Laser resurfacing black skin


Interview Transcript

Interviewer: What types of skin conditions can laser skin therapy treat? How does it work, and why you should have a dermatologist do the procedure? That’s next on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Your skin protects you, and just like any other protective cover it takes damage from the sun, the wind, even pollution. The result a lot of times is fine lines, wrinkles, pigment problems on the face, acne scars, sun damage, the stuff you look in the mirror, you see, and you’re like, “I wish that could go away.” Well, you don’t have to live with all those things. Dermatologists can use lasers to take up to five years off the skin by treating surface issues.

We’re with Dr. David Smart. He’s a dermatologist with University of Utah Health Care. I want to learn more about your lasers and this skin therapy. So what are some of the common conditions that lasers can treat?

Dr. Smart: Well, that’s a great question. I think people don’t quite realize, there are many different types of lasers, and different types of lasers treat many different skin conditions. I like to describe lasers as being a modality or a treatment to help normalize the skin. Meaning, when you have too much hair, lasers can remove it. When you have too little hair, lasers can help grow it back. If you have too many brown spots, lasers can help get rid of those brown spots. If you don’t have enough, if you have some light spots, lasers can help bring back that color.

So there are a variety of lasers that go after many different targets, and in the end they really help normalize or bring that skin back to health.

Interviewer: That’s pretty amazing. How long has this technology been around?

Dr. Smart: It is quite recent in the grand scheme of medicine. In the last 20 or 30 years, there have been many really impressive, remarkable breakthroughs in laser medicine.

Interviewer: So is it fair to say that if you have some sort of a skin issue that bothers you and you’re thinking to yourself, “Oh, I wish I could do something about that,” lasers might be able to offer a solution?

Dr. Smart: There’s a solution for that. It’s certainly a possibility.

Interviewer: All right. Get a little geeky for me here. Tell me how does a laser . . . What’s going on? Like when the laser hits my skin, how is it fixing problems?

Dr. Smart: Light. When we’re dealing with the spectrum of light, not all light is the same. You’ve got a wide spectrum of light, and that light comes in different sizes. The sunlight is a specific size, and then you get into visible light, blue light, all the colors that you see, that’s a different size. You get into ultraviolet, infrared. So there is a spectrum of light.

On that spectrum of light, there are certain things that absorb different wavelengths of light with different sort of affinities, meaning, this brown spot, that’s going to absorb this wavelength of light. But really, that other one is not going to even touch it. Fat cells absorb different wavelengths of light, color-making cells. Tattoo pigment absorbs different wavelengths of light.

So what’s happening is, depending on the medical condition that you have, someone who knows about laser medicine is choosing a specific wavelength of light, a specific type of laser to treat your condition, because your condition responds to a specific band of light.

When that band of light hits that target, the light is absorbed preferentially by that target and not by the surrounding tissue so that that target can be effectively heat-damaged without damaging everything around it.

Interviewer: When you say “that target,” this is a cellular level?

Dr. Smart: Yeah. We’re talking real small. We’re talking particles. Like the molecule that makes brown in your skin, that’s a possible target. The molecule that makes red in your blood vessels, that’s a target.

Interviewer: So let’s just take the molecule that makes brown. The laser hits it, then what happens to that?

Dr. Smart: The laser hits it, and depending on what setting you’ve chosen on the laser, you’re either warming it up or you’re shaking it to the point of disruption or explosion, essentially.

Interviewer: If you want to get rid of it, I would imagine you explode it.

Dr. Smart: Explode it, exactly.

Interviewer: If you want to make it more pronounced, you would warm it up.

Dr. Smart: Yeah, precisely. You would warm it up slowly, and that decreases the inflammatory pathway around it. That can result in improvement in conditions like psoriasis, vitiligo which is a color problem, and even that’s why hair loss seems to be helped with certain types of lasers.

Interviewer: What about wrinkles? How are you getting rid of those wrinkles?

Dr. Smart: That’s a great question, and while we’re geeking out about this the target that you use to get rid of wrinkles is actually water. So you deliver the laser energy at a very specific depth. So you’re telling the laser how deep you want to go, and you’re essentially exploding, or removing, or damaging all cells that have water, which is all cells, in them in a specific pattern at a specific depth. So when you’ve calculated that out, you are effectively controlling which skin you’re removing and which skin you’re leaving.

Like aerating a lawn, the tool that you use is you really just cut it out. With the laser, the laser uses a wavelength that targets water and removes everything with water in that area so that the skin underneath can say, “Yeah. We are looking a little bit old. We are starting to get a little bit thin. We should rejuvenate this area,” and the skin really does the rest. It’s pretty remarkable that you cause the damage, the skin is what heals and cures itself.

Interviewer: Oh, so you’re intentionally damaging skin in order to motivate it.

Dr. Smart: Force it to say, “Hey, step up to the plate here. Start working,” and it does.

Interviewer: Very cool. Tell me a little bit about using these lasers, because I think I’ve heard ads for a lot of organizations that might use lasers for skin treatment. You’re a doctor, a physician, a dermatologist, this is your area of expertise. Do you receive some special training, or is there an advantage to coming to you to use this technology?

Dr. Smart: Oh, you bet. So lasers were invented by dermatologists. Back on the East Coast, sort of the grandfathers of laser medicine are dermatologists out of Harvard, and they in fact own many of the companies back there that have created these layers to treat a variety of skin conditions. So there is specialty training both in residency, and there is specialty training in post-residency.

For me, myself, I completed a laser and cosmetic fellowship, extra training after residency for over a year in Manhattan, and those kinds of things do exist. But they’re just getting started, and mostly just in dermatology.

Some very important issues, lasers are fairly powerful. Every now and again, more regularly than I’d like to see, a lot of people come in with complications that they’ve received at medi-spas, or somebody that decided they wanted to stop being whatever their profession was and start treating skin problems and call themselves a laser center.

So you do have to watch out for that, because there is specialty training and not every laser is created the same. Some lasers are Ferraris and some lasers are the Kia Souls, the very cheap type of lasers.

There are more side effects for the lasers that claim to do absolutely everything. And for people who are running them that really don’t know the difference in how the chest skin is different from the face, and how the face skin is different from the scalp, what laser settings need to be used to treat those areas, and sometimes to the patient’s detriment.

Interviewer: I think the important thing to remember is you’ve got the technology, and then you need to have the skilled technician that understands how the technology works, how the skin works, how the body is different.

Dr. Smart: Yeah, definitely.

Interviewer: Are the treatments for the various skin conditions relatively the same, in so far as how many treatments you’re going to need, how often you need to go in, how long it’s going to take? Or does it vary quite a bit?

Dr. Smart: It varies quite a bit. I’ll use one specific example, and that’s laser resurfacing. Laser resurfacing does a great job at, those lasers that you mentioned before, taking five years off the skin, those are resurfacing lasers.

Interviewer: How do you take five years off the skin? What exactly is going on there?

Dr. Smart: So like you said, skin takes a lot of the brunt of the damage, pollution, time, weather, sun, all of that, and it starts to get blotchy overtime. The pores start to get larger. The texture is not as smooth. It’s more cobblestone-y, “crepe-y” we like to call it, a sort of fine paper type of appearance with a lot of wrinkles. Removing those things, normalizing the color, taking away the brown spots and the red spots, making it a smooth tone, and also smoothening out the texture, that’s taking at least five years in many cases off the skin.

Interviewer: It sounds like to do something like that, you’re probably using a lot of different lasers. Like you’ve kind of got to mix and match for each patient that comes in, “What are the issues we’re trying to solve?”

Dr. Smart: Certainly.

Interviewer: And put together a treatment regimen.

Dr. Smart: Yeah. It’s very, very personalized, which brings me back to that point before that not one laser is going to do all of these things. Some of the lasers actually do take quite a bit of time, a course of them. You are going to want to repeat some of these lasers four to six times. Some of the other lasers that have a little bit more bang right up front as far as their efficacy, they also have more downtime. So there are some lasers that are going to get you five years off the skin with just one treatment, but you’re probably going to not want to leave the house for a week.

You’re going to be a little bit red. It’s going to be apparent that you had something done for several weeks after that treatment. Whereas, some of the other lasers that do the same thing in a more conservative, more elegant fashion, they get you the same result, but it might take six months, nine months of repeating this laser treatment on a regular basis. But your downtime, much better.

