What's the best laser for skin resurfacing?

Skin resurfacing implies that you want to have the outer most layers removed to expose the immature layers of the skin. The older outer skin is removed and the immature skin grows and heals the skin leaving fresher looking younger skin.

No single company has the best laser. The types of lasers that will resurface the skin are the Carbon Dioxide (CO2) or Erbium lasers. These are lasers that can precisely control the depth of skin removal. They will work the best. The more aggressive you are the deeper the laser will penetrate and more skin layers will be removed. The deeper you go, the longer the recovery, the more risk of permanent complications in the skin. So be very careful in your decisions about lasers and how deep you want to be treated.

We have had the best, longest lasting results with the least depigmentation, scarring and hyperpigmentation with the CO2 laser. While it is possible to perform this treatment under local anesthesia with nerve blocks, most of our patients opt for IV sedation with an anesthesiologist for greater comfort.

There are so many variables that it would be impossible to give a correct yet short answer. To be honest, you are not going to able to answer that question at all, even with a lot of research. Here is why:

There are many kinds of skin (light, dark, dry, oily, scarred, wrinkled, sun damaged, etc). There are many types of lasers, (CO2, Erbium YAG, etc). You need an expert with experience to help you figure out how to address the problems. Take a look at the answers below....every expert has a different opinion. In short, if they can't agree on which laser is the best, then you probably can't get the answer you are seeking.

Having said that, I really like my new Lux 1440 Laser from Palomar. Look at the reduction of crows feet on this patient after 1 treatment...with no anesthesia at all.... (see link below, upper left corner).

This is a patient of mine that was unhappy with her crows feet. After a single treatment, she feels her crows feet are better than they have been for years!

This question is like "What is the best hair style?". The answer is "It depends".

The gold standard laser for skin resurfacing used to be the CO2 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.

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

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! One trick pony only knows one trick!

The best laser for skin resurfacing varies depending on the skin type and the condition of the skin.  You should consider a practice that can offer a choice of lasers or that can combine different modalities to produce optimal results.

I do not think there is a particular best laser for resurfacing. They all have advantages and disadvantages. A good physician will have a choice of multiple resurfacing options available to the patient with an option that is tailored to that specific patient.

I have a choice of multiple modalities to offer my patients and I will offer options to my patients by outlining the pro/cons to each procedure.

I regularly get patients coming to me saying that they went to Dr. X and was told that Laser A is the best. That is because they only have Laser A. What about Laser B, C, D or E?

I think the best laser for resurfacing is the one that has been picked after a thoughtful discussion with the patient.

There may not be a best device. It may be that one physician obtains better results using a particular device while another physician prefers a different device because, in their hands, they are able to produce better results with the latter.

In the past, deep chemical peels were performed using phenol and other chemicals. Tightening was seen commonly, but the skin developed a significant lightening of coloration permanently and there is some risk to the heart’s rhythm when this procedure is performed.

Carbon dioxide laser was developed more than a decade ago but people found that this second degree burn often produced an unsatisfactory white skin color after a delay of one year.

Scarring has occurred as a result of both the deep chemical peel and carbon dioxide laser. The recuperation was 10-12 days with both of these procedures and bright redness remained for close to a year in some patients.

Newer, less invasive procedures such as fractional laser resurfacing and Portrait plasma thermal resurfacing produce nice results with healing that requires 3-7 days. The prevalence of scarring is much less with these procedures.

The texture of the skin after resurfacing has never looked as natural and vibrant when procedures other than Portrait plasma or fractional resurfacing had been performed. Make sure that you consult with a physician who has a significant experience in the use of these modalities.

I've read through all the answers on this page and they are excellent. In the interests of saving time, let's go through the bullet points:

• The right laser depends on what you are treating (redness, brown spots, wrinkles, laxity, etc.)

