Laser Therapy 101: Ablative Lasers and Skin Resurfacing with Dr. Jessica Krant

Procedures, Skin Care Advice
Laser Therapy 101: Ablative Lasers and Skin Resurfacing with Dr. Jessica Krant

With today’s technology, lasers are everywhere. Some of the most common procedures performed second to injectables, lasers can be a confusing subject to try to investigate and understand. Rather than leave you to mine the depths of the internet for answers, over the next couple of weeks we will review lasers in a comprehensive three-part series. This week, we discuss the different types of ablative lasers and what they can do for your skin.

Laser Therapy 101: The Basic Difference between Ablative and Non-Ablative

The term laser is actually an acronym for “Light Amplification by the Stimulated Emission of Radiation.” While the word “radiation” might sound worrisome, remember that all visible light is a form of radiation, but since it’s non-ionizing radiation, it’s different from nuclear radioactivity and can’t make you sick. Laser therapy describes any treatment using precise cohesive or “collimated” beams of light to heat, cut, burn, or destroy tissue. Each source of energy for the different lasers produces a specific wavelength of light which aims for different targets and can be varied in intensity and pulse length, depending upon the needs of the patient.

Generally, ablative lasers are more aggressive than non-ablative in that ablative lasers remove thin layers of skin, while non-ablative lasers gently stimulate collagen production to tighten skin over time. This is why non-ablative lasers typically require little to no downtime while ablative lasers require a certain period of healing time. Typically, ablative lasers are used for skin resurfacing.

Carbon Dioxide Lasers

Carbon dioxide (CO2) lasers are one of the oldest types of lasers used for cosmetic purposes. This is the most aggressive of ablative lasers that removes thin layers of skin to remove heavier fine lines and wrinkles, smooth acne scars, treat warts, and contour skin. The type of intensity and pulse used depends on the desired results; for example, focused/rapid pulsing removes fine lines and wrinkles, defocused will treat warts and shallow tumors, and continuous light actually cuts the skin to remove skin cancer, pigmented lesions, and warts.

Because of the more aggressive nature of the CO2 laser, the results are longer lasting than what you might receive from other lasers. During the procedure, the collagen structure of your skin may contract by up to 15-25%, which serves as a tighter template for new collagen production. This remodeling can last up to 18 months or longer.

A typical CO2 laser procedure will take approximately 30-45 minutes for partial treatment, while a full-facial treatment can last up to two hours. Local or general (if full-face) anesthesia can be used to minimize pain. Because of its high intensity, healing time can take up to three weeks depending on the treatment. The treated areas will be pinkish/red, which generally fades within 2-3 months. CO2 laser treatment may cause hyper- or hypopigmentation, which is particularly prevalent in darker skin tones; some doctors recommend minimizing this by using a bleaching agent prior to treatment. The risk of permanent side effects is highest with this laser, which is why many doctors no longer perform procedures with it in the continuous form the way it was originally used.

Fractional CO2 Lasers

Newer types of CO2 (and other) lasers use fractioned light, which breaks the light beam into microscopic thermal zones (MTZs) that only treat a partial (fractional) area of the targeted skin. These allow the surrounding untreated skin to serve as a regenerative source for the treated areas to help heal the area with more healthy skin and less scarring. This is why fractional CO2 lasers usually only require about one week of healing for each session. However, since only a small percentage of the skin is treated with each session, many more sessions are required over time for the result to begin to approach full resurfacing.

Erbium: Yttrium Aluminum Garnet (Er:YAG) Lasers

Er:YAG lasers were initially introduced into the United States as a bone-cutting tool in 1996, but are now used to remove superficial lines and wrinkles. The Er:YAG wavelength is easily absorbed by water, so its heat effects are scattered, making its energy ten times more efficient than the CO2 laser. This allows for finer control and superficial tissue ablation, which means less injury of the surrounding tissue.

Because of its gentle skin penetration, Er:YAG treatment usually only requires local anesthesia and has fewer side effects, so your recovery should only last about a week. It only contracts collagen by 1-2% during the procedure, so its effects aren’t as long lasting (up to 12 months) as the CO2 laser. Of course, when this laser is fractionated, multiple sessions are required to achieve desired results.

Bottom Line

Ablative lasers require the most healing time, but when performed carefully by an experienced, well-trained physician, the results may be the most dramatic and long-lasting. No matter the type of laser, it is important to find a well-trained, board-certified dermatologist that you trust rather than to just look for a specific brand of device. Your healthy recovery is as dependent upon how your doctor handles the laser as the type of laser used.

by Dr. Jessica Krant

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