Q: Non-ablative laser resurfacing pros and cons

Pros There’s little to no downtime. You may have redness or mild swelling for anywhere from a few hours to a few days afterward (depending on the intensity of your treatment), but you should be able to return to your normal activities right away. A series of three to six non-ablative laser treatments, spaced a month apart, should lead to “very good to excellent results over the long term,” says Dr. Clevens. These less aggressive lasers can generally be used safely on all skin tones. Cons Depending on the setting your provider uses, you may still have significant redness for up to a week after treatment. You’ll have to commit to the series of treatments, over several months, to see significant results. Any laser facial treatment may trigger cold sores from the herpes virus. Your doctor can prescribe an antiviral medication, if you’re at risk. Because they still rely on heat, even these gentler treatments can flare melasma in certain patients.

Q: Ablative laser resurfacing pros and cons

Pros You typically need only one treatment to see a dramatic improvement, even for deep wrinkles and other signs of aging. The heat stimulates new collagen production, which firms mildly lax skin over time. It may help reduce the risk of skin cancer in the treated area. Cons You’ll have 7–12 days of downtime post-treatment. If you’re acne-prone, skin ablation may cause breakouts: the occlusive ointment you’ll need to apply in the days post-treatment can trap bacteria and oil. This treatment may also trigger an outbreak of cold sores, if you’re prone to them. Most doctors prescribe antiviral medication, to be safe. Ablative laser skin rejuvenation treatments are safest for those with lighter complexions (which tend to accrue the most sun damage). Those with darker skin types are at potential risk for side effects like hyper and hypopigmentation, especially with fully ablative lasers (versus fractional).

Question 1

What is laser resurfacing?

Accepted Answer

Laser skin resurfacing is a nonsurgical, in-office treatment that heats up the skin’s superficial and/or lower layers, to cause controlled microdamage and trigger the body’s healing response. The most aggressive versions of laser resurfacing completely remove the top layer of skin. As it regenerates, the skin’s tone and texture improve.

This treatment is commonly used to treat fine lines and wrinkles, hyperpigmentation, acne scars, certain types of dark circles, crepey skin, and dullness.

Some laser skin treatments can also help tighten mildly sagging skin, for a younger appearance.

Question 2

Ablative vs. non-ablative: Which laser treatment is right for you?

Accepted Answer

There are two primary categories of laser skin resurfacing treatments: ablative and non-ablative.

Ablative laser treatments

CO2 (carbon dioxide) or Erbium lasers remove the epidermis, the surface layer of your skin, while heating up the water molecules in the dermis (the lower layer) to trigger the healing response.
The CO2 typically outshines the Erbium in the treatment of scars and sagging skin, but a fully ablative treatment can be so aggressive that it requires general anesthesia and up to two weeks of downtime while new skin forms.
The Erbium is less aggressive than the CO2, so it can be performed with a local anesthetic and may come with less downtime.
Both types are recommended only for people with fair skin (Fitzpatrick types I-III).
Ross Clevens, a facial plastic surgeon in Melbourne, Florida, explains that ablative lasers can deliver a dramatic improvement of deeper wrinkles, significant sun damage, or sagging skin in a single treatment. He commonly combines ablative resurfacing with another type of facial plastic surgery, like a facelift, because healing from both surgery and skin resurfacing simultaneously is more efficient.

Related: The Return of the CO2: Why These Next-Level Lasers Are Making a Comeback

Non-ablative laser treatments

Clear + Brilliant, Laser Genesis, the Neo Elite Aerolase, and similar treatments leave the epidermis intact, heating only the dermis.
These gentler treatments are suitable for all skin tones and complications are rare. They also come with little to no downtime.
The only drawback: you’ll need a series of treatments to see significant results.

Fractionated lasers

Fraxel, Halo, and other fractionated lasers break their energy into thousands of tiny beams that target a fraction (20–40%) of the skin at one time. This diminishes trauma to the skin and speeds healing.
They can be ablative, non, or a hybrid, as is the case with Halo.
“Fraxel, the most well-known fractional laser, “is used ablatively with the Fraxel Repair CO2 laser or non-ablatively with the Fraxel Dual/Restore laser,” according to Dr. Ron Shelton, a dermatologic surgeon in New York City.
An ablative fractionated laser will still leave you red and raw, but downtime is typically much shorter than with traditional CO2 laser skin resurfacing: between a few days and a week, depending on the intensity of your treatment.

Question 3

Non-ablative laser resurfacing pros and cons

Accepted Answer

Pros

There’s little to no downtime. You may have redness or mild swelling for anywhere from a few hours to a few days afterward (depending on the intensity of your treatment), but you should be able to return to your normal activities right away.
A series of three to six non-ablative laser treatments, spaced a month apart, should lead to “very good to excellent results over the long term,” says Dr. Clevens.
These less aggressive lasers can generally be used safely on all skin tones.

