The Pixel laser is a plug-in device to Alma Lasers's Harmony modular platform. Since the laser unit is situated inside the handpiece itself, a physician can add on a Pixel module to the Harmony without the purchase of an additional machine.

A digital photograph is composed of thousands or millions of individual squares, called pixels. Alma Lasers utilizes a so-called pixel mosaic of topographical skin treatment that places dots of erbium laser (2,940 nm) microthermal injury pixels that are interspersed with pixels of untreated skin. Using tight beam focusing, high local laser irradiance is produced in each microthermal column, while keeping average irradiance to low levels that avoid bulk heating of the skin.

These zones of ablative fractional photothermolysis (AFPT) produce tiny thermal wounds, while sparing the tissue that surrounds the tiny columns of tissue injury. The thermal ablative areas of treatment stimulate a wound-healing response that tightens the skin and smoothes wrinkles. Most or much of the treatment area remains intact and becomes a reservoir for rapid wound healing (Figure 63.1).

Approximately 15 to 20% of an 11 × 11 mm spot is treated. Rapid reepithelization and fast epidermal repair result due to the short migration path for new viable cells such as epidermal stem cells and transient amplifying cell populations.

The erbium laser is an excellent modality for AFPT. Micromanagement of the thermal ablative effect is achieved by altering the pixel pattern, the laser energy, the pulse duration, the number of passes, and the number of stacks.