Interviewer: There again, that’s where having somebody that really understands the skin and how these lasers work, and the best laser for the job. Are there side effects to these treatments? Twenty, 25 years down the road, am I going to have less skin now and I’m going to be more vulnerable to the elements?

Dr. Smart: That’s a great question. Surprisingly, no. To be totally fair, we haven’t been doing these treatments on a very large scale for more than a few decades. So we don’t have quite that much evidence. But going back to what I said, normalizing the skin, so the skin actually becomes healthier, stronger, and thicker with repeated laser treatments, rather than thinner and less skin.

Interviewer: This is such a crude analogy. It’s not like sandblasting?

Dr. Smart: No, it’s not like sandblasting.

Interviewer: It actually makes the skin healthier. That’s fascinating.

Dr. Smart: Yeah. It’s more like aerating a lawn, actually. You’re removing certain places, but leaving healthy patches to grow in, fill in that area.

Interviewer: Then, overtime it becomes a healthier lawn.

Dr. Smart: It’s even healthier, yeah.

Interviewer: The skin becomes healthier with laser treatment as well.

Dr. Smart: Precisely.

Interviewer: Are there any side effects? You had mentioned that some treatments you might need to take a few days off, because somebody would be able to tell that something happened.

Dr. Smart: Oh, yeah. Most definitely, and of course depending on the laser entirely. But laser energy is essentially, when it all boils down to it, heat. So burns are the most common side effect, burning, blistering, and most of the time you’re trying to get a mild burn. You’re going for a light sunburn appearance, because that’s what the result is to show efficacy.

You really do want to have some appearance that something’s been done. Generally speaking, that can go away in anywhere from 30 minutes to a day, a few days, and that just depends on the laser you choose and what you’re going after.

Interviewer: What should a listener know to make an informed decision about this? I think we’ve covered a lot of the bases. Is there anything that I forgot?

Dr. Smart: There are many different lasers, and there are many different problems, tattoos, scars, and a variety of medical treatments that can effectively be treated by laser. So you really just have to go somewhere that has some experience.

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If you’re noticing unwanted changes in your skin, whether from too much time sun bathing or age — or if you have a tattoo you regret — laser skin treatments may help.

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Lasers can target many problems, including spider veins, age spots, unwanted hair, fine lines and wrinkles, or acne scars. These treatments help by removing or minimizing irregularities in your skin.

There are many different types of lasers, but the technique is the same: A dermatologist uses the laser to direct short, concentrated, pulsating beams of light at a specific target in the skin. The heat and light do the work to improve irregularities in your skin.

Here are various skin conditions dermatologists typically can remove or improve with laser treatments.

Spider veins

Spider veins typically become more noticeable over time. These tiny blood vessels close to the surface of the skin are the No. 1 reason for laser treatment requests, says cosmetic dermatologist Shilpi Khetarpal, MD. “The most common cause of spider veins is cumulative sun exposure,” she says. “Most patients are 40 years old and up.”

A laser can specifically target these tiny vessels, heat them up and cause them to collapse. Typically, three sessions will improve your skin’s appearance by about 50 percent. You’ll probably also need periodic touch-ups.

Spider veins generally affect the face, neck and chest. You also may see them on your legs, usually surrounding varicose veins. After varicose vein treatment, a dermatologist can use a laser to touch up the surrounding spider veins, Dr. Khetarpal says.

Brown age spots

These flat, brown spots on the skin, also known as “sun spots,” can occur in all skin types. They usually show up as you age. You may notice them on your neck, face, chest and hands—any area that has been exposed to the sun. “Laser treatment is extremely effective in treating age spots,” Dr. Khetarpal says. “Ninety percent of patients have two sessions and are very happy with the results.”

Unwanted hair

Whether you have unwanted hair on your lip, abdomen or elsewhere, laser treatments can permanently remove it. The beam targets hair follicles. The heat and light from the laser damage the follicles and stop hair growth.

“On average, four to six sessions can result in up to 100 percent reduction,” Dr. Khetarpal says.

The thicker the hair, the better it responds to laser treatments. You’ll also see better results if you have light skin and dark hair.

Acne scars

Acne is a common skin condition that affects about 80 percent of those between ages 11 and 30 at some point. When the irritation finally clears up, laser treatments can help minimize remaining scars.

“Newer scars do better with laser treatment than older ones,” Dr. Khetarpal says.

Lasers can target blood vessels and help lighten flat or raised scars that are pink or purple. Lasers also help flatten raised scars. A newer non-ablative laser can even help smooth indented scars, she says.

Depending on the severity and type of scar, you’ll typically need four to six laser sessions.

Unwanted tattoos

Removing a tattoo can take six sessions or more, depending on the age, size and type of tattoo (amateur or professional), Dr. Khetarpal says. Darker colors, (black and blue) are easier to remove than yellow, orange and pink. Smaller tattoos require fewer pulses; larger ones require more.

Possible side effects

All types of laser treatments may cause temporary side effects such as redness, discoloration, swelling and mild discomfort.

Your dermatologist can tell you what to expect and how long healing should take. He or she may first test an inconspicuous spot to assess how your skin will respond.

Whatever problem you want to treat, make sure you select a doctor who has experience with the type of laser treatment you need, Dr. Khetarpal says. It is important to make sure they are board certified and have knowledge about the laser and condition that is being treated.

If you think you can flip a switch to get smoother, brighter skin, well… you kinda can. Some of the newest anti-aging innovations offer the same technology that’s available in dermatologists’ offices—LED lights, lasers, electrical currents—in a lower-strength form you use in your own bathroom. And doctors say they can deliver similar results, if you’re up for putting in the time. “With these gadgets, it can take months of diligent use before you see a difference in your skin, whereas a similar office procedure may do the same after only one or two sessions,” says Ellen Marmur, M.D., an associate clinical professor of dermatology at New York City’s Mount Sinai School of Medicine.

Of course, those one or two sessions can cost you thousands of dollars, while most at-home tools range from $200 to $500. Still, these machines aren’t cheap, so are they worth it? “If your skin is sensitive to ingredients like retinoids, a device offers a gentler alternative,” says Marmur. “Plus, it can boost the effectiveness of your anti-aging products.” We asked a slew of women, all over 35, to try out the latest models for several months, then report back. Here are the FDA-approved gadgets that our testers and top dermatologists say truly work.

Smooths wrinkles: LightStim for Wrinkles, $249

What it does: LEDs (light-emitting diodes) beam painless wavelengths into the skin. “This revs up your skin’s collagen production, which over time reduces wrinkles and prevents new ones from forming,” says Fredric Brandt, M.D., a board-certified dermatologist in New York City and Miami. “Plus, it’s safe and gentle on all skin tones.”

How to use it: After cleansing, hold the wand on each section of skin you want to treat for three minutes per area. Depending on how much skin you plan to cover, the full shebang takes 10 to 20 minutes, five times a week. You’ll see results after eight weeks, at which point you can cut back usage to twice a week.

What to expect: “The light felt warm and relaxing,” says Felicia, 48, who has olive skin and saw a big improvement on her forehead lines and brown spots. “By two weeks in, my skin looked so good I stopped wearing foundation.”

The bottom line: LightStim can fade fine lines and moderate sun spots, “but if you have heavy-duty sun damage or wrinkles, you’ll see better results from a professional laser treatment,” says Brandt. “However, I like that you can use this device with anti-agers like retinol or glycolic acid post-treatment, and it won’t cause extra irritation.”

Fades spots and lines: Tria Age-Defying Laser, $495

What it does: It sounds right out of a James Bond movie: A diode laser boosts collagen and elastin to smooth wrinkles, though devotees say it also makes their skin soft and even-toned (currently, the Tria is FDA-cleared only to treat lines). “It’s modeled after the fractionated lasers that doctors use, which trigger the skin’s healing response,” says Macrene Alexiades-Armenakas, M.D., Ph.D., an associate clinical professor of dermatology at Yale University School of Medicine.

How to use it: On clean skin, place the tool on one cheek; continually glide it over the area until the buzzer beeps, then do the same on your other cheek, forehead, and chin. The device has three levels (you gradually work up to level 3), so depending on which one you use, it can take up to 10 minutes to treat your whole face. Do this five nights a week for 12 weeks, then repeat the cycle later on if new spots or lines appear.