Cons

Depending on the setting your provider uses, you may still have significant redness for up to a week after treatment.
You’ll have to commit to the series of treatments, over several months, to see significant results.
Any laser facial treatment may trigger cold sores from the herpes virus. Your doctor can prescribe an antiviral medication, if you’re at risk.
Because they still rely on heat, even these gentler treatments can flare melasma in certain patients.

Question 4

Ablative laser resurfacing pros and cons

Accepted Answer

Pros

You typically need only one treatment to see a dramatic improvement, even for deep wrinkles and other signs of aging.
The heat stimulates new collagen production, which firms mildly lax skin over time.
It may help reduce the risk of skin cancer in the treated area.

Cons

You’ll have 7–12 days of downtime post-treatment.
If you’re acne-prone, skin ablation may cause breakouts: the occlusive ointment you’ll need to apply in the days post-treatment can trap bacteria and oil.
This treatment may also trigger an outbreak of cold sores, if you’re prone to them. Most doctors prescribe antiviral medication, to be safe.
Ablative laser skin rejuvenation treatments are safest for those with lighter complexions (which tend to accrue the most sun damage). Those with darker skin types are at potential risk for side effects like hyper and hypopigmentation, especially with fully ablative lasers (versus fractional).

Question 5

How much is laser resurfacing?

Accepted Answer

Your laser skin resurfacing cost will depend on what type of laser your dermatologist uses, how many treatments you need, and a few other key factors.

You can finance your treatment.

See our complete guide to laser resurfacing costs

Question 6

Laser resurfacing before and after pictures

Accepted Answer

The laser resurfacing photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 7

What happens during a laser resurfacing treatment?

Accepted Answer

The details of your treatment will depend on the type of laser your provider uses.

For an ablative laser skin resurfacing treatment:

Prior to your appointment, your doctor—ideally a board-certified dermatologist or plastic surgeon—may prescribe an antiviral medication (if you are prone to cold sores) plus an antibiotic, to reduce the risk of infection.
Some doctors may have you use a topical retinoid or lightening cream like hydroquinone for a month prior, to help boost cell turnover and prevent hyperpigmentation.
Most will also ask you to stay out of the sun for two to four weeks prior to your treatment and for at least a month afterward, because a tan could lead to pigmentation problems.
Ablative laser skin resurfacing is usually performed in a doctor's office or operating room.
Depending on the intensity of your treatment plan, you’ll either be given a local anesthetic with sedation or general anesthesia (though the latter is increasingly rare).
Your provider will then use the laser to remove the outer layer of your skin, as well as heat the lower skin layers. This triggers a natural healing response, stimulates collagen production, and causes existing collagen fibers to shrink, tightening and smoothing your skin from the inside.
The treatment can take from 30 minutes to two hours, depending on the size of the area.
Afterward, your doctor will apply a thick ointment and, often, a dressing. You’ll need to arrange for someone to take you home.

For a non-ablative laser skin resurfacing treatment:

Your dermatologist may apply a numbing cream to your face, and you’ll wait about an hour for it to take effect. Some people opt for additional pain medication like Advil or request anti-anxiety medication.
Once the area is numb, your doctor will glide the laser across the treatment area, heating the collagen in the lower layers of the skin to stimulate production and tighten existing collagen fibers.
The treatment can take between 15 minutes and two hours, depending on the laser and the size of the area you’re treating.

Question 8

How long does laser resurfacing take to heal?

Accepted Answer

Your recovery time and aftercare instructions will depend on the type of laser resurfacing you’ve gotten.

Recovering from an ablative treatment:

Expect to need up to two weeks of downtime while your skin heals, says Dr. Shelton.
Your skin will look severely sunburned, and it may be raw, swollen, itchy, and blistered.
It may even ooze for a few days, followed by crusting and peeling. Resist the temptation to pick or scratch your skin during the healing process; this can cause scarring.
For the first few days, you’ll also need to be especially diligent about hygiene and skin care. Cleanse your skin several times a day with a saline or vinegar solution, followed by a moisturizer, as directed by your doctor.
Los Angeles facial plastic surgeon Dr. Jacob Sedgh says, “Keeping the skin moist and lubricated promotes faster healing. Vaseline and Aquaphor are two of the most commonly used topicals with minimal reactivity and sensitivity issues. In cases when risk of infection is considered to be higher, vinegar soaks play a role too.”
Some swelling is also normal. Sleeping on an extra pillow and applying ice packs may help alleviate it.
If your swelling is more extreme, your doctor may prescribe steroids, to calm down the inflammation.
After 10 to 14 days, when most of the peeling is done, you can usually start wearing oil-free makeup to hide any redness.
Your skin may remain pink for several months, especially if you’re naturally fair-skinned.
Slather on a broad-spectrum sunscreen (SPF of 50 or higher) daily, wear a wide-brimmed hat, and avoid the sun as much as possible, to protect your new skin.
Many people choose to have laser skin resurfacing in fall or winter, when UV rays are less intense and there’s less risk of unintended sun exposure (high-SPF sunscreen is still a must, however).

