Laser facial rejuvenation is one of the most popular but most confusing  treatments today.

What’s the difference between a lunchtime laser and a fractionated laser?  An ablative or a nonablative laser?  If many plastic surgeons are confused by the plethora of lasers available, how can the average consumer or patient know what laser is best for removing their wrinkles and tightening their skin?

Lasers work by focusing energy on a certain color of the spectrum.  These colors vary from the color of water (CO2 lasers) to brown (Nd-YAG) to red (Pulse Dye) and others.  When the high intensity light energy of a laser encounters the color it focuses on, heat is created.   This heat can be utilized to cut the skin, burn the upper layers of skin off, heat the deeper layers of the skin, and destroy blemishes.

Lasering the upper layers of the skin can create a powerful exfoliation, essentially removing these upper layers and their associated blemishes and fine wrinkles.  Eventually the upper layers of the skin grow back within a week or two, smoother and clearer than before.  When the heat of a laser reaches the deeper skin, it denatures, or breaks down collagen which are the building blocks of skin.  When the collagen reforms it becomes tighter and more packed.  This results in tighter skin with less looseness.

So essentially all facial lasers are used to (1) burn off the upper layers of skin with their associated blemishes and wrinkles and/or (2) heat the deeper layers of skin to tighten the collagen.

Here are the general types of lasers and what they can do for you.

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

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

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

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

Make sure to always choose a surgeon certified by The American Board of Plastic Surgery and do your homework.  You only have one face!

Anthony Youn is a plastic surgeon who blogs at Celebrity Cosmetic Surgery and is the author of In Stitches.

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