpaper and shed over 3 to 7 days depending on depth. Cleanse gently 2 to 4 times a day and reapply ointment; do not pick, scrub, or exfoliate. Skip exercise, heat, and sweat until the surface has closed, usually day 3 to 4 at moderate depth. Makeup with mineral SPF can go on once the crusts have shed.
Pinkness fades over 1 to 3 weeks and early smoothing is visible. Mineral SPF 30 or higher reapplied every two hours outdoors, hats, and shade for 2 to 4 weeks protect the result from post-inflammatory pigment in Arizona. Retinoids resume at about 2 weeks. The next session in a series of 2 to 3 falls at 4 to 8 weeks, still within October to April. Read more in the Skin in Arizona guide.
Scars and texture keep improving for 3 to 6 months after each session as new collagen fills in around the channels, so the series is judged at 3 to 6 months after the last treatment, not the week after. Sciton describes annual maintenance after the initial series; most Scottsdale patients maintain with one session or a light MicroLaserPeel each laser season and HydraFacial through the summer.
Before & After
ProFractional, Before and After Treatment
ProFractional results are best judged in photographs taken in the same raking light before the first session and 3 to 6 months after the last, once collagen has remodeled. Aesthetica by Ashley Howarth MD maintains before-and-after galleries for ProFractional, MicroLaserPeel, HALO, and Contour TRL, and the team can show you cases that match your skin type, your scar type, whether the concern is acne scars or texture, and the time of year during your visit.
Patient Case Summaries
Selected ProFractional Case Summaries
These deidentified case summaries illustrate how the physician-led team at Aesthetica by Ashley Howarth MD plans ProFractional treatment in Scottsdale. They include conservative sessions performed by the team and deep sessions performed by Dr. Howarth, fair and darker skin types, summer and laser-season timing, a single treatment and a session stacked with MicroLaserPeel, a first series and maintenance, and a consultation in which the honest answer was to see a dermatologist first. Each summary connects the patient’s concern and skin assessment with the treatment performed or the recommendation made.
Case 01
Acne scar series
Rolling and boxcar cheek scars treated in a series of three conservative sessions
Patient presentation
A man in his thirties, a long-term Scottsdale resident whose acne had ended a decade earlier, asked whether the shallow rolling and boxcar scars across both cheeks could be softened enough to stop showing in office lighting.
Skin assessment
The assessment in raking light found moderate rolling and boxcar scars on Fitzpatrick II skin with no ice-pick scars, no tethering, no active acne, and no isotretinoin in the past year. He could take 4 days of recovery three times over one winter and was untanned in November.
Procedure performed
Three ProFractional sessions to both cheeks at conservative depth and about 15 percent coverage, 6 weeks apart between November and March, performed by the physician-led laser technician under Dr. Howarth’s protocol, with numbing cream and antiviral prophylaxis.
Clinical rationale
Moderate rolling and boxcar scars on fair skin respond to repeated fractional injury at a depth that reaches the scar base, and at conservative depth the session falls within the team’s protocol range, so a series of three was planned rather than one deep physician-performed session.
Follow-up
At 4 months after the third session the scars were noticeably shallower and the cheeks smoother in photographs; he maintains with one session each laser season.
Case 02
Physician-performed deep plan
Deep ice-pick and boxcar scars treated by Dr. Howarth with ProFractional stacked on MicroLaserPeel
Patient presentation
A woman in her forties who had moved to Scottsdale from Chicago reported deep pitted scars on her temples and cheeks from severe teenage acne, plus a rough surface that had worsened in the dry air.
Skin assessment
The assessment found deep ice-pick and boxcar scars on Fitzpatrick II skin, several rolling scars tethered to the underlying tissue, rough texture across the cheeks, no active acne, and no lesion of concern. She could take 10 days of recovery in January.
Procedure performed
A single session performed by Dr. Howarth: subcision of the tethered rolling scars, then a 50 micron MicroLaserPeel to the full face stacked with deep ProFractional channels to the scarred zones, under topical anesthesia with local nerve blocks; a second deep session followed 8 weeks later.
Clinical rationale
Ice-pick and deep boxcar scars need channels near the maximum depth, tethered scars need release before any laser will lift them, and the rough surface needed the full-field peel; a combined plan at that depth is physician-performed because depth judgment by zone and complication management are surgical decisions.
Follow-up
She peeled for 8 days after each session and was pink for 3 weeks; at 6 months the deep scars were markedly shallower and the texture even, and she plans a maintenance session next winter.