Recovering from a non-ablative laser resurfacing treatment

You should not have significant downtime or need any time off work after this type of laser skin resurfacing.
Your skin will be a bit red and swollen for a few hours or a few days, and possibly darken and flake in spots.
Taking ibuprofen, using moisturizing cream liberally, and applying ice packs should help quell redness and swelling.
As with all laser procedures (or any cosmetic procedure, for that matter), sunscreen and sun avoidance are critical components of aftercare.

Question 9

How soon will you see laser resurfacing results?

Accepted Answer

You’ll see ablative laser resurfacing results once the peeling and (some of) the redness has subsided post-treatment: usually after 10–14 days.

You’ll see optimal results in three to six months; it can take that long for all new collagen to develop.

Non-ablative laser resurfacing results appear over the course of several months, so they may feel more subtle than those from an ablative treatment. But once you’ve completed your series of treatments, you should notice a significant difference in skin tone and texture, with further improvement for several more months.

Most RealSelf members say that laser skin resurfacing (both types) are “Worth It,” reporting such improvements as a reduction in fine lines and wrinkles; more even tone; softer skin; smoother texture; diminished scarring; and tighter, firmer skin.

See laser resurfacing before and after photos

Related: The Treatments and Ingredients Actually Proven to Reduce Wrinkles

Question 10

How long does laser resurfacing last?

Accepted Answer

Laser skin resurfacing treatment results should last several years, though nothing will stop the effects of time. “My ablative patients still see significant improvement in their skin as long as a decade beyond their procedure, while my non-ablative patients usually are ready for a touchup after two to five years,” says Dr. Clevens.

In both cases, Dr. Clevens says, daily and diligent sun protection is essential for maintaining results. He also suggests combining laser resurfacing with IPL (intense pulsed light) photofacial treatments, to keep sun damage or age spots under control.

Likewise, routine pulsed dye laser treatments can improve the skin’s overall appearance by minimizing red tones in the skin.

Question 11

What are the risks and side effects of laser resurfacing?

Accepted Answer

While laser skin resurfacing treatments are considered safe when done by a board-certified dermatologist or plastic surgeon, people do (very rarely) have infections, acne breakouts, or other problems during healing, particularly with ablative facial laser procedures.

Additionally, patients with olive, brown, or deep skin tones run the risk of developing hyperpigmentation after ablative laser resurfacing. There’s also some risk of deepening pigment on light skin that’s tanned and worsening melasma in those who are prone.

Ask your doctor to outline these risks and develop a plan to minimize them.

Related: Top Cosmetic Treatments for Deep Skin Tones

Question 12

What are some alternatives to laser resurfacing?

Accepted Answer

Consider these nonsurgical skin treatments for rejuvenation too, if improved tone and texture is your goal.

Microdermabrasion sloughs away dead skin cells manually, using crystals or diamond microparticles.
Chemical peels come in a range of strengths and remove layers of skin to reveal fresh, new skin beneath.
Microneedling punctures the top layer of your skin with tiny needles, creating micro injuries that stimulate your skin’s healing response and boost collagen and elastin production.
RF microneedling delivers radiofrequency energy into the dermis via the tips of tiny needles to further enhance collagen production.

Related: Chemical Peel vs. Laser: Which Treatment Is Right for You?

Question 13

Sources & studies

Accepted Answer

Elsaie, Mohamed Lotfy, and Heather Woolery-Lloyd. “Latest Laser and Light-Based Advances for Ethnic Skin Rejuvenation.” Indian Journal of Dermatology, vol. 53, no. 2, 2008.

Preissig, Jason, et al. “Current Laser Resurfacing Technologies: A Review That Delves Beneath the Surface.” Seminars in Plastic Surgery, vol. 26, no. 03, Aug. 2012.

Tanzi, E, et al. “Fraxel Laser Indications and Long-Term Follow-Up.” Aesthetic Surgery Journal, vol. 28, no. 6, 2008.

LASER RESURFACING

Ronald Shelton, MD

Genevieve Monsma

Ronald Shelton, MD

Genevieve Monsma

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	Neo Laser nonsurgical	CO2 Laser nonsurgical	Clear + Brilliant nonsurgical	Halo Laser nonsurgical	Laser Genesis nonsurgical	Fraxel Laser nonsurgical
Worth It Rating	Not yet available	87%	57%	85%	95%	71%
Average Cost	Not yet available	$3078	$1150	$1732	$771	$1433
Downtime	No downtime	1–2 weeks of downtime	No downtime	2–7 days of downtime	No downtime	Up to 1 week of downtime
Anesthesia	No anesthesia	Local or general anesthesia	Topical anesthesia (if needed)	Topical anesthesia	No anesthesia	Topical anesthesia

	Microdermabrasion nonsurgical	Chemical Peel nonsurgical	Microneedling nonsurgical
Worth It Rating	92%	83%	86%
Average Cost	$177	$438	$950
Downtime	No downtime	Up to 2 weeks of downtime	1–3 days of downtime
Anesthesia	No anesthesia	No anesthesia	Topical anesthesia

Ronald Shelton, MD

Genevieve Monsma

Ronald Shelton, MD

Genevieve Monsma

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