What to expect: “The zapping felt like hot pinpricks, but it was tolerable,” says Elizabeth, 45, who wanted to get rid of brown spots on her fair skin. “When I first used the Tria, my entire face looked sunburnt afterward, though the redness subsided after about an hour.” Within two weeks, Elizabeth said her skin looked even and luminous, “and by the end of the three months, my crow’s-feet were much softer, too.”

The bottom line: “Because the Tria causes temporary skin inflammation, don’t use a retinoid or a glycolic acid product on the same nights that you do the treatment,” says Alexiades-Armenakas. “It’ll also make skin more sensitive to the sun, so you must wear a broad-spectrum, SPF 30 sunscreen every day.”

Firms slack skin: NuFace Mini Facial Toning Device, $199

What it does: Like a personal trainer for your face, this massaging gadget tones skin so it gets smoother and tighter by emitting low-level electrical currents.

How to use it: Apply the face gel that comes in the kit (it helps the currents penetrate skin), then slowly roll the metal spheres in an upward motion over each area you want to tighten. The entire treatment takes only a few minutes, but you have to do it five times a week for eight weeks, then two to three times a week to keep up the results.

What to expect: “It’s like a cold, slightly tingly massage,” says 44-year-old Wendi, who used NuFace on her jawline, neck, cheeks, and forehead. “I saw immediate tightening after the first use, and over the eight weeks, my skin became much firmer. I got a lot of ‘Wow, you look amazing!’ remarks from friends, and a few even told me I looked much younger.”

The bottom line: While the skin-tightening effect is legit, it’s also short-lived. “The microcurrents cause minor swelling that makes skin look plump and lifted, but the effect starts to fade after a few hours,” explains Marmur. “So long as you’re using the device five days a week you’ll keep seeing results, but there’s no long-term benefit—though the massaging action improves circulation and gives skin a healthy glow.”

Clears up adult acne: Quasar Baby Blue, $349

What it does: This wand waves its magic on pimples, releasing gentle blue LED light that destroys acne-causing bacteria and shrinks a zit in as little as a few days.

How to use it: On just-washed skin, glide the device over breakout-prone areas using circular motions. Treat each area for four minutes, three to five days a week for eight weeks. Then, to stay pimple-free, use it one to three days a week.

What to expect: After trying every over-the-counter product to nix her chin and jaw acne, Lauren, 36, said this little machine cleared up her skin in just 48 hours. “I’ve been using it a few times a week for two months now, and I haven’t had a single breakout,” she says.

The bottom line: “This device is the same technology that we use in-office to treat persistent acne,” says Marmur. “It really does the job without drying out your skin the way some products can.”

The 5 Top Face Laser Treatments and How They Can Help Your Skin

Laser skin resurfacing is one of the best ways to address many of the most common skin concerns, including sunspots, age spots, wrinkles, rosacea, redness, acne scars and even acne itself. We’re lucky to have an abundance of effective lasers available to treat these skin concerns, but knowing which one is the right fit for your skin can be confusing. While the correct treatment will ultimately be determined after a consult with your dermatology provider, here’s a look at the top lasers for the face.

1. The Best Laser to Give Your Skin an Insta-Glow: Laser Genesis

Laser Genesis is known as one of the best lunchtime cosmetic procedures because you can leave the dermatology office looking better than you did when you walked in and it only takes about 15 minutes. This “super facial” uses a 1064 nm wavelength to gently heat the dermis and rid of any diffuse redness, making it great for those with rosacea. Laser Genesis also boosts collagen production to rid of fine lines and wrinkles and gives the complexion a beautiful glow. There’s no downtime and no commitment with Laser Genesis!

2. The Best Laser to Rid of Acne Scars: Fractional CO2 Laser

Acne scars are a complexion-destroying reminder of nasty bouts with acne. Pimples are bad enough, but once a scar forms from them, you know you’ve got trouble on your hands. Acne scars are notoriously hard to conceal and they can distract from your beautiful brown eyes or your juicy full lips. This laser is best for deep acne scars–the kind that are pitted and impossible to cover up. This type of laser for the face will poke teeny tiny holes into the deepest layer of the skin to regenerate collagen growth and fill in the areas of tissue loss due to acne scars. The best fractional CO2 lasers are the Fraxel Re: pair, MiXto laser, TotalFX and Matrix CO2.

3. The Best Laser for the Face to Zap Broken Blood Vessels: Pulsed Dye Laser

When trying to banish broken blood vessels and broken capillaries from your face, you’ll want to rely on a vascular laser like a pulsed dye laser. The good news is that pulsed dye lasers don’t require any pain management and has zero downtime. These types of lasers use yellow light to very gently heat up the skin and destroy blood vessels, while leaving any surrounding skin untouched. One of the best Pulsed Dye Laser machines is the Vbeam Perfecta from Syneron Candela.

4. The Best Laser to Get Instead of a Facelift: Fraxel

Probably best known in pop culture as the go-to laser for Kim Kardashian, the Fraxel Laser is a serious powerhouse in the complexion rejuvenating category. The best in class for wrinkle removal, treatment of crow’s feet, sun damage removal and overall skin rejuvenation is the Fraxel Re:pair laser. Yes, there is some downtime with Fraxel, but after a couple days looking like you have a sunburn, your skin will look 10 years younger, tighter and completely refreshed.

5. The Best Laser for Removing Sun Damage: IPL

Brown spots from too much sun have a way of really ruining a gorgeous complexion. We’re not talking about a cute smattering of freckles, but those jagged marks of pigmentation where the sun had its way with your skin. We love IPL (aka Laser Photo Rejuvenation) to really get rid of those suckers. This targets melanin in dark spots. After a few days they flake off and reveal a perfectly even and gorgeous complexion.

What to Know Before Undergoing Laser Resurfacing for Better Skin

Glass skin. We all want it, and yet that dewy, airbrushed glow is elusive for most of us, regardless of age. Sloughing off dead cells at home with masks, scrubs, glycolics, and retinols can help. And clinical resurfacing procedures that cause slight injuries to the skin — think chemical peels, dermabrasion, or microneedling — can get you there faster. But when you need a supercharged solution, there’s nothing more effective than lasers.

“Lasers are great tools that can help improve various problems of the skin, such as acne scarring, fine lines, wrinkles, sun spots, and even tattoos and loose skin,” says the New York City–based dermatologist Tara Rao, MD.

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What Are Lasers and How Do They Work?

So what exactly is a laser, anyway? The word stands for light amplification by stimulated emission of radiation, according to NASA. As used in dermatology, they’re “a skin-resurfacing modality that harnesses the power of light and heat to improve skin tone, texture, and coloration,” says Lara Devgan, MD, a plastic surgeon based in New York City. “It does that by creating a controlled injury in the tissue that stimulates the body to have a healing response that makes it look better.”

When you work out, you intentionally cause small tears to your muscles, which grow back stronger, research notes. Lasers work in a similar way: They use light and heat energy to cause controlled damage to the surface of the skin, so that your body reacts to heal the tissue by creating new skin.

The result? Revved production of collagen, says Rachel Nazarian, MD, which is a benefit that other research shows. With age, collagen production wanes, leading to fine lines and wrinkles, according to the Cleveland Clinic.

If you’ve seen Chelsea Handler’s viral Instagram post of her “before and after” laser treatment, you’re probably already sold on the benefits. And Handler’s not alone: Other celebrity influencers have been touting the effects of their own laser treatments on social media (Drew Barrymore’s makeup-free mug looked angelic as she raved about the benefits of Clear + Brilliant; and Kim Kardashian sometimes makes it seem like having a private laser guru is as indispensable as owning a toothbrush). No wonder laser resurfacing is more popular than ever.

According to a 2018 report from the American Society of Plastic Surgeons, from 2000 to 2018, laser resurfacing procedures increased by 248 percent, from 170,951 to 600,000.

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Still, lasers can pose risks to your skin health. Here’s what you need to know to avoid getting burned.

1. Don’t Assume the Person Operating the Laser Is a Trained Professional

In the era of med spas and Botox bars, the lines between pampering, aesthetics, and medical treatments is increasingly blurred. Inconsistent legislation only compounds the problem.

