As kids, we thought lasers were used strictly for advanced scientific research. Imagine our surprise when we grew up to discover that this technology has become a key component of many people’s skincare routines. Lasers, which deliver various wavelengths and pulse widths to penetrate the dermis or epidermis, can do everything from permanently reducing excess body hair to fading facial redness. What’s hard to keep track of, though, is which laser does what — there are seemingly endless options for treatment, and we’re willing to wager this category is possibly the most confusing categories of aesthetic procedures to navigate.
To simplify things, we’re going to focus on just one category in this article: laser skin resurfacing. For many people, this is one of the most effective ways to even out their complexion’s texture and tone. The most formidable iteration of laser skin resurfacing is ablative laser. What’s that? We break down everything you need to know, below.
What is an ablative laser?
There are two main types of skin-resurfacing lasers on the market: non-ablative and ablative. In the simplest terms, non-ablative lasers heat up the underlying tissue to stimulate collagen production and tighten skin, without wounding the surface. Ablative lasers use CO₂ (carbon dioxide) or erbium to remove the top layer of damaged skin. Their results are more intense, with more associated downtime than non-ablative lasers.
How does an ablative laser work?
According to Kim Nichols, MD, a board-certified dermatologist in Greenwich, Connecticut “Ablative lasers deliver an intense wavelength of light to the skin, which removes the outer layers of aged or sun-damaged skin.” This causes the old skin on the surface to shed, revealing the fresh, new skin underneath. “During this process, the heat of the pulses causes the skin tissue to evaporate or ablate, and the light is absorbed by the body as energy,” adds Dr. Nichols.
Depending on the machine used, the laser may be fractionated. This means the laser’s energy beams are delivered to only a fraction of the skin via thousands of tiny columns called microthermal treatment zones. Fractionated laser keeps healthy surrounding tissue intact, which results in faster healing in comparison to all the tissue was exposed. Both ablative and non-ablative lasers can be fractionated.
What’s the difference between CO₂ and erbium?
Carbon dioxide laser resurfacing is an older method associated with more discomfort and greater recovery time, since it uses a longer wavelength that penetrates deeper into the complexion. Erbium lasers remove a much thinner layer of skin than CO₂ and use less heat. If you’re discomfort averse, and think that erbium is the best choice solely because it’s less painful, think twice. Carbon dioxide lasers are highly effective at treating lines and scarring, so it may be worth it if your doctor deems you a good candidate.
How do you know whether you need an ablative or non-ablative laser treatment?
You should consult with a licensed provider who can analyze your skin and determine the best course of action prior to treatment. “Ablative lasers are used for patients who have more serious concerns, such as an accumulation of sun spots acquired over the years or aging skin,” explains Dr. Nichols. “It is also commonly used to combat the appearance of post-inflammatory hyperpigmentation caused by acne.” Non-ablative lasers commonly treat rosacea, spider veins, and less severe acne-related skin concerns.
It’s also important to take the patient’s lifestyle into account, adds Elizabeth Tanzi, MD, a board-certified dermatologist in Washington, D.C. “Depending on whether they can tolerate a lengthy recovery or would prefer multiple treatments with recovery that is not too extensive, the laser [provider] may recommend one type of laser over another.”
Who is not a good candidate for ablative laser treatment?
Anyone who has very sensitive, fragile skin, or an active infection, smokes regularly, or has a systemic medical issue that could slow healing should avoid ablative lasers, says Dr. Tanzi. Doctors generally advise against laser skin resurfacing for those with darker skin tones, due to the risk of hyperpigmentation. In that case, the American Board of Cosmetic Surgery® recommends radiofrequency treatments or microneedling. If you do decide to get an ablative resurfacing treatment, avoid excessive sun exposure and discontinue the use of any retinol at least seven days before, says Dr. Nichols.
[Editor's note: Retinol shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.]
What should you look for when deciding where to go?
Look for a licensed provider with plenty of experience and expertise in using all types of lasers. Check out before-and-after photos, read reviews, and ask thorough questions during your consultation. “Does the [provider] have experience treating your skin problem [and] your skin type?” asks Dr. Tanzi. She recommends asking if they commonly perform ablative laser treatments, and why they are recommending that specific laser. “Sometimes, an office may only have a few lasers, which means the recommendation may not be the best option for your skin type or concern,” she warns. “Never be afraid to ask questions!”
How long does the procedure last, and how much discomfort will there be?
The treatment time may vary depending on your provider, the technology he or she is using, and your skin’s needs. That said, you can expect the procedure to take anywhere from 30 minutes to two hours. Your doctor will use local anesthesia — either topical or an injection — to numb the area, but there is a chance you may still feel minor discomfort. “These lasers heat the skin to the point of vaporization — that’s really hot!” notes Dr. Tanzi. Afterward, a cooling compress will be held against the skin to help bring down inflammation.
How long is recovery, and what should you do for your skin during that time?
Both doctors agree that a week or two, give or take a couple of days, is how long most people will need to take off from normal activities. During that time, your skin will be red and swollen before it blisters and flakes off. You’ll want to avoid makeup and sun exposure (always wear broad-spectrum SPF when you leave the house) and keep your skincare routine as simple as possible.
A gentle cleanser and a thick moisturizer — like Cetaphil® Gentle Cleanser ($12) and SkinMedica® TNS Ceramide Treatment Cream™ ($69) — are all you’ll need until your skin is fully healed. Dr. Tanzi recommends using Alastin® Regenerating Skin Nectar ($195) two weeks prior to treatment and two weeks after to assist in healing. Remember, your full results can take months to see as your collagen is working to regenerate itself.
How many sessions do you need?
It really depends on your unique concerns and how your skin reacts. “Because ablative lasers treat the cells at a deeper level, patients typically only need one treatment for their desired results,” says Dr. Nichols. That said, depending on your goals, multiple treatments may be necessary.
How much does a session cost?
Prices vary widely depending on your doctor’s experience, location, the type of machine (manufacturer), and the size of the area being treated, but Dr. Nichols and Dr. Tanzi provided a range between $500 and $5,000 per session.
Dr. Kim Nichols and Dr. Elizabeth Tanzi are paid Allergan® consultants.
SkinMedica® is an Allergan®-owned skincare line.