Laser skin resurfacing and other rejuvenation treatments use pulses of light to revitalize the skin. These treatments are used for a variety of cosmetic and condition-based concerns.

What is laser skin resurfacing?

Laser skin resurfacing and laser rejuvenation are nonsurgical procedures used to improve the appearance of the skin. Many laser treatments stimulate the production of collagen, a protein that gives skin structure and elasticity. Laser skin treatments can address a variety of skin conditions, including:

• Acne
• Burn scars
• Hidradenitis suppurativa
• Melasma (dark brown to gray-brown, symmetric patches of pigment on the face)
• Residual pigmentation, including:
  • Age spots
  • Birth marks
  • Cafe au lait macules
  • Hyperpigmentation
  • Keratosis
  • Liver spots
• Vascular lesions, including
  • Port-wine stains
  • Rosacea
  • Telangiectasias
• Scarring
• Spider veins and leg veins
• Sun damage
• Uneven skin tone and texture
• Wrinkles

Laser treatment can also be used for tattoo removal and hair removal. However, lasers do not treat sagging skin.

Types of Laser Treatments for Skin

Many different types of laser treatments are available. Each works in a slightly different way, but they generally fall into two groups: ablative and nonablative lasers.

Ablative Lasers

Ablative lasers use targeted beams of laser energy to vaporize the top layers of the skin to reveal healthy new skin below. (Ablation is the removal or destruction of normal tissue.) The treatments can also stimulate the production of collagen.

Treatment: These treatments can have dramatic effects, but recovery can be lengthy. Most people only need one treatment with an ablative laser. Healing can take four to six weeks. However, the results can be significant, and improvements often last for years.

Conditions treated: Ablative lasers are effective at treating a variety of concerns, including scars, wrinkles, discoloration and uneven skin texture. Ablative lasers may also be used to treat some types of skin cancer or precancerous growths.

Common ablative lasers include:

CO2 Lasers

Carbon dioxide (CO2) lasers are widely used for laser skin resurfacing. They are effective at treating scars and burns, as well as signs of aging, especially deep wrinkles. One downside of CO2 lasers is the risk that they can cause hypopigmentation (light spots), especially in people with darker skin. For this reason, they are most often recommended for people with lighter skin tones.

Erbium Lasers

Erbium lasers, also known as erbium-YAG or Er:YAG lasers, are newer treatments used for skin resurfacing. Erbium lasers are less likely than CO2 lasers to cause hypopigmentation, though it can occur in some people. While erbium lasers can improve mild and moderate facial wrinkles, they tend not to work as well as CO2 lasers for deeper wrinkles. Erbium lasers are effective for treating burns or scarring.

Nonablative Lasers

Nonablative lasers apply heat and/or light to the surface of the skin without destroying its top layers.

Treatment: Nonablative treatments are gentler than ablative lasers, and the results are less dramatic. Individuals may need four to six sessions with these lasers, with results emerging gradually. Compared to ablative lasers, however, these gentler options result in fewer side effects and shorter recovery times. Nonablative lasers do not pose a risk of hypopigmentation, so they are suitable for people with darker skin tones.

Conditions treated: Like ablative lasers, these therapies can reduce discoloration, improve the appearance of wrinkles and enhance skin texture. Some nonablative treatments also stimulate collagen production.

Common types of nonablative lasers include:

Pulsed Dye Lasers

These lasers heat and destroy small blood vessels in the skin. This makes them a good choice for treating red discoloration such as rosacea, spider veins and hemangiomas. These lasers can also improve the appearance of acne, scars and stretch marks.

Intense Pulsed Light Therapy

Intense pulsed light (IPL) therapy is not a true laser, but a treatment that uses pulses of light across a broad spectrum. Because IPL emits light across many wavelengths, it is useful for treating a wide range of skin types and conditions, including acne, discoloration, uneven texture and fine facial wrinkles. The treatment is also used to remove unwanted hair.

Nd:YAG Lasers

The Nd:YAG laser is commonly used for skin rejuvenation. It avoids damaging the top layers of skin. Instead, it penetrates deep into the skin to stimulate collagen production. Nd:YAG lasers are effective for treating wrinkles, acne and acne scars. They are also used to remove unwanted hair.