In New York State, aestheticians often perform laser procedures, according to the state’s department of labor. Most med spas prefer that their aestheticians have some level of study, but the law doesn’t require it. Right across the river in New Jersey, you must be a registered nurse (RN) or a physician assistant (PA), notes the New Jersey Division of Consumer Affairs. Other states have their own rules, according to a’s state-by-state analysis.

As magical as they may seem, lasers aren’t toys. “The thing that makes lasers so powerful and also so dangerous is that tiny fluctuations in how light and heat are manipulated — and the exact wavelength and energy — can be the difference between giving you perfect skin and a catastrophic burn or hyper- or hypopigmentation,” says Dr. Devgan. “The laser itself means very little, compared with the person on the other end of the laser who’s programming the settings and manually putting it on your face.”

So if you’re seeking treatment, it’s smart to see a board-certified plastic surgeon or dermatologist with significant experience in resurfacing laser treatments. “The majority of complications occur in the hands of people who are not derms or plastic surgeons — whether that’s your dentist or a person taking a weekend laser course and buying a laser — which is unfortunately becoming way too prevalent,” says the New York City–based dermatologist Sapna Westley, MD.

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The key certifications to look for are from the American Board of Plastic Surgery (ABPS), the American Board of Dermatology (ABD), or the American Osteopathic Board of Dermatology (AOBD). Also check the specific board that has given the expert a professional certification, and be sure they are certified to perform the specific procedure being offered, such as lasers, says Alan Matarasso, MD, a plastic surgeon in New York City and the president of the American Society of Plastic Surgeons.

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2. Know the Basic Categories of Resurfacing Lasers

There are several key categories of lasers, including ablative and nonablative (the former wounds the skin while the latter doesn’t) as well as fractional. Other therapies, such as light therapies, are gentler options for skin resurfacing.


These are the most powerful lasers. They remove the epidermis (the top layer of your skin) and part of your dermis (the second layer of your skin) by superheating water in the skin. This causes controlled vaporization of skin cells, says Manish Shah, MD, a board-certified plastic surgeon in Denver. “The body responds by making new, younger-looking skin,” she says. “The skin gets tighter, while the fine lines are removed and the wrinkles are softened. Sun spots are lightened, and benign skin growths are destroyed.”

Recovery time with ablative lasers is about a week, says Shah. And because skin can be sensitive in the immediate weeks following the procedure, it’s a good idea to use sunscreen for protection. “ can expect final results in about six months,” she adds, but “stubborn skin conditions might need several treatments to get the best results.”

Examples of ablative lasers are the carbon dioxide laser (CO2), and the newer erbium YAG (Er:YAG), which provides similar benefits but with fewer side effects than the CO2 laser, Nazarian says.

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CO2 Skin-care professionals considered this powerful laser the gold standard in the 1990s and 2000s, and despite the possible side effects (like waxiness and hyperpigmentation), it’s still used sometimes today for its extreme effectiveness. In particular, this laser works well in fair skin tones, Devgan says.

The CO2 (carbon dioxide) laser removes all of the epidermis and some of the dermis, according to a scientific review of techniques. Typical recovery time is two weeks, Devgan says.

Despite their continued presence in dermatologists’ offices, “the industry as a whole doesn’t use them that much anymore, because erbium lasers can accomplish basically all those things with fewer side effects,” Devgan adds.

Erbium Many healthcare professionals prefer this ablative laser for aggressive resurfacing with fewer side effects than CO2 lasers and its shorter downtime, according to a review published in August 2017 in the Journal of Cosmetic and Laser Therapies. “It’s powerful but also highly specific, so it can be very customized to treat a variety of different skin tones and a variety of concerns, from fine lines to texture, melasma, hyperpigmentation, irregularities in tone and coloration to overall luster of the skin,” Devgan says.


Dubbed “nonwounding” lasers by the Mayo Clinic, nonablative lasers are gentler than their ablative counterpart. “While ablative lasers direct their energy at the top layer of skin to renew the most superficial parts, nonablative lasers work by directing their energy much lower into the deeper tissue,” Nazarian says.

According to a review published in the Journal of Clinical and Aesthetic Dermatology, while the results of nonablative lasers are mild, they are better for people with darker skin because they pose a low risk of hyper- or hypopigmentation. If you’re okay with getting slower results over a longer period of time and undergoing more sessions, this is the laser for you.

RELATED: 7 Wellness Bloggers’ Best Tips for Instantly Brightening Dull Skin


Since hitting the market in 2004, fractionated lasers have become game changers. “The fractionated laser delivers heat and light in a pixelated fashion,” says The New York City celebrity cosmetic dermatologist Paul Jarrod Frank, MD. “So instead of burning 100 percent of the skin, there are almost these digital pixels of laser that destroy the target, allowing for quick healing without causing trauma to 100 percent of the skin at one time.”

Think of them as a “medium” option between ablative and nonablative lasers, Devgan says. “The idea is that you can get a lot of the benefits of an ablative laser, but a little bit less downtime because there are small islands of dermal elements that help the tissues heal a little bit faster,” she says.

Among fractionated lasers, the brand Fraxel has become like Xerox or Kleenex — almost synonymous with the category. Fraxel lasers can be divided into many types, based on how ablative or nonablative the treatment is. For example, there’s Fraxel Restore, a nonablative option; Fraxel Repair, an ablative fractionated CO2 laser; and Fraxel Dual, a nonbablative option with two lasers: one to target pigmentation and sun damage and the other to target wrinkles and acne scarring.

RELATED: I Smeared Snail Slime on My Skin for 1 Month. Here’s What Happened

Light Therapies

Another popular nonabalative treatment, as the Mayo Clinic notes, are light therapies, which are also known as intense pulsed light (IPL) or violet-blue light (VBL). They aren’t lasers, nor do they resurface skin. Instead, they’re a “rejuvenating” therapy, Westley says.

They achieve many of the same results that lasers do, but in a more targeted, gentler way. “Instead of using one laser that focuses on your skin, uses several wavelengths of light at once,” says Sheel Desai Solomon, MD, a board-certified dermatology in Raleigh-Durham, North Carolina.

Devgan says light therapies won’t give you those dramatic before-and-after photos, but they’re great for skin maintenance, “especially for the younger population that doesn’t need much work.” Just keep in mind that because it’s gentler, you’ll need more sessions to see serious results, Devgan says.

Shah adds that this technology carries few risks, but there are still problems with burns and pigmentation abnormalities. “Topical anesthesia is usually enough to make light therapies tolerable.”

Additional Lasers

Of course, it’s important to note there are many other types of resurfacing lasers that specifically target coloration such redness or pigment, as well as treating everything from rosacea, spider veins, sun spots, and melasma to scar and tattoo removal. Some of these include Q-switched, pulsed dye, Nd:YAG, and Picosecond. The PicoSure brand laser falls in this relatively new and promising category.

3. Don’t Get Hung Up on Laser Brand Names

One problem with the surging popularity of laser treatments is that you may think you’re already an expert in this field because you saw an Instagram post or have peers who’ve undergone laser treatments themselves. But Westley says the brand names of the lasers are less important than the wavelengths used and the knowledge level of the health professional performing the treatment. “There are parameters, and we need to know what settings to use, and everyone comes with a different skin type. And with darker skin you have to be more cautious with the settings,” Westley says. “I’ve seen a lot of people end up with burns and scarring post lasers because wrong wavelengths were used, or they were undertreated and they didn’t get the results that they could have gotten.”

The focus on brands instead of the overarching wavelengths or categories, and their capabilities and limitations, can leave you uninformed and prone to limited, if not unwise, choices. “It’s sort of like if you only knew Coca-Cola, but you weren’t able to put it in the category of dark-colored sodas,” Devgan says.

RELATED: A Detailed Guide to Vitamin C Serums

4. Work With Your Dermatologist to Choose the Right Laser for You

It’s wise to get treatment from someone who has experience operating a range of lasers, says Westley. “Doctors with several machines are able to customize the treatments in terms of what wavelengths of lasers they would do the best with, and sometimes it’s a combination of various lasers and wavelengths.”

Dr. Frank agrees. “The current and future of noninvasive cosmetic dermatology is in combining a lot of small things to get big results, so you can’t just go to someone that only offers one device,” he says.

So if you’re considering getting a laser treatment, make sure you understand the pros and cons, and be sure to ask about recovery time.