• The laser should be used by a physician with adequate training, experience, and credentials

• Sometimes laser is not the best option, therefore it is important to see a physician who has different options and can offer you the one that is right for you. Sometimes a chemical peel or dermabrasion is a better choice

• Different doctors have different lasers. Unfortunately, the truth of the matter is that nobody can afford to buy all the available lasers and have them all sitting in their offices. Hopefully your doctor has a good machine and even more importantly, sound judgment.

• The same technology, for example, fractionated CO2, now is available from different manufacturers. Active FX and Deep FX has a fair representation on this page, and I believe, it is currently the best option for fractionated CO2 resurfacing. It is good for lines, wrinkles and some scars.

• To make sure your doctor is using the right laser on you, look at some before and after pictures of prior patients, and make sure you have an extensive conversation with your doctor about all the options and their risks and benefits.

Active and Deep FX fractionated Laser Resurfacing is in my opinion the best laser for skin resurfacing.

I love the Contour Laser manufactured by Sciton.

The Contour laser is really two lasers in one. It has both a short pulse Erbium laser - and this is the conventional Erbium laser available under many names - and additionally it has a long pulse Erbium laser.

The longer the pulse, the higher the energy delivered to your skin, and the more effective the correction.

By varying the settings, I can individualize how much each of the two lasers within the Contour Laser come into play. Therefore, I can create a personalized treatment plan for each patient's skin.

We have treated hundreds of patients with the Contour Laser with uniformly good results and no pigment problems. Other lasers are associated with unacceptable bleaching of the skin, and we have not seen this bleaching with the Contour Laser.

There are many different kinds of resurfacing lasers. Many are similar, yet there are several taht do very different things.  In the early years of resurfacing, CO2 lasers were the hot thing( no pun intended).  Them erbium lasers came in with a more controlled resurfacing mode.  (I have an erbium and can do light peels as well as deep peels that are very controlled). Still, there are more choices in the last couple of years.  Now there are Fraxel lasers which can combine CO2 or Erbium technology to offer different options.  There are also Rhytec plasma lasers.  All these lasers can give excellent results using safe parameters.

Before you consider any skin resurfacing procedure, educate yourself in various options, ask for patient before and after photographs, be very clear about recovery time, know risks and all possible complications. If posible, ask to persoanlly speak to at least two other patients who have had the procedure done before you.

Skin resurfacing is a very aggressive approach to reversing many signs of aging and if done by an experienced, well trained physician can have remarkable improvements in several signs of aging:

• Fine and deep lines
• brown sun spots
• rough skin texture
• acne and surgical scarring
• tightening of skin with improvement of jowls, eyelids etc.
• treatment of superficial skin lesions such as Actinic keratosis, Viral papilloma etc.

Common resurfacing procedures are

• CO2 laser , very agggressive, usually done in Operating room with IV or general anesthesia, long (4 to 6 week ) recovery period. Leads to obvious bleaching of treated skin. Not suitabel for off face areas such as neck, chest etc.
• Fractional lasers, done in the office, most need a series of treatments, results are not as impressive as CO2 laser in treatment of deep wrinkles, facial elasticity, sacrs etc.
• Rhytec Plasma skin regeneration is a new technology that uses Plasma energy to evenly heat superficial and deeper layers of skin. The treatment is done at your physician's office with local anesthesia and oral sedation. The difference between this treatment and an ablative laser is that with plasma, your skin remains intact and forms a biological dressing which promotes faster healing of deeper skin. The superficial skin falls off within 4 to 6 days removing all superficial skin lesions aand improving skin texture. The deeper skin starts a process of new collagen regeneration. A single high energy treatment is sufficient for significant improvement of deep wrinkles, brown spots, facial elasticity and superficial skin lesions. Furthermore, unlike CO 2 laser, the treatment does not lead to depigmentation (skin bleaching) and is safe and effective for off face use (neck, chest and hands).  With only 8 to 10 days of down time and cost of $ 4000 to $5000 for face and neck, the results are quite impressive!

