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.
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 HairFacts.com’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.
Ablative
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. “[Patients] 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.
Nonablative
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.
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Fractionated
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 [recovery time] 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.
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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, [light therapy] 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.
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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.
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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.”
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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.
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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 [at some point]. 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.
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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.”