Which laser treatment is best for facial rejuvenation and skin tightening?
This is an excellent question. “Rejuvenation” suggests that you want to address signs of aging. The laser most suited for facial rejuvenation depends on what aging changes you want to address. With aging, the skin loses tone leading to the development of fine wrinkle lines. We also develop irregularities in our skin pigment and a more coarse skin texture. We also see small broken blood vessels (telangiectasias) emerge and splotchy areas of redness can develop, especially in individuals with a fair complexion or in those who have had quite a bit of sun exposure through life. Most of these changes can be addressed with laser and light treatments or peels. The most complete treatment for general skin rejuvenation is with a carbon dioxide (CO2) laser. CO2 lasers pass energy into the deepest layers of the skin and induce collagen remodeling which tightens or tones the skin. New skin is also generated in the areas of laser treatment. There are full field CO2 lasers, which treat essentially the full (99% plus) skin surface, and fractionated CO2 lasers, which treat a fraction of the skin surface (usually 25-50%) through microscopically separate treatment zones. Full field CO2 lasers offer more aggressive skin rejuvenation, but have an expected longer recovery time with increased skin redness, more risk of significant skin lightening (hypopigmentation), and risk of irregular darker pigment deposition (hyperpigmentation) in the healing laser treated areas. Given these risks, I usually recommend fractionated CO2 laser resurfacing for comprehensive rejuvenation treatments with laser resurfacing as I feel it is a nice balance between benefit and downtime. Although deeper tissue laxity is best addressed with surgical treatments, like a facelift or blepharoplasty, CO2 laser resurfacing can be expected to significantly soften fine wrinkle lines in the skin surface.
Erbium lasers are also useful for skin rejuvenation. Erbium lasers, like CO2 lasers, can be full field or fractionated and, because they do not penetrate as deeply as CO2 lasers, both full field and fractionated Erbium lasers typically produce less downtime. Although they do not typically produce as much skin tightening (because the laser energy does not penetrate as deeply), Erbium lasers are effective in rejuvenating the skin surface by improving texture, pore size, and irregular dark pigmented areas. Erbium lasers are also frequently used in a series of treatments for best results with less significant downtime.
Non-ablative laser and light treatments, like Intense Pulsed Light (IPL) will also rejuvenate the skin. They can be used to focus on specific concerns, such as dark pigment, areas of redness, or telangiectasias. They can also be used for hair removal and can be helpful in treatment of active acne. Non-ablative lasers typically cause less recovery and downtime than ablative lasers because none of the skin surface is vaporized in treatment. However, as non-ablative treatments do not vaporize any of the skin surface, they are typically not considered effective in improving skin texture. There are a number of other non-ablative laser or light energy treatments that are designed specifically to tighten the skin and deeper laxity. Opinions regarding these non-ablative skin tightening systems vary and most of the studies promoting their efficacy are sponsored by system manufacturers. Truly objective, unbiased studies demonstrating lasting effectiveness in skin tightening are few and far between. Personally, I typically recommend surgical treatment to achieve skin tightening unless an individual is not a candidate for surgical procedures. In such cases, I advise the patients that benefits would most likely be subtle, a series treatments are typically required, and maintenance treatments are usually recommended to maintain benefit.
Do laser treatments stimulate collagen production?
Yes. Deeper treatments typically induce more production of new collagen and more collagen re-organization. This is part of the reason that deeper laser treatments, like CO2 laser treatments, refine fine wrinkle lines and give the skin a more “toned” appearance. Collagen production and reorganization will continue for several months after deeper laser treatments, which explains why your true results aren’t immediately evident in the first few weeks after deeper laser skin resurfacing. More superficial treatments also stimulate collagen production, but to a much less significant degree. The collagen remodeling from superficial treatments is typically not significant or noticeable after a single treatment, but your skin’s collagen could be expected to, “be in better shape,” over the course of years if you maintain a regimen of lighter laser treatments.
What is the best time of the year for laser skin resurfacing?
