Using Cosmetic Lasers to Resurface the Skin

There are several laser platforms currently in use for rejuvenating the skin. These lasers are used to achieve desired texture, tone, and pigmentation. They work by resurfacing the skin to minimize wrinkles, photoaging, hyperpigmentation, and acne scars.

Let's look at the different types of cosmetic lasers, and how they work to get results.

The complexities of cosmetic laser

Lasers are increasingly used to improve skin aesthetics in a minimally invasive way. As the relevant technologies have advanced, lasers have become more effective at achieving desired results with fewer unwanted side effects, and shorter recovery times. At the same time, the complexity of laser options has increased, making it harder to navigate the choices—which include ablative vs. non-ablative lasers, non-fractioned vs. fractioned lasers, and radiofrequency technology options.

Compounding the complexity, clinicians have begun combining different lasers to target the outcomes patients want more. While healthcare providers can help guide you through the possibilities, having a general understanding of what the different categories of lasers do can be invaluable. This knowledge can make the process of deciding which lasers are best for you easier—if you decide to pursue laser-driven skin rejuvenation.

Ablative lasers: effectiveness and risk factors

Ablative lasers are more aggressive than non-ablative lasers, so they produce more dramatic results but are also associated with more unwanted side effects and longer recovery times. Ablative lasers work by vaporizing skin tissue and are used for more significant skin challenges than can be addressed with non-ablative lasers.

Though newer models of ablative lasers are safer than the original models, they still carry risks. These risks include cosmetic side effects such as scarring and discoloration, as well as more serious problems like infections.

CO2 lasers: effectiveness and risk factors

Carbon dioxide (CO2) lasers and erbium-doped yttrium aluminum garnet (Er: YAG lasers) are ablative. They work by damaging existing collagen, which stimulates the production of new collagen and the appearance of younger-looking skin. Compared to CO2 lasers, Er: YAG lasers result in greater absorption and therefore less penetration depth, meaning that surrounding skin tissue tends to be less damaged when this type of laser is used. Specifically, less swelling and fewer days of skin crusting are observed with Er: YAG lasers relative to CO2 lasers.

Non-ablative lasers: less effective but with an easier recovery

The gentler nature of non-ablative lasers makes them less effective than ablative lasers. However, they facilitate faster healing. Unlike ablative lasers, non-ablative types keep the outside layer of the skin intact. People with darker skin are noted as good candidates for these lasers because non-ablative lasers are less likely to cause changes in skin pigmentation.

Radiofrequency technologies

Radiofrequency technologies are non-ablative and are used to resurface the skin by heating deeper layers of the skin. They penetrate more deeply than other lasers and work to shrink collagen and tighten the skin.

While these technologies are like lasers in that they damage collagen to stimulate the production of new collagen, radiofrequency technologies also heat the fat under the skin. This characteristic of radiofrequency technologies can cause unwanted reduction in fat and volume.

Fractionated vs. non-fractionated lasers

• Non-fractionated. Non-fractionated lasers affect the full surface of the skin exposed to the laser.
• Fractionated. Fractionated lasers distribute the effects more evenly, providing a lower risk for complications but requiring more treatments to achieve the same results.

Combining lasers to customize results

Because each type of laser has specific advantages, clinicians have begun combining them to reap the benefits of multiple lasers at once. Research on the effects of combining two different ablative lasers has shown positive results. For instance, when CO2 treatment is followed by the use of an Er: YAG laser, the greater efficacy of the CO2 laser is achieved, but with the reduced side effects that tend to accompany the Er: YAG laser. Even with non-ablative lasers, using two in combination appears to provide superior outcomes compared to either one used alone.

There is also data showing that combining fractional ablative and non-ablative lasers can achieve superior results of ablative lasers—but with the reduced side effects associated with non-ablative lasers. Combining lasers has also been shown to be beneficial for other cosmetic concerns that are not related to aging, such as redness.

Research into the effects of combining certain lasers has revealed that in some cases, using multiple lasers can enable newly produced collagen to stick together better—leading to stronger skin. As more research becomes focused on the effects of different laser combinations, it will become clearer how to optimize the available technologies to achieve desired results.