Minneapolis Laser Resurfacing doctors

You have had the perspective of two procedures with the same machine, same doctor, and same target area, so your experience does have some value in anticipating potential outcomes. Your doctor also sounds as if he is honest and forthcoming about the reasons your experience was so different the second time around.

"New gas" means a rejuvenated laser tube for the resonating chamber, which in this case is a CO2-containing laser tube. This means a stronger beam for otherwise identical settings. However, most lasers have internal "check and balance" sensors that keep the actual energy output within specified tolerances of the front panel readings. So, all things otherwise being equal, the output should be very close for identical settings with an "old" tube and a refreshed, re-gassed laser tube.

So, the real difference here is the "new protocol." Some laser surgeons use "standard" settings suggested by the laser manufacturer, and these are usually quite conservative (read safe). Once more experience is gained, the laser operator utilizes tissue responses as the procedure is performed, and in cases such as yours, the very valuable experience gained by your first procedure. It sounds as if you had a more aggressive second laser procedure, and should expect a more dramatic result. Obviously, more agressive settings mean more dramatic results, but at the potential for longer healing and higher risk of scar formation. So everything is on a scale of judgement and experience.

By the way, this is not something you should worry about. Your laser surgeon's job is to convince you of his experience and capability, just as an expert race car driver is expected to make his own decisions about acceleration, braking, and speed. Each driver does this slightly differently, and only one driver wins the race, and many crash. But in this example, your laser settings are designed to give you the best result within the parameters of the operator's training and experience, and his desire to avoid complications in EVERY case, not just to barely scrape by and accept the occasional bad result--NOT acceptable.

It's not about the machine or the settings, it's about the skill and expertise of the operator!

I have extensive experieince with the Fraxel Repair (CO2) laser which causes skin tightening, especially in the thin skin areas under the eyes. I have also seen many cancer removal scars and Mohs'  flaps improve with the Fraxel, avoiding the need for scar revision.

The best rejuvenation results in my practice are achieved when the patient has Fraxel combined with volume enhancement, such as Sculptra. The combination is synergistic, adding volume below the skin layer to compensate for facial fat and bone loss with age.

You seem to have pretty realistic expectations, and the three classes of devices are RF (radio-frequency) like Thermage, Velasmooth (Velashape), Accent, Exilis, and perhaps others; external ultrasound like Ultrashape, Ultherapy, and others; and light-based (could be laser, LED, or infrared) such as Zerona, Titan, Smoothshapes, and others.

A fourth class could be considered combination devices, such as Velasmooth and Velashape which combine massage, RF, and infrared; Ultrashape (newest version 3) which combines RF and external ultrasound; ReFirme, which is IR and RF; etc.

Sometimes I consider these multiple-modality devices to be a sign of single-method ineffectiveness, so why not add another method? (Also good for marketing, which ALL of these devices have in common!).

Other times I consider combination devices to be evidence of combination therapy perhaps being better than individual, but you can look up each of these devices/treatments/methods here on RealSelf and see the "Worth-It" ratings. You will see that the best of these is Ultherapy at 89% "worth-it" and $2600 average cost, Exilis at 80% and $1300 average cost, Accent at 54% "worth-it" with an average cost of $2300, and the worst, Velashape at 31% and $1600 average cost, and Ultrashape at 36% and $2800 average cost. Most of the rest have a "worth-it" rating in the 30 and 40% range. ReFirme is at 50% and $900 cost. Thermage is at 40% "worth-it" and $2700 average cost, and Zerona 37% "worth-it" at $2100 cost.

Even Endermologie, an FDA-approved massage, diet, and exercise program for treatment of cellulite that has been available for years (we offer it in our skin and body clinics) has a worth-it rating of 48% at $1600 average cost!

You can also see that cost has virtually NO CORRELATION with effectiveness (if "worth-it" reviews are accurate, and the more of them there are, the more accurate they should be)!

Doctors don't typically administer any of these non-surgical treatments--this is obviously important when choosing a surgeon, but not for these non-surgical treatments where a technician will spend the proper amount of time (hopefully) with you. Experience of the technician and how long a clinic or spa has used  the device should guide you here. Don't fall for the "latest and greatest and up-to-datest" ploy of marketing by those who seek to sell you the Emperor's clothes!

Please read the "Not worth-it" reviews. Your eyes may be opened to the fact that there is a sucker in every crowd, and that even totally bogus treatments (placebos) can have positive results. Balance the risks and costs with your admittedly-realistic goals, and you may come to the conclusion that a nice new dress, (faux) fur coat, or cruise is a more rewarding expenditure of your money. Best wishes.