Fall and winter are the most popular times of year for laser resurfacing as it is easier to minimize sun exposure during the colder, darker months. However, laser treatments can certainly be done in the spring and summer as long as precautions are made to minimize excessive sun exposure to laser treated areas. A good sun block containing titanium dioxide or zinc oxide is usually adequate as long as it is re-applied multiple times a day, and a sun hat will also help to further minimize risk of excessive exposure for laser treated facial areas. Laser resurfacing stimulates new skin production. I advise my patients that they should treat their laser resurfaced skin like “baby skin.”
What is the difference between Fraxel and Pearl lasers?
Fraxel® and Pearl® are simply name brands of lasers made by different manufacturers. The Fraxel line of lasers is made by Solta Medical, Inc. The Fraxel Re:pair® laser is a fractionated CO2 laser. The Pearl® line of lasers is made by Cutera, Inc. The Pearl Fractional® is a fractionated Erbium (2790 nm YSGG) laser. CO2 lasers, in general, are thought to penetrate deeper into the skin for more significant collagen remodeling and refinement of fine wrinkle lines than Erbium lasers.
What is the best laser treatment for scars and large pores?
For scars and large pore contour and skin texture improvement I typically recommend the fractional CO2 laser. A full field CO2 laser can also be used, but much longer downtime could be expected. Erbium lasers can also significantly improve surface texture for scars and large pores, and some fractionated Erbium lasers will improve contour to some degree, but CO2 lasers in general will induce more collagen remodeling and scar contour improvement than Erbium lasers as they are able to pass more laser energy into deeper layers of the skin. To improve redness of scar, IPL or pulsed dye lasers can be beneficial through a series of treatments. If scar redness is a concern for a new scar, laser treatment is often not required as redness can be expected to fade for several months in the first year after skin injury in most adults.
Which treatment is better for chin and upper lip lines, Laser or Dermabrasion?
To treat the general area I usually recommend fractionated CO2 laser as it is a nice balance between significant improvement with less downtime and risk for hypopigmentation than deep peels, full field laser, or deep dermabrasion over a large area. More than one treatment can be required and focused dermabrasion can be done over the deepest furrows or lip lines. I recommend laser as the primary treatment as it allows the surgeon to deliver treatment to a more predictable and uniform depth than dermabrasion or peels alone.
Which laser is better for neck tightening with minimal downtime?
As I stated in response to question 1, I typically recommend the fractionated CO2 laser for the neck, but I caution my patients to expect that it is expected to “tone” the skin rather than cause any deeper soft tissue or muscle tightening. Also, as I stated for question 1, I am hesitant to strongly recommend non-ablative laser treatments with the goal of achieving significant skin tightening in the neck. I do not use a non-ablative laser for neck tightening, personally, unless an individual is a poor candidate for surgical neck tightening or CO2 laser treatment. There are physicians who strongly advocate for the use of non-ablative tightening systems, and certainly some physicians report success with their use. However, truly objective evidence from unbiased clinical studies is generally lacking regarding these types of treatments so I tend to not recommend them in most cases.
What are the potential side effects of laser skin resurfacing?
Laser skin resurfacing is, generally speaking, safe for lighter skin types. Darker skin types, or skin with a greater density of pigment, is at more risk of significant pigment abnormalities after laser treatment. Your skin type and any history of irregular pigmentation should always be discussed with your doctor before your laser treatment to make sure that it is appropriate and that all the risks and benefits of a given treatment are discussed and considered along with your skin type and medical history. In considering side effect risk, fractionated lasers in general tend to be associated with less risk of side effects than full field laser treatments as only a fraction of the skin surface is treated. In addition, Erbium treatments tend to not penetrate as deep into the skin as CO2 laser treatments, so they are usually associated with less side effect risk and downtime. The main risks to consider for any laser treatment are irregular pigmentation, prolonged redness, undesirable scarring, and the risk of cold sores or herpetic lesions.
