Laser Facial Rejuvenation 101 – Part II

In my last post we covered the basics of laser facial rejuvenation.  Today we’ll cover the general types of lasers and what they can do for you.

1. Ablative Lasers – The oldest types of facial lasers include the CO2 and erbium lasers.  These were widely used in the late 90’s and early 2000’s and, although still being used in many practices, have been gradually replaced by the fractionated lasers.  The traditional ablative lasers function to literally burn all the skin off the face, from the top down.  In this way the skin is completely exfoliated, removing the blemishes and fine lines, in addition to heating the deeper layers of the skin, resulting in long-term tightening.  The problems with these treatments are the painful recovery and the potential for color changes to the skin.  The results from these treatments are, however, the gold standard for laser facial rejuvenation.

2. Nonablative lasers – The intense recovery and potential for complications with ablative lasers caused many plastic surgeons to search for alternative techniques to tighten the skin without pain and downtime.  Nonablative lasers accomplish this by focusing on heating up the deeper layers of the skin while leaving the surface untouched.  These treatments, which include the Cynosure Laser FACIAL, have no downtime but do not create significant exfoliation, and hence have limited effects on surface blemishes.  In addition, they necessitate multiple treatments to even come close to the effects of an ablative laser.

3. Fractionated lasers – For some patients the ablative lasers are too powerful and the nonablative lasers are not powerful enough.  Fractionated lasers can be a perfect in-between.  Instead of burning all the skin surface, like an ablative laser, or none of it, like a nonablative laser, the fractionated lasers burn a ‘fraction’ of the surface.  This results in skin tightening and exfoliation with some downtime, but not nearly what is seen with ablative lasers.  Fractionated lasers may require multiple treatments to approximate the results of an ablative laser.  Examples of fractionated lasers include Fraxel and Active / Deep FX.

4. Other skin tightening treatments – Although not actually lasers, another group of skin tightening treatments should also be mentioned.  Radiofrequency devices function to create heat in the deeper skin, causing skin tightening.  RF devices like Syneron’s eMatrix are considered nonablative, but as they evolve they are becoming more like fractionated lasers.  Another RF device is Thermage, made popular several years ago by Oprah. 

So that’s it!  Hopefully these two posts can help serve as a guide for any type of anti-aging laser treatment you consider.  Make sure to always choose a surgeon certified by The American Board of Plastic Surgery and do your homework.  You only have one face!

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Responses:

  1. 2 comments:

    (1) Regarding nonablative lasers, you write, “…they necessitate multiple treatments to even come close to the effects of an ablative laser.” You are too generous! I would argue that, when considering wrinkle removal, the results of nonablative lasers NEVER come close to the results of the ablative lasers, no matter how many treatments a patient undergoes.

    I do have a “lunch time” laser in my office, and I like it for removing brown spots, for decreasing pore size, and for generally improving the tone and texture of the skin. However, I warn patients that nonablative lasers do NOT reduce fine wrinkles.

    (2) Regarding fractionated lasers, I agree that they are “in between” devices. They are ablative, but they only ablate a fraction of the skin surface. For wrinkle removal, they are, therefore, less powerful than traditional ablative lasers, but significantly more worthwhile than the nonablative devices.

    However, I distinguish between fractionated erbium lasers and fractionated CO2 lasers. The fractionated erbium machines are pretty unimpressive. For the pain and expense, my patients have been dissatisfied, and we no longer offer these in my practice.

    However, the fractionated CO2 lasers are interesting. Relatively new, this sub-class of lasers may be the best answer for many patients. Unfortunately, this technology is so new that there are not good data regarding long-term efficacy. But this is the sub-class to keep an eye on.

    Comment by Michael C. Pickart, M.D., F.A.C.S. on December 28, 2010 at 5:25 pm

  2. Thanks for the comments Dr. Pickart. Your honest analysis is a breath of fresh air when compared to all the hucksters currently inhabiting the plastic (cosmetic) surgery field.

    Comment by Editor on December 29, 2010 at 2:53 am

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