RELATED: 7 Dermatologist-Approved Tricks to Make Your Skin Look Younger

5. Come to Your Consultation Armed With Questions

“The basic rule of thumb with lasers is that the more aggressive the treatment, the more downtime and the better the result,” says Devgan. “The less aggressive the treatment, the less downtime and also the less dramatic the result and the more treatments you’ll need to get a nice outcome.”

For example, says Devgan, IPL could be a great treatment for somebody who is busy and simply wants to maintain their skin. But if you’re seeking a 180-degree transformation, this may not be the right option for you.

Before you meet with a doctor, make a list of the top three things that are bothering you about your skin. Ultimately, your dermatologist can help you weigh the factors against one another to help you identify the right laser or light therapy.

6. If You Have a Dark Skin Tone, Approach Lasers With Caution

Not all skin colors react to lasers the same way. Dermatologists utilize the Fitzpatrick scale, a system of classifying human skin color, to estimate the response of different types of skin to ultraviolet (UV) light. According to this system, there are five basic categories, with 1 being the lightest and 6 having the most melanin.

“It’s possible to use any type of laser on any skin tone, but you have to be very mindful,” says Devgan. “The risk with more pigment in the skin is hyperpigmentation, which paradoxically means you’re risking making someone have more blotchiness or darkness or brown spots on their skin as an unwanted side effect when maybe that’s exactly what they’re trying to treat.

“Overall, my approach is to be very conservative when lasering Fitzpatrick skin types 4, 5, 6.”

But that doesn’t mean darker skin tones need to shy away from lasers completely. Instead, practice caution and find a provider who has experience using the laser that is best for your skin type, and who can best assess the value versus risks. “A common misconception is that laser resurfacing is only safe for light skin types,” says Solomon. “While it’s true that certain lasers pose a higher risk for cell damage or discoloration in darker skin, there are safe and effective resurfacing options. For lighter-toned African American, Hispanic, or Asian skin tones, erbium lasers can sometimes be a good option, posing less risk for discoloration.”

Nonetheless, Solomon says sometimes patients with “darker brown or black skin may need to consider other skin resurfacing options, such as radio-frequency treatments or microneedling.”

RELATED: What Your Breakouts Tell You About Your Acne

7. Know That Lasers Can Help Treat Acne Scars, but They Aren’t Good for Active Acne

“Lasers and other light therapies may seem like the perfect acne treatment — just beam a light to make the acne disappear,” Solomon says. But it’s not that simple.

Lasers can be effective for resurfacing acne scars, but for active acne, you’ll want to opt for treatment with blue or blue-red light, advises the American Academy of Dermatology.

Devgan says she often treats patients with acne scars by using an erbium laser for resurfacing. “If someone has active acne, I would do something more like an intense pulsed light with an acne reduction filter,” she says.

According to a study published in the May–June 2015 issue of the Indian Dermatology Online Journal, IPL and photodynamic light therapies can help reduce inflammation and acne scarring, but they are less effective on whiteheads and blackheads, or on cysts or nodules. To give you the best results, your dermatologist may recommend using another acne treatment, such as medicine that you apply to your skin. Results vary from person to person. “Right now, there’s no way to know who will see clearer skin and how much the skin will clear when treated with a laser or other light treatment,” Devgan says. According to the American Academy of Dermatology (AAD), multiple treatments deliver significantly better results than a single treatment.

RELATED: 10 Ingredients That Can Help Fight Signs of Aging

8. Keep Your Expectations in Check

Lasers are powerful and can produce amazing results, but they aren’t miracle machines. Depending on your specific skin condition and the kind of treatments you get, results can take time, and repeat sessions may be necessary, even with the most aggressive laser.

“Anything that involves epithelial cells, like in your skin, nails, and hair, is going to require retreatment. That would be like having the best gel manicure of your life; you’re still going to need a new one . Or the best hair colorist in the world; you’re still going to get roots. These epithelial cells will always turn over. Whatever you do is going to require maintenance at home in your daily routine.” And while your results may last several years, per the ABPS, they’re not permanent.

RELATED: Can Sipping Bone Broth Make You Look Younger?

9. Understand That Maintaining Your Results Is in Your Hands

“If somebody is going to be investing time and money into a laser routine at the doctor’s office, it’s really vital that they do a good topical maintenance routine at home to optimize the results of the treatment,” says Westley. “Home regimes should include regular use of retinoids, vitamin C serum, and sunscreen, of course.”

Devgan agrees that at-home maintenance is key, as is avoiding behavior patterns that are going to re-create problems for you. “If you go out into the sun or you skip using your retinoid or you touch your face and continue to break out, no laser will save you,” she says. “You have to have the behavior modification also. Then also, just be very wary of anything that sounds too good to be true, because as they say, it probably is.”

17 Things to Know About Laser Treatments


Dr Vanessa Phua used to be an ophthalmologist performing complicated eye surgery. But for the past 14 years, she’s been applying her gift of precision to aesthetic laser skin treatments. She shares with us what the new ones are, the right time to do them and if anyone will be able to tell.

1. What does a laser treatment do?

VP: Lasers generate invisible light energy that can span hundreds to thousands of nanometres (a nanometre is one billionth of a metre). Lasers can treat a variety of skin problems, from acne, rosacea, eczema and hyperpigmentation to skin-renewal concerns and even hair and tattoo removal. There’s no such thing as one-laser-fits-all. I adjust the laser wavelengths based on the patient’s skin condition – the longer the wavelength, the deeper the laser penetration into skin.

2. What’s an Asian skin-friendly laser?

VP: The Enlighten Picosecond is more suitable for Asian skin because it prevents hyperpigmentation from coming back. It’s a green laser emitting low energy, which makes it more protective. It won’t injure the surrounding skin. So it’s safer for those with deeper skin tones who are more likely to suffer burns from traditional laser machines which target the entire face instead of areas with pigmentation problems.

3. Is laser treatment a good intro to aesthetic treatments?

VP: It’s a good start as it can work on all skin concerns. There are two categories of lasers. Non-ablative lasers – such as ND:YAG, Enlighten Picosecond, and Dual Yellow Copper Bromide – are more commonly used on younger skin to even out skin tone, smooth roughness, treat acne scars, enlarged pores and superficial pigmentation, and reduce fine lines. Ablative lasers – such as those used in fractional skin resurfacing – are suitable for people in their late 40s and beyond who require more skin tightening and lifting, and want to treat deep wrinkles.


4. When can one start using laser treatments?

VP: Someone as young as a 16-year-old with acne can start such treatments. And the signs of ageing become more obvious from your mid-20s, so a preventive approach is better than a reactive one. Treat problems such as fine lines, the appearance of enlarged pores, uneven skin tone, dullness and roughness before they become more prominent and deep-set.

5. Can it ever be too late for lasers?

VP: There’s no such thing. My oldest patient is 81 years old, and she only started seeing me when she was 67. Pigmentation problems were her main concern, so I started her on lasers to treat her melasma and superficial sun spots. We did all the aesthetic procedures in a way that wouldn’t show up as major changes on her face. Her skin is currently brighter and more even-toned, with fewer visible wrinkles.

6. What does a typical course of laser treatments entail?

VP: Treatments are done at least once a month over a six-month duration if we’re dealing with acne and long-term melasma caused by hormonal disturbances.


7. Is there a waiting period between treatments?

VP: Laser treatments are generally done once in three to four weeks, as the skin needs that amount of turnover time.


8. How much can I expect to pay?

VP: It’s about $500 a month on average, but take into consideration other expenses such as skincare, boosters and add-on treatments too, subject to your skin type.

9. What should I expect to see after the first session, and by the end of the course?

VP: Generally, after the first session, you can expect your skin tone to be more even, dull areas to be slightly reduced, and an overall brighter complexion. By the end of the course, you can expect a minimised appearance of pores, acne scars and dark spots, controlled oil production, and better skin radiance.


10. Will lasers fix my skin permanently?

VP: Skin will age, and it will revert to showing the normal signs of ageing if you go completely laser-free. The treatments can be once every two or three months, but you’ll need to commit to lifetime maintenance for healthy-looking skin.

11. Can people tell if I’ve had it done?

VP: Not with a skilled and experienced doctor. It might take an average of three to five days for your skin to heal and for the redness to subside if you have just done an ablative laser treatment, but after the downtime, the results are very natural.


12. Does it make my skin thinner?

VP: That’s a misconception. In fact, your skin becomes healthier and more resilient since laser treatments encourage skin to produce more collagen.