Lasers can cause excessive lightening of the skin (hypopigmentation) or darkening of the skin (hyperpigmentation) as an inflammatory response to your treatment. Less aggressive laser treatments carry a lower risk of these issues. Additionally, the lighter your starting skin tone and the more you are able to protect your skin from sun exposure before and especially after your laser treatment, the less likely you are to have complications related to irregular pigmentation from laser skin resurfacing.
Some degree of redness (erythema) is always expected after laser treatment. Typically the redness begins to fade to pink after a few days and is concealable with mineral based makeup by around 7-10 days in most cases when a fractionated CO2 laser is used. Erbium treatment redness is usually concealable earlier, by 5-7 days. Prolonged redness is a risk for any laser resurfacing treatment and its risk increases as the intensity or the aggressiveness of the treatment increases. For most fractionated CO2 treatments, treatment redness is expected to fade to a light pink and then resolve within several weeks to 2 or 3 months. For full field CO2 laser resurfacing, redness takes longer to resolve and some pink may still be noticeable 4-6 months after treatment. In addition, any pre-existent skin redness condition, such as rosacea, can increase your risk for prolonged redness after treatment, although the laser resurfacing will ultimately improve your “baseline” level of skin redness after healing is done.
Cold sores or herpetic lesions can also occur after any laser skin resurfacing procedure. As with other side effects, risk increases as the intensity or aggressiveness of treatment increases. A history of cold sores also increases the risk and should be discussed with your doctor before treatment. Anti-viral medications are typically prescribed and started before laser treatment to minimize any risk of post-treatment cold sores occurring.
How long should I wait between laser treatments?
The waiting period between laser treatments depends on how aggressive the treatment was. For most fractionated CO2 laser treatments, I typically recommend patients wait 6 to 12 months before considering another treatment. For Erbium treatments, most can be done as a series with 4-6 weeks between treatment sessions, although a longer waiting period should be used for more aggressive erbium treatments.
Laser skin resurfacing – pros and cons?
The expected benefits and side effect risks have already been addressed. The only other points that come to mind are related to treatment control and cost in comparison to “non-laser” skin resurfacing. Lasers are considered a more controlled way to resurface the skin than peels and dermabrasion. Laser parameters can be adjusted to achieve a certain depth of penetration and treatment density. Once these parameters have been set a uniform treatment can be expected with less room, in my opinion, for operator error than peels and dermabrasion. Though practitioners with years of experience with dermabrasion and peels can achieve excellent results with uniformity across a treated area, I believe the control is easier to achieve with laser skin resurfacing.
Cost of skin resurfacing, however, with lasers will more often be more considerable than for dermabrasion or peels. The laser equipment used is the reason for this increased cost as most laser skin resurfacing machines are expensive and some have “disposable costs,” or parts that must be replaced frequently after treatments. Some machines have parts that must be replaced even after a single treatment, and unfortunately some of that cost is passed on to the patient. Dermabrasion machines, in comparison, are relatively inexpensive as are peel solutions.
What is the best skin aftercare following laser resurfacing?
There are a number of skin care regimens utilized by various physician practices and clinics. In general, a petrolatum based occlusive ointment, such as aquaphor, is commonly used. Many practices will also have specific products that are medical grade and contain specific elements to promote more rapid wound healing, or they may be less messy to maintain than aquaphor. In my practice I use a medical grade petrolatum based ointment for the first week that is a little less heavy than aquaphor so it is applied in a thinner layer. This tends to be a little less messy than aquaphor, but we will use aquaphor if any skin reactions are noted for our recommended laser balm. We then transition our patients to a light, non-reactive moisturizer for sensitive skin in the second week after the laser resurfacing treatment. We also include these products as part of our “laser resurfacing package,” for full face treatment so that patients do not feel they need to go out and buy additional products to complete their treatment. There are a number of name brand products out there that are excellent, but some of them are expensive and the additional expense may not come with significant benefit over simpler, more basic products. In general I would follow the instructions and recommendations of your physician for laser resurfacing after care products and make sure to discuss any history of sensitivity to certain skin care products before using them after your laser resurfacing procedure, especially in the first few weeks following treatment.
