What's the Best Laser for Skin Resurfacing?

The new fractional lasers are becoming very popular and rightfully so. These methods (Erbium based or CO2 based) offer much quicker healing time and recovery period but with serial treatments are required.

The gold standard laser for skin resurfacing used to be the c02 laser. But because of its aggressiveness, long healing period, and eventual hypo-pigmentation, it is not very mainstream any more. Erbium resurfacing is more gentler and with repeated treatments, you can achieve similar results. At the same time, the old and time tested chemical peels are excellent less expensive way to re-surface your skin. Whatever method you choose, the doctor must know the different types of skins to avoid unnecessary complications.

Ablative co2 laser skin resurfacing came first, gave great results, but fell somewhat out of favor as hyperalimentation occurred a year or so after treatment. Wrinkles, spots, and sun damage still gone, but line of demarcation where treatment stopped, and lighter skin color where treatment was done. 

Ablative erbium laser resurfacing came next, but treated much more superficial layers, so skin healed faster, with less redness, but with less dramatic changes. If the doctor promoted this as "better than CO2" and charged as much, patients were unhappy, but not because the laser had a "problem" other than milder results. Bad doctor "marketing!"

By the time that third-generation combination CO2/erbium-YAG lasers came along about ten years ago, the herd of dermatologists, plastic surgeons, and other laser doctors had moved on to the "non-ablative" lasers or therapies such as Thermage, N-lite, Cool-touch, Smoothbeam, Fotofacial, and many others. These all "worked" to varying degrees, but usually with very minimal results. Prices dropped, and so did most of the hype, and "the herd" of doctors that need the "latest and the greatest" moved on to fractional laser resurfacing.

Fractional lasers started with Erbium wavelengths, and treated the skin in tiny polka-dots. Bridges of intact skin were left untreated, which is said to promote faster healing and less down-time (partially true). Actually, less skin treated = less result, which required multiple treatments, which = more procedures, more healing and MORE cumulative downtime. Oh, and the total cost adds up to a tidy sum usually! The results are real, but with superficial layer and polka-dot treatment came mild results. More, give us more!

The next fractional lasers returned to CO2 wavelengths, which penetrate deeper, and still treated skin in tiny polka-dots. Fortunately, unless the energy was turned up too much, or the polka-dot density too tight, hyperalimentation changes were limited, and the results were indeed better. Still only in the fraction of the skin treated, still requiring more than one treatment for results that could approach that of well-performed third-generation combination CO2/Erbium-YAG ablative laser rejuvenation, and still adding up to a tidy sum for only "fractional" results. 

The best one is the one that suits your particular needs and your budget. Consult with a physician who has multiple lasers at his disposal. This is very important because if he only has one laser, he will obviously be very biased towards that particular laser he owns! In order to find the best laser treatment for you, look for a plastic surgeon with significant experience in aesthetic lasers treatments, aesthetic plastic surgery and non-surgical aesthetic enhancement treatments.