 When choosing the right procedure, several factors have to be considered

• Skin type, light vs dark
• extent of photoaging mild, moderate or severe
• Downtime for recovery
• Budget

CO2 Laser

In our practice we are very happy with the Active FX fractional CO2 laser. It provides our patients with most of the benefits of the CO2 laser without the downsides. However, no laser will be as successful at obtaining the fabulous results of a well done CO2 laser. But then again, those patients suffered from long recovery periods and very obvious hypopigmentation ("bleaching") problems.

When you are deciding on what laser to use, you have to ask yourself 3 questions:

1. What level of results do I want?
2. What downtime can I tolerate?
3. How much do I want to pay?

Light therapies (BBL, IPL, etc.) are cost-effective, short downtime procedures. However, they require multiple trips, are very operator dependent, and can cost a lot after a while.

Fractional technologies (erbium and CO2) can provide more significant improvements, but have levels of recovery measured over 4-10 days. Patients usually need one or two treatments, but the treatments are significantly more expensive.

Full ablation technologies (erbium and CO2) create the best results but have downtimes in the 2-3 week range with long-standing redness. They are painful enough to often need IV sedation and a trip to the OR significantly raising the cost of treatment. One treatment is usually all that is necessary though.

I hope this helps you.

Because surgery alone cannot correct the tone and texture of your skin, a laser resurfacing procedure to reduce the signs of aging skin allowing it to assume a more rejuvenated, refreshed appearance is often recommended.

Laser skin resurfacing is used to remove areas of damaged or wrinkled skin. This process gently removes skin imperfections and dramatically reduces lines and wrinkles, while using the most advanced technology available and providing safe and effective treatment to the skin. Sun-damaged and aging skin can be removed, layer by layer, helping to protect and stimulate regeneration of deeper more healthy skin.

Many facial conditions, such as fine wrinkling around the eyelids, forehead, nose and mouth can be made smother with this simple process. Deep laugh and frown lines can be minimized. Even the lingering effects of acne scars can be successfully treated with laser resurfacing.  In addition, pigmented skin lesions due to age and sun exposure and red spots can be eliminated.

Laser resurfacing may be performed on the entire face or only in specific areas. Often the procedure is done in conjunction with other cosmetic procedure such as eyelid or facelift surgery.

There are many different lasers on the market and different lasers that are designed to treat different problems.  The gold standard for laser skin resurfacing has been the CO2 laser. This still remains the gold standard for laser skin resurfacing, however new laser technology has improved this laser. 

As mentioned above, CO2 laser skin resurfacing is best for treating and eliminating :

• Fine lines and wrinkles
• Sagging skin
• Acne scarring
• Pigmentation (sun damage spots) 

It also helps to produce a more even surface and tone to the skin itself. Although patients have always enjoyed a fantastic result from CO2 laser skin resurfacing, its drawbacks have been the downtime and persistent redness for up to 6 months.

Recently, a fractionated CO2 laser became available which has allowed physicians to produce the same results as the ultrapulse (original) CO2 laser but with much less downtime and redness. The fractionated CO2 laser has also allowed us to perform the procedure in the office under topical anesthesia rather than in the operating room under general anesthesia, which is traditionally how it has been performed in the past. With the new fractionated CO2 laser, we are able to control the depth of penetration of the laser depending on individual patient needs, and this has created greater patient satisfaction.

Of course there are many other lasers out there and a consultation with your doctor to determine your individual needs will always give the best results. You should ask yourself what is it that is bothering  you, be it brown spots, acne scars, blood vessels or fine lines and wrinkles. Your doctor should not only take your concerns into consideration but also consider your age and the degree of collagen and elastin loss.

If you have a few brown spots that you desire to eliminate and are young, you may consider a laser that will just target those few brown spots. However, if you have fine lines, wrinkles, age spots and desire a skin tightening effect, you may want to consider the fractionated CO2 laser resurfacing. Again, consider your age and what it is that is bothering you and be honest with your doctor so he or she can treat you with the most effective laser for your individual needs.