13. Is there such a thing as overdoing it?

VP: If you overdo it, your skin might not have time to recover and may become sensitive, which could possibly give rise to other pigmentation issues. But an experienced doctor will not go overboard with the laser wavelength.

14. What about the pain and discomfort?

VP: For patients undergoing more intense laser treatments, we apply a topical anaesthetic cream. Other times, we use a cold compress to help reduce discomfort, but most laser treatments generally do not require any form of numbing.

15. Should I exfoliate my skin pre-treatment?

VP: I usually advise my patients not to exfoliate for at least one week before the treatment. This is because exfoliating causes the skin to be more sensitive to the laser, which means you might feel the sensation of heat slightly more than you usually would.


16. What about when I’m on my period?

VP: It won’t negatively affect the outcome of the treatment, but some women may be more sensitive to heat-induced pain during this time.

17. Do I really have to avoid outdoor activities or sun exposure post-laser?

VP: Yes, and it is even more crucial for you to do so if you’ve just completed a fractional skin resurfacing laser treatment, which treats more severe skin damage and wrinkling by removing microscopic columns of skin while leaving the surrounding tissue untreated. This prompts the body’s natural healing process to create new, healthy collagen to replace the removed columns of skin. This ablative treatment leaves skin especially raw and vulnerable, so it is highly recommended that you avoid swimming, diving and overexposure to the sun for at least two weeks.

Dr Vanessa Phua is based at The Chelsea Clinic, #05-08A Wheelock Place.

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Laser therapy in skin of colour

What is skin of colour?

Skin of colour refers generally to non-white skin types with a particular emphasis on Fitzpatrick skin phototypes V and VI. It is characterised by increased epidermal melanin (a brown pigment), more widely distributed melanosomes (the melanin-containing granules within melanocytes), labile melanocyte response, and overactive fibroblasts.

Skin of colour

How does skin of colour vary from non-pigmented white skin?

Since melanin absorbs and scatters the energy transmitted from ultraviolet radiation (UVR), persons with skin of colour experience less epidermal damage after exposure to UVR and show fewer signs of photoageing than people with lighter skin types .

Skin of colour almost always develops pigmentary changes when exposed to injury or inflammation (postinflammatory hyperpigmentation and postinflammatory hypopigmentation), whereas pigmentary changes are uncommon in white skin .

Melanin can act as a competitive chromophore (a coloured molecule that absorbs transmitted energy), which increases the risk of side effects after epidermal injury by a laser .

People with skin of colour have a higher prevalence of hypertrophic scarring and keloids after injury than those with white skin due to genetic factors associated with hyperactive fibroblasts .

What are the indications for laser therapy in skin of colour?

The medical indications for laser therapy are similar whatever the colour of the skin. However, women of colour often seek treatment for hyperpigmentation and uneven skin colour as these are common aesthetic concerns .

Laser therapy may also be used to remove dark, coarse, terminal hairs, which may lead to pseudofolliculitis barbae, folliculitis keloidalis nuchae, and folliculitis decalvans, conditions more common in skin of colour .

Laser hair removal in skin of colour

The safest laser for persons with skin of colour is the long-pulsed Nd:YAG.

  • Its wavelength (1064 nm) is at the end of the absorption spectrum of melanin.
  • It results in sufficient thermal injury to dark coarse hairs and spares the epidermis .
  • It allows energy to be delivered slowly, resulting in heat dissipation and cooling, minimising damage to the epidermis.

The use of the alexandrite laser (755 nm) has not been extensively studied in skin of colour. It has been reported to cause blistering in patients with Fitzpatrick skin types V–VI .

Use of a diode laser (800 nm) has been reported to be mainly safe with low complication rates, including transient blistering and pigment alteration .

Resurfacing acne scars

Acne scars may be treated with an ablative CO2 or Er:YAG laser, but these are best avoided in skin types V–VI as thermal injury commonly causes postinflammatory hyperpigmentation .

Non-ablative Nd:YAG has fewer side effects compared to ablative laser resurfacing, and produces comparable results.

Tattoo removal

Few studies of the removal of tattoos in skin of colour have been reported. Charcoal-based blue/black religious tattoos in Ethiopian patients with skin types V and VI were removed using a Q-switched Nd:YAG . Almost half of the patients developed mild postinflammatory hyperpigmentation lasting between 2 and 4 months.

Removal of tattoos in skin of colour can be difficult and unpredictable because of the epidermal melanin, which absorbs the transmitted energy preventing it reach ink in the dermis.

What can help improve the outcomes of laser therapy in skin of colour?


Cooling is used to protect the epidermis from thermal injury .

  • Contact cooling, which relies on conduction, can be active (sapphire laser windows, copper tips) or passive (ice cubes).
  • Non-contact cooling uses cold air convection or cryo-cooling.


Epidermal injury should be monitored carefully in skin of colour.

  • A Nd:YAG laser with a long wavelength and wider pulse times is often the most suitable device.
  • A test pulse or pulses can be used to check the immediate effects of the laser on the skin.
  • Multiple, short sessions can also help reduce epidermal damage compared to single, longer sessions .


Patient expectations should be realistic, and they should be informed about the risk of complications and side effects associated with laser therapies .

Want to take years off your face? These treatments can rejuvenate your skin

An increasing array of nonsurgical products and procedures aim to reduce the effects of time and sun exposure.

Published: January, 2017

Image: studiokovac/Thinkstock

It’s often said that our lives are written on our faces. But if you feel like doing a little editing—erasing a few fine lines, softening a deep furrow, or evening out some patchy spots—there’s an increasing array of products and procedures to help rejuvenate skin worn by time and sun exposure. “When it comes to skin treatments, there’s lots of good news in therapies for medical conditions as well as cosmetic concerns,” says Dr. Kenneth Arndt, adjunct professor of dermatology at Harvard Medical School and medical editor of the Harvard Special Health Report Skin Care and Repair.

A growing population of healthy, active older women who want to look as young as they feel has spurred the development of skin rejuvenation techniques that are more subtle and have much shorter recovery times than facelifts. “It’s important to choose your treatments with care and to check and double-check the reputation and accreditation of clinicians performing invasive skin procedures,” Dr. Arndt says. You may want to consult a dermatologist to weigh the possible risks and likely benefits of various treatments. Cosmetic procedures aren’t covered by insurance, so cost might also be an important factor in choosing a skin rejuvenation procedure.

The most common procedures

The following are several often-used techniques to remove fine wrinkles, scars, uneven pigmentation, and other imperfections.

Botox. Injections of botulinum toxin—a category that includes Botox, Dysport, and Xeomin—are relatively affordable, have very few risks, and require no recovery time. And they’re quite effective at temporarily smoothing a wrinkled face, brow, or neck.

Soft tissue fillers. Injections of soft-tissue fillers under the skin can add height to cheekbones, improve the jaw line, diminish acne or surgical scars, restore fullness to hollow cheeks and eyes, fill fine vertical lines, resculpt lips, and fill in nasolabial folds (the deep lines that run from the outside of the nostrils to the corners of the mouth). Some fillers, such as hyaluronic acid and poly-L-lactic acid, are eventually absorbed by the body. Others contain tiny beads of solid materials suspended in gel. The gel is absorbed over time, and the beads form a scaffold for collagen growth.

Chemical peels. Peels are used to treat wrinkles, age spots, discoloration, precancerous skin growths, and superficial scarring. An acid solution—usually glycolic, salicylic, or trichloroacetic acid—is applied to the skin, dissolving skin cells and removing the top layers of the epidermis. The effects vary based on how deeply the peel penetrates, which is determined by the type and strength of the solution used.

Microdermabrasion. In this procedure, the doctor or aesthetician sands an area with tiny aluminum hydroxide crystals to create smoother-looking skin. It’s relatively inexpensive, and no recovery time is needed.

Microneedling . This technique—in which a doctor repeatedly applies an electric or battery-operated instrument containing multiple small, thin, sharp needles to the skin—isn’t as painful as it sounds. The needles cause tiny injuries that stimulate the production of collagen and elastin. Therapeutic substances, such as hyaluronic acid or ascorbic acid, can be applied before or after needling so the substance penetrates deeply. This procedure is relatively risk-free and inexpensive.