Case 03
Darker skin type
Acne scars on Fitzpatrick IV skin treated at reduced density after a test area
Patient presentation
A woman in her twenties, recently relocated to Scottsdale from Southern California, asked for the strongest laser available for rolling acne scars on her cheeks that made her avoid photographs.
Skin assessment
The assessment found moderate rolling scars with post-inflammatory hyperpigmentation on Fitzpatrick IV skin, no active acne, and a history of darkening after minor injuries. Fractional erbium is workable at this skin type, but density, depth, and sun exposure decide the pigment risk.
Procedure performed
Six weeks of topical pigment preparation, a test area behind one ear, then three ProFractional sessions at reduced density and moderate depth 8 weeks apart between November and April, performed by the physician-led team under Dr. Howarth’s darker-skin protocol, with the topical program continued throughout.
Clinical rationale
Published fractional erbium results in Fitzpatrick III and IV skin show scar improvement with a low rate of pigment change when density is kept low and sun is avoided, so the plan traded speed for safety with lower coverage, longer intervals, and pretreatment rather than refusing treatment.
Follow-up
No new hyperpigmentation occurred, the scars softened over the series, and she continues daily SPF and the topical program with one session planned each winter.
Case 04
Summer timing
A request for ProFractional in July that started with SkinPen and waited for October
Patient presentation
A man in his twenties asked for ProFractional in July to treat boxcar scars on his cheeks before starting a new job in September.
Skin assessment
His skin was tanned from summer cycling, the Arizona UV index was above 11 most afternoons, and he could not avoid sun for 2 to 4 weeks after each session. The risk of post-inflammatory hyperpigmentation from fractional ablation on tanned skin outweighed the benefit before the job.
Recommendation
Two SkinPen microneedling sessions in July and August with strict sun avoidance, a corrected mineral SPF habit, and a ProFractional series booked to begin in October once the tan had faded.
Clinical rationale
Microneedling creates no thermal injury and no ablated surface, so it can be done in summer with sun avoidance and begins collagen remodeling; fractional erbium on tanned skin in an Arizona July was more likely to leave marks than remove them, so the series waited for laser season.
Follow-up
The scars were slightly softer by September, and he completed three ProFractional sessions between October and February with a clear improvement at 6 months.
Case 05
Regional perioral
Fine lines around the mouth treated with zone-specific ProFractional by Dr. Howarth
Patient presentation
A woman in her fifties, a long-term Arizona resident, reported fine vertical lines above her upper lip and around the mouth that lipstick bled into, and asked whether the whole face needed to be lasered to fix them.
Skin assessment
The assessment found fine to moderate perioral rhytides on Fitzpatrick II skin, not yet deeply etched, with the rest of the face in good condition after years of BBL maintenance. She wanted a single recovery, not a series, and was untanned in February.
Procedure performed
A single zone-specific session performed by Dr. Howarth: deep ProFractional to the perioral zone with coagulation, feathered at the edges into a light MicroLaserPeel across the lower face to blend the transition, under local nerve blocks with antiviral prophylaxis.
Clinical rationale
Treating one zone deeply and blending it into untreated skin is where depth judgment matters most, so regional resurfacing is physician-performed; the lines were not etched enough to need full-field Contour TRL, and a single deep fractional session with a blended edge fit her recovery.
Follow-up
She peeled for 7 days and was pink around the mouth for 3 weeks; at 6 months the lines were markedly softer and lipstick no longer bled. She was told that if the lines etch further with age, Contour TRL is the next step.
Case 06
See a dermatologist first
Active cystic acne with new scars, and why the laser waited
Patient presentation
A woman in her thirties asked for ProFractional to treat scars on her jawline and cheeks that were still forming, hoping to stop the scarring as it happened.
Skin assessment
The assessment found active inflammatory and cystic acne along the jawline on Fitzpatrick III skin with fresh red scars among older depressed ones. Treating scars with a fractional laser while acne is active risks spreading infection and makes new scars as fast as it treats old ones.
Recommendation
Referral to a dermatologist for medical control of the acne first, with a note that if isotretinoin was prescribed the laser would wait until 6 to 12 months after the course; interim care with gentle facials and Forever Clear BBL once the dermatologist agreed; ProFractional planned for the following laser season.
Clinical rationale
Scar treatment succeeds only after the process making the scars has stopped, so the honest answer was medical acne control before any resurfacing, and an honest no is part of a physician-led plan.