Fraxel Re:pair is at the cutting edge of the future of facial plastic surgery. It is the best and latest laser available for skin resurfacing. It combines the gold standard carbon dioxide laser with the new fractionated laser technology. It is not only delivered to the skin in a fractionated manner (like pixel dots making up a picture), but the physician can use the control dials to use a "fraction" of the laser energy depending upon the individual patients need.

Make sure to choose your physician carefully as this is a most powerful laser technology.

For best wrinkle and tightening results, ablative laser resurfacing is needed.  Ablative means to remove or vaporize tissue.  There are now a few lasers that do fractional CO2 resurfacing - the Fraxel re:pair, Lasering Mixto, and the Deep Fx. 

Of these, the Fraxel re:pair has more density ability - up to 70% of skin resurfaced vs 25% for the Mixto and 30% for the Deep Fx.  The Fraxel re:pair can also go deeper - 1.6mm, vs 0.7mm for the Mixto, and 1mm for the Deep Fx.

Deeper and more density, mean more downtime, but better results.  Also, Fraxel has 2 years of data on their laser, the other 2 have minimal data. 

Side effects and risks have been minimized using the Fractional technololgy for the Fraxel re:pair according to their research of over 500 patients over 2 years.  There have been no incidences of hypopigmentation or scarring.  Recovery time is about 1 week.

In my opinion, the Fraxel is currently the best laser for resurfacing, if you can afford the 1 week of downtime.

The ActiveFX is a fractional resurfacing technique where a high-energy beam of laser light interacts with the skin's surface, causing the upper layer to peel off and regenerate a layer of new, healthy skin.

ActiveFX Benefits:

1. Causes immediate skin tightening and more tightening then 5 treatments with the Fraxel, Portrait, and Refirme
2. Instant results in one treatment with 5 days of downtime
3. 20 minute procedure time for full face
4. Only FDA approved device to stimulate new collagen
5. Vaporizes lines, wrinkles, acne scars, dark spots, skin laxity and discoloration

In summary, the ActiveFX is the most effective skin resurfacing device available today.

For more aggressive rejuvenation, more focus is now being directed to the myriad of laser treatments now available which can essentially dial in depth of penetration and very closely define downtime while still providing dramatic results. An example of this is the new fractioned lasers which can essentially treat facial aging using a grid pattern which leaves normal skin in-between treated areas. The result is less downtime and much faster healing.

One of the lasers that is showing a significant amount of promise in this area is the Lumenis ACTIVE FX laser. This device delivers a grid treatment pattern using the pulsed carbon dioxide laser leaving normal, untreated areas in-between. The results so far have been dramatic and even show promise in treating acute and chronic scars.

For skin resurfacing there are two main types of lasers, carbon dioxide (CO2) and erbium.

• CO2 skin resurfacing is the most aggressive and produces the most dramatic results but also requires longer healing times.
• Erbium resurfacing is gentler and produces good results with quicker recovery.
• There are lasers, such as the Derma K laser, which combine the advantages of both CO2 and erbium into one laser.

To some extent, the answer to this question depends on how much downtime you can afford and how difficult your condition is to treat.

CO2 resurfacing and deep chemical peels are the most aggressive form of resurfacing treatments available. They can also have up to several weeks of healing time. These treatments are generally reserved for those patients with very, very deep wrinkles (think the Marlboro man at 80 years old).

Erbium and fractional resurfacing are the second tier of resurfacing treatments and involve a moderate amount of downtime (3-7 days). The procedures do not require bandaging and do not reguire general anesthesia like CO2 resurfacing would. Results for these two types of resurfacing will be less dramatic than with CO2 resurfacing would be, but are much easier to recover from. These procedures are used for cases of mild to moderate acne scars and wrinkles.

Non-ablative (no downtime) resurfacing options, such as microdermabrasian, non-ablative lasers, and mild chemical peels, all accomplish some form of resurfacing although for acne scars and wrinkles, the results of these treatments are much less dramatic than the first two options, Erbium and CO2. These procedures would be used for mild cases of acne scars and wrinkles wher no downtime is a requirement.