Laser therapy. Lasers can remove moderate to deep lines and wrinkles and significantly improve skin tone, texture, and tightness. Lasers’ ability to target specific types of cells in distinct skin layers enables them to treat conditions such as port-wine stains, pigmented birthmarks, and spider veins. They can also erase acne pits and many other scars. Your dermatologist or cosmetic surgeon can help you determine which type of laser therapy is best for you.

Yes, you can try these at home!

Home chemical peels and micro-derm-abrasion kits generally have the same ingredients as medical professionals use, but in lower concentrations. There are also a variety of home microneedling rollers that can be used to deliver retinols, moisturizers, and other compounds into the skin. Home laser, LED light, and ultrasound devices are also less powerful than professional equipment, but they can be effective if you have the patience to perform treatments on a frequent basis for many weeks or months.

These products and devices can remove dead skin and diminish scars and fine lines safely for a fraction of the cost of professional treatment. Because the results are less dramatic, nonprescription options work best for minor skin flaws. Be sure to read and follow directions to use them safely.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.


  • What is laser skin resurfacing?
  • 1. When should I have laser skin resurfacing?
  • 2. Treatments may hurt—or it may not
  • 3. Having darker skin does not necessarily preclude you from laser resurfacing
  • 4. It makes a difference who performs your laser skin resurfacing treatments
  • 5. Certain medications or conditions affect how the skin reacts to laser treatment
  • 6. Different lasers are optimized for different issues and skin types
    • CO2 Lasers
    • Erbium Lasers
    • Pulsed-Dye Lasers
    • Fractional Lasers
    • IPL (intense pulsed light)
  • 7. Plan on having multiple treatments
  • 8. Depending on the treatment, you may need some downtime

What is laser skin resurfacing?

Laser skin resurfacing is a proven way to help reduce wrinkles, age spots, acne scars, and other blemishes as well as tighten skin and balance tone. But precisely because lasers can do so much, and vary widely in how they act on your skin, it is hard to know where to start when researching treatment—even the most perfunctory search reveals a slew of competing devices and methods.

We want you to be informed, not overwhelmed. Before you go too far down the Google rabbit hole, we suggest taking a step back from all the hype and reading the following key things to know about laser skin resurfacing.

Don’t get caught up in brand names—instead focus on your goals: what skin problems do you want to address, and what results are you hoping for?

1. When should I have laser skin resurfacing?

Did you know that autumn is considered “laser season”? Because laser-treated skin is hypersensitive to sun exposure for up to a year following some procedures, many cosmetic surgeons recommend undergoing laser resurfacing during fall or winter months, when daytime hours are shorter and you are spending most of your time indoors.

Regardless of what time of year you have your laser procedure, wear a broad-spectrum SPF 30 or higher sunscreen daily and reapply as needed. This not only helps to keep your results looking their best, it also provides protection against skin cancer and helps prevent additional premature aging.

2. Treatments may hurt—or it may not

Patients and doctors commonly compare the sensation felt during laser treatments to a rubber band snapping against the skin. However, what laser resurfacing feels like depends on the laser, the depth and area of treatment, and an individual’s tolerance for pain.

Deeper ablative (some outer layers of skin are removed) laser treatments may require local anesthetic injections or intravenous sedation to keep a patient comfortable. Examples of ablative lasers are CO2 lasers and Erbium YAG lasers.

Some non-ablative laser treatments (the laser passes through the skin without removing layers) cause little-to-no pain and require only a topical numbing cream to offset discomfort. Non-ablative lasers include pulsed-dye, ND: Yag, and Alexandrite lasers. Following the procedure, some degree of tenderness in the treatment area can be expected. Your provider will recommend safe ways to control discomfort after laser resurfacing when necessary.

3. Having darker skin does not necessarily preclude you from laser resurfacing

A common misconception is that laser resurfacing is only safe for light skin types. While it is true that certain lasers pose a higher risk for cell damage or discoloration in darker skin, there are safe and effective resurfacing options. For lighter-toned African American, Hispanic or Asian skin tones, Erbium laser resurfacing can sometimes be a good option, posing less risk for discoloration. Patients with darker brown or black skin may need to consider other skin resurfacing options, such as radio-frequency treatments or microneedling.

The best way to ensure a safe, effective treatment for your skin type? Consult with a provider who has extensive training and knowledge in laser resurfacing procedures and experience working with darker skinned patients.

4. It makes a difference who performs your laser skin resurfacing treatments

In the hands of a highly trained, knowledgeable professional, laser resurfacing is a safe way to dramatically improve your skin’s appearance. In the hands of a poorly trained individual, lasers can be ineffective or even dangerous. Choose a laser resurfacing provider based on an individual’s experience, training, and qualification. Don’t make your pick based solely on who offers the best deal or has a brand name laser platform.

Choose a laser resurfacing provider based on experience, training, and qualification—don’t simply look for the best deal or the newest laser platform.

Your best bet? Choose a cosmetic surgeon board certified by the American Board of Cosmetic Surgery. Every ABCS certified surgeon has undergone a rigorous training fellowship that includes non-surgical treatments such as laser skin resurfacing. You can use our Find-A-Surgeon Tool to locate cosmetic surgeons near you.

5. Certain medications or conditions affect how the skin reacts to laser treatment

Always be upfront and honest with your provider about your medical history and any medications or supplements you are taking. For instance, if you are prone to cold sores or fever blisters, laser treatments may induce breakouts. Acne medications that contain isotretinoin (i.e., Accutane) can lead to poor healing or scarring from laser resurfacing, while common over-the-counter products like aspirin can increase the risk of post-procedure bleeding.

Common over-the-counter products like aspirin can increase the risk of post-procedure bleeding; other meds can lead to poor healing or scarring after laser treatments

Diabetes and other chronic conditions can also impact safety and results with laser resurfacing. You should also quit smoking at least 2 weeks prior to and after laser treatments to avoid complications with healing and provide your body with the best chance for optimal results.

6. Different lasers are optimized for different issues and skin types

The reason there are so many different laser options is that no one laser can treat all patients and all skin concerns. Here are a few varieties you are likely to come across in your research:

  • CO2 Lasers are generally ablative lasers used to treat scars, warts, wrinkles and other deeper skin flaws.
  • Erbium Lasers can be ablative or non-ablative. They promote collagen remodeling, making them popular options for treating fine lines, wrinkles, skin laxity, and age spots.
  • Pulsed-Dye Lasers are typically non-ablative lasers that heat the skin and absorb pigments to reduce redness, hyperpigmentation, broken capillaries, and rosacea.
  • Fractional Lasers break up the laser energy into thousands of tiny beams to treat only a fraction of the skin in the area, which reduces downtime. Fractional lasers can be ablative or non-ablative, and are used to treat a number of age-related blemishes.
  • IPL (intense pulsed light) treatments technically are not lasers, but are often used to treat similar concerns as lasers, such as sun damage, acne, rosacea, and hyperpigmentation. Learn more about IPL treatments

Rather than get caught up in brand names and laser wavelengths, focus on your individual goals: what skin problems do you want to address, and what results are you hoping for? The good news is you don’t have to determine this on your own: a board certified cosmetic surgeon or qualified skin care professional trained in laser resurfacing will be able to recommend the best treatment for you based on your skin type.

7. Plan on having multiple treatments

While in some cases, a single laser treatment will take care of a patient’s concerns, most non-ablative lasers call for a series of treatments to produce the most satisfying results. This is a trade-off that comes with a no-downtime treatment, but once the treatment series is complete, results are long-lasting.

8. Depending on the treatment, you may need some downtime

Although laser treatments are generally considered non-surgical, not all are downtime-free. Laser resurfacing recovery time varies depending on the type of laser used as well as an individual’s health and healing rate.

Non-ablative lasers often require no downtime at all, while ablative lasers can require a 2 to 3 week healing process, depending on depth, before the new skin has healed completely and final results are evident.

This does not mean you have to stay at home for a month; it just means that your skin will be raw, red and scab over as it heals. You may not feel comfortable in certain social situations, and you will need to modify your activities to avoid situations where infection is possible (swimming, gym workouts, etc.).

If you are considering laser treatments to improve your skin, we encourage you to contact a board certified cosmetic surgeon. Our member directory is an easy way to locate a surgeon near you. In the meantime, you can read more about lasers and other skin resurfacing treatments in our ABCS procedure learning center.