Follow-up
Her acne cleared on the dermatologist’s regimen without isotretinoin, and she began a three-session ProFractional series to the jawline and cheeks the following November.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Aesthetica by Ashley Howarth MD
Aesthetica by Ashley Howarth MD is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Book a skin assessment directly online, or request a consultation and describe the scars, texture, or lines you notice, where they are, whether your acne is still active, and how many days of recovery you can take. Either path starts with the same examination of your skin.
Depth, density, a performer, and dates in laser season
You leave your first visit with a written plan: the scar type and the depth and density chosen for it; whether the physician-led team or Dr. Howarth performs it; whether MicroLaserPeel, BBL, subcision, or filler is combined; how many sessions and which months between October and April; and the ointment, sunscreen, and home routine that protects the result.
Sessions 4 to 8 weeks apart, results judged at 3 to 6 months
Each session is reviewed before the next at 4 to 8 weeks, and the series is photographed at 3 to 6 months after the last. Most Scottsdale plans then repeat annually: one maintenance session or a light peel each laser season, summer HydraFacial or SkinPen, year-round mineral sunscreen. A-List members have the next season scheduled before they leave the last one.
Your Questions, Answered
ProFractional Frequently Asked Questions
ProFractional is Sciton’s ablative fractional erbium laser. The 2940 nm erbium:YAG wavelength drills a grid of narrow, separated microchannels into the skin at a depth adjustable from 25 microns to 1.5 mm, leaving the skin between channels untouched. The untouched skin heals the channels within days while the dermis builds new collagen, which improves acne scars, texture, and fine lines with 3 to 7 days of recovery.
ProFractional treats acne scars of the rolling, boxcar, and ice-pick types, surgical and injury scars, orange-peel texture, enlarged pores, fine lines, and one-zone problems such as lines around the mouth, on the face, neck, chest, and hands. It does not treat active acne, loose skin, or deeply etched wrinkles across a whole zone, which go to a dermatologist, surgery, or Contour TRL.
Water in the skin absorbs the 2940 nm erbium wavelength almost completely, so each pulse vaporizes a narrow column of tissue to a set depth with little heat spread. Sciton adds adjustable coagulation, a controlled band of heat around each channel that tightens tissue and limits bleeding. Only 5 to 20 percent of the surface is treated per pass, so the surrounding skin closes the channels in days while collagen rebuilds for months.
Fitzpatrick I to III skin is treated at standard settings. Fitzpatrick IV skin is treated at reduced density after topical pretreatment and a test area, because fractional ablation raises the risk of post-inflammatory hyperpigmentation; published results in Asian skin support this approach. Fitzpatrick V and VI skin is usually directed to SkinPen microneedling or MOXI instead. Tanned skin of any type postpones treatment.
Most acne scar and texture plans use 1 to 3 treatments spaced 4 to 8 weeks apart, and Sciton describes annual maintenance after the initial series. Deep scars may need a physician-performed deep session or two rather than three lighter ones. In Arizona the series is planned to finish within laser season, October to April, so a first session in October leaves room for two more before spring.
With numbing cream for 45 to 60 minutes, a conservative session feels like a series of hot pinpricks during the 20 to 40 minute pass and like a strong sunburn for several hours afterward. Deep, zone-specific, and stacked plans, performed by Dr. Howarth, add local nerve blocks and oral medication when needed. Cool compresses and ointment manage the first evening.
Downtime is 3 to 4 days at conservative depth, 5 to 7 days at deep settings, and 7 to 10 days when stacked with a deep MicroLaserPeel: the channels crust into fine dots that shed, then pinkness fades over 1 to 3 weeks. After the surface closes, 2 to 4 weeks of strict sun protection follow, which in Scottsdale means scheduling between October and April.
Early smoothing is visible once the crusts shed and pinkness fades, at 1 to 3 weeks, but the real change comes from collagen remodeling that continues for 3 to 6 months after each session. Scars and texture are therefore photographed and judged 3 to 6 months after the last session in the series, not the week after.
Yes. ProFractional is most often stacked with MicroLaserPeel in the same session, the full-field peel for the surface and the channels for the dermis; stacked sessions with a deep peel are performed by Dr. Howarth. BBL is added first in the same visit for pigment and redness. Tethered scars are released with subcision or supported with filler, and SkinPen or MOXI covers the summer months.
Collagen built in a treated scar is permanent, so scar improvement from a completed series holds; the skin around it continues to age and take sun. With daily mineral SPF 30 or higher, most Scottsdale patients hold the result and maintain texture with one session or a light peel each laser season. Without sunscreen, texture and pigment change return within a few summers even though the scars stay improved.
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