Red Light Therapy

Red light therapy is not a true laser. This gentle treatment uses a light-emitting diode (LED) to emit red light into the skin. The treatment may stimulate collagen production to improve wrinkles and skin texture. It can also be used to treat acne. Red light therapy devices are sold for home use, but those are typically less powerful than the red light treatments used by doctors.

Nonablative CO2 Lasers

These are similar to ablative CO2 lasers because they are used for skin resurfacing. Because they are nonablative, their effects may not last as long, but they are gentler and have faster healing.

Fractional Lasers

As laser technology has advanced, new tools have been developed to reduce side effects. One important development is the creation of fractional lasers, also known as fractionated lasers.

Traditional lasers apply a solid beam of energy across the entire area of skin being treated. They are sometimes described as full-field lasers. By contrast, fractional lasers deliver laser energy in a series of narrow columns across the area being treated.

Imagine a fractional laser applied to the face in a polka-dot pattern, for example, with the skin between the dots untreated. This method produces results that are similar to full-field lasers, but with a smaller dose of laser energy overall. As a result, individuals may experience fewer side effects and shorter recoveries after treatment with fractional lasers.

Both ablative and nonablative lasers are available in fractional and nonfractional versions.

Risks and Side Effects of Laser Skin Resurfacing

As laser technology has improved, skin resurfacing and rejuvenation procedures have become safer. These treatments still pose some side effects and risks, however, including:

• Infection
• Itching or pain
• Peeling
• Redness and swelling
• Scarring
• Skin darkening (hyperpigmentation) or lightening (hypopigmentation)
• “Weeping” (oozing fluid) and crusting

To reduce the risk of infection, individuals shouldn’t have laser treatments if they have an open wound, active infection or active acne breakout. Some medications can interfere with healing, so it’s important to share medication history with your doctor before the procedure.

What happens during a laser skin resurfacing procedure?

Laser treatment procedures vary depending on the type of laser and the area of skin being treated.

Nonablative Procedures:

Individuals who receive milder, nonablative treatments are typically awake for the procedure. Depending on the treatment, you may be given a topical numbing cream to reduce discomfort.

People usually wear special goggles to protect their eyes from the laser’s light. The treatments typically take less than 30 minutes. During the treatment, you may feel a slight stinging or snapping sensation as the laser pulses against the skin.

Ablative Procedures:

During more aggressive ablative laser procedures, individuals are sometimes sedated or given general anesthesia. Those who are awake during the treatment receive local anesthesia to numb the skin. People also wear goggles to protect the eyes.

You might hear a snapping sound or feel slight stinging as the laser vaporizes the top layers of skin. The surgeon and the team will gently wipe away discarded layers of skin. Following the treatment, they will cover the treated area with protective ointment and gauze.

What to Expect After Laser Skin Resurfacing Treatment

It may take a week or more for the skin to heal after a laser treatment. Healing after ablative treatments can take four to six weeks.

During the healing process, the skin may be red, raw and swollen. Bleeding is usually minimal, but the skin might weep clear fluid or develop a crust. Over the next month or so, redness will fade and new skin will emerge.

After a laser treatment, it’s important to follow the doctor’s instructions to prevent infection and promote healing. Applying a cold compress to the skin may help ease discomfort. The doctor may prescribe antibiotic and antiviral medications to prevent infection.

Following laser treatments, follow these guidelines:

• Clean the skin gently, following the doctor’s instructions.
• Apply ointment as instructed for seven to 10 days to keep the face moist and speed healing.
• Take any medications as prescribed by the doctor.
• Contact the doctor if you notice symptoms such as fever, bleeding or excessive pain.
• Follow up with the doctor as instructed to monitor the healing process.
• Avoid sun exposure as you heal, according to the doctor’s recommendations.
• Use sunscreen every day to protect the skin.

What is the cost of laser skin resurfacing?

Many of the treatments for laser skin resurfacing are considered cosmetic, and insurance does not reimburse for these treatments. If your procedure is to treat burns and scars, discuss the treatment plan with your insurance provider.