Common Questions Answered About Facial Laser Resurfacing

Facial laser resurfacing can treat sagging skin, wrinkles, acne scars, and sun spots, among other things. But if you don’t know much about laser treatment, the subject can be a little daunting. Below, we’ve answered five common questions about laser resurfacing to help you determine if it’s the right skin care treatment for you and prepare you for a less stressful experience.

  1. What can facial laser resurfacing do for my skin?

Laser resurfacing helps smooth and rejuvenate the skin, making your face look younger and healthier. It can help:

  • even out your skin tone after pigmentation or sunspot damage;
  • clear up broken blood vessels;
  • tighten loose, sagging skin;
  • minimize wrinkles and fine lines
  • fix discoloration;
  • and reduce redness

Additional common skin conditions our patients use facial laser resurfacing to treat are: acne scars; age spots; discoloration; hyperpigmentation; rosacea

  1. How does laser treatment work?

Depending on your situation and the results you want, your dermatologist may use one of several different lasers for your treatment. The way they work can be defined by two methods of laser treatment.

  • Ablative Lasers – remove skin tissue by vaporizing the top layers of skin to reveal the younger, healthier skin underneath. This treatment also stimulates the growth of new collagens (your skin’s main structural protein). Fractional CO2 and erbium are some of the most common types of ablative lasers.
  • Non-Ablative Lasers help repair the skin without removing any layers. Instead, heat is used to produce new collagen.

While some patients only require one session of treatment, others will need more to get the skin looking its best. Beyond treating the condition itself, more treatment sessions may also result in longer-lasting, more effective results.

  1. Which type of laser should I use?

Your dermatologist will recommend the type of laser that’s best for you based on your medical history, skin type, and what results you’re looking for. CO2 lasers are usually used for treating wrinkles, warts, acne scars, and discoloration. Erbium lasers tend to cause less side effects and are usually used to treat blemishes closer to the skin’s surface: such as fine lines, age spots, and loose skin. Non-ablative lasers work best for reducing redness and hyperpigmentation.

  1. Does a laser treatment hurt?

Whether or not laser treatment is painful simply depends on the type of laser and the depth of treatment. Certain non-ablative lasers may cause no pain and can even be soothing. If treatment is with a deeper laser, your dermatologist will precede the treatment with anesthesia, numbing cream, or sedation to keep you comfortable during the treatment process. After treatment, your face may feel tender. Understanding the recovery process for varying lasers is among the consideration factors for the laser treatment chosen.

  1. What’s the downtime for recovery?

If your dermatologist uses a non-ablative laser for your treatment, you probably won’t need any downtime afterward. If an ablative laser is used, then you may need anywhere from three days to three weeks of recovery time depending on the type of laser, the condition being treated and the extent of the treatment. Downtime also depends on your health and your body’s natural healing capacity. Your dermatologist will probably recommend that you soak the treated area and apply ointment or other medicine on a daily basis until your face has healed completely.

  1. How will I look after laser treatment?

During healing, your skin will probably look red, raw, and scabby. While you may need to avoid certain things like extended sun exposure, as well as swimming pools and gyms (to prevent infection), you’ll still be able to do all the other things you normally do. You just might feel a little self-conscious – which is perfectly understandable. The recovery time is part of the process, but the results are long lasting.

Imagine you could take all your skin concerns—hyperpigmentation, acne scars, dullness, fine lines—and peel them all away to reveal a new layer of glowy, healthy skin. That’s essentially what Fraxel lasers do. Which is why the on-the-rise treatment has become a solution for people serious about blasting away imperfections for good. “I use Fraxel literally everyday,” NYC-based dermatologist Marnie Nussbaum tells “My best patients are the acne scarring patients who can’t believe that something has given them such a rush of self esteem. And the photo damage patients getting their skin to a neutral tone instead of being speckled is really satisfying to them. People are really happy with it.”

It can be intimidating to undergo a procedure like this so we went to Nussbaum to break down everything you need to know before trying Fraxel.

What do Fraxel lasers treat?

Nussbaum says most patients come into her office seeking Fraxel laser treatments for three reasons: hyperpigmentation or sun damage, wrinkles, and acne scarring. People most commonly have lasers applied to their whole faces, but the neck, décolletage, hands, and arms are also popular areas to treat.

For textured acne scars, in particular (think: icepick, boxcar, and rolling scars), lasers are more effective than any topical treatment. “Being able to go that deep allows you to really break up that scar tissue that’s clouding the textural difference, whereas a cream wouldn’t be able to,” Nussbaum explains.

Are there different types of fraxel lasers?

Nussbaum says the Fraxel dual laser is the type you commonly find in dermatologists’ offices. It features two lasers with different wavelengths in one device: One that targets pigmentation and sun damage and another that goes deeper to target wrinkles, texture, and acne scarring. There is Fraxel Restore, a non-ablative (meaning no open wounds) laser, and Fraxel Repair, which is the most powerful and uses an ablative fractionated carbon dioxide laser for more severe cases. The latter requires more extensive downtime.

How do Fraxel lasers work?

No matter which Fraxel laser you choose, the mechanism is the same. Nussbaum explains the energy from the lasers creates tiny “columns of thermal destruction” in the skin that stimulate the growth of new, healthy skin cells to replace old, damaged cells. “It’s really working from the inside out,” Nussbaum says of the skin turnover and collagen production, which is actually just the body’s natural healing process accelerated.

How do you prepare for a Fraxel laser treatment?

First, make sure you don’t have extensive breakouts, open wounds, or infections on the face. Stop using products with retinoids one week before your treatment. On the actual day-of, you’ll be topically numbed for 45 minutes, and the procedure itself takes 20 to 30 minutes depending on where you’re getting treated.

Do Fraxel lasers hurt?

Nussbaum describes the sensation as “a little teeny prickling,” but because your face will be numbed so it should only be “mildly uncomfortable.”

How much downtime do you need after a Fraxel treatment?

“I always tell my patients there will be three to five days of downtime,” Nussbaum says, “You won’t look like raw meat but you’re going to be red, peeling, and scaley.”

What does aftercare look like?

Make sure to use ample amounts of sun protection. You’re also going to want to avoid any harsh products or prescription acne products on your skin for up to a week. Use a gentle cleanser and moisturizer twice a day and avoid peeling and picking your skin at all costs. “That will only make you red and take longer to heal. It’ll peel when it’s ready. No exfoliation,” Nussbaum warns. She swears by a DIY compress made with half whole milk and half ice water because the lactic acid and fat content in the milk helps calm the skin. “It sinks right into the channels that we’ve made in the skin,” she says.

As for actual products, Nussbaum recommends “gentle cleansers like the Elta MD Foaming Facial cleanser twice a day. Then, I recommend a Vitamin C in the recovery period like Skinceuticals Phloretin gel every morning. Use Elta MD sunscreen in the morning, but any moisturizer like Cerave PM is great because it’s not too thick, so if you put it on during the day it won’t clog the pores.”

Foaming Facial Cleanser Ame Skin Theraphy $26.00 Phloretin CF Gel (1 fl oz.) SkinCeuticals $166.00 PM Face Moisturizer for Nighttime Use CeraVe $15.99 UV Clear Broad-Spectrum SPF 46 (1.7 oz.) EltaMD $35.00

How many sessions of Fraxel should you do to see results?

It depends on what you are targeting. If it’s pigment, you will see results in one to two sessions. If you’re trying to get rid of wrinkles or acne scarring, it’s three to five sessions. For both acne and wrinkles, it’s recommended to space out sessions four weeks apart. For photo damage, you space out sessions six to eight weeks apart.

Here, impressive results from someone who went for Fraxel repair (the strongest setting):

How much does it cost?

It varies depending on your practitioner, but Nussbaum says to expect $1200 – $1600 per session.

Are there any side effects?

Aside from redness, Nussbaum warns that some patients might experience a purging of sorts with a breakout of whiteheads because of the rapid skin turnover. If someone is prone to breakouts, Nussbaum will put them on antibiotics. “Very rarely, it can worse melasma,” she adds.

Related Stories Kristina Rodulfo Beauty Director Kristina Rodulfo is the Beauty Director of Women’s Health—she oversees beauty coverage across print and digital and is an expert in product testing, identifying trends, and exploring the intersections of beauty, wellness, and culture.

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