When the dark spots, wrinkles, or sagging get to a point where you need to address them stat, topical skin-care ingredients can only do so much. That’s where the pros come in. And in 2020, there’s a machine for every issue, each engineered to deliver dramatic results in a shorter amount of time than home remedies do. But with so many options to choose from, which one is right for you? We asked dermatologists to share their favorite tools for every skin concern.
For brown spots, try: YAG or picosecond lasers
A resurfacing laser, such as a YAG laser with a 532 or 755 nm wavelength, is your best bet for brown spots. “Often, I combine spot treatment with global treatment, for the best result—meaning I treat all over for mottled or dull color and treat the darkest spots with a second pass,” says New Orleans board-certified dermatologist Dr. Mary Lupo. The targeted pigment absorbs the laser energy, which then heats and destroys it. While sunspots are rare in skin of color, she recommends a gentler picosecond laser with a 1064 nm wavelength in these cases, to get results while minimizing further, incidental pigmentation that can be sparked by overly aggressive treatments.
Number of treatments recommended: two or three
What it costs: $675 per session, on average
For overall sun damage, try: fractional lasers
Fractionated lasers, such as Fraxel, can tackle all sorts of sun damage, from discoloration to fine lines. “Fraxel is my favorite laser for general sun damage. For hyperpigmentation or sunspots, that’s my go-to,” says Dr. Michele Green, a board-certified dermatologist in New York City, who prefers the non-ablative fractionated laser. It works by creating controlled injuries in just a fraction of the skin (roughly 25–40% of the skin’s surface). The remaining healthy cells kick-start the healing process, which stimulates collagen production and speeds skin cell turnover.
Number of treatments recommended: two or three (though even one makes a noticeable difference)
What it costs: $1,700 per session, on average
For redness, try: vascular lasers, like Excel V or Vbeam
Because redness typically results from blood vessels that have become enlarged or damaged, “the best in-office tool to address facial redness is a laser that uses a wavelength targeting the blood in the problematic vessels,” explains McLean, Virginia board-certified dermatologic surgeon Dr. Nicole Hayre, who’s a fan of the Excel V laser. “When the laser fires, it sends energy into the target area,” causing blood vessels to shrink. Dr. Green relies on the Vbeam, another vascular laser that uses pulsed dye energy, for patients with any sort of redness, including rosacea and red-toned scarring.
Number of treatments recommended: about five, one month apart (plus yearly maintenance sessions, to keep vessels at bay)
What it costs: $425 per treatment, on average
Related: 5 Best In-Office Treatments to Try If You’re Not Ready for Fraxel
For large pores, try: microneedling
Microneedling is a go-to for shrinking the appearance of pores. “The needles make tiny holes in the skin, which causes the skin to repair itself and grow more collagen,” says Dr. Hayre. “This helps to give the skin a more youthful look and can help with fine lines, thinning skin, and large pores.”
Number of treatments recommended: ra series of three, each a month apart
What it costs: $625, on average, for a series of three
For dullness and uneven skin tone, try: Clear + Brilliant
Dr. Lupo is a fan of the Clear + Brilliant, since a series of these treatments can make quick work of dullness and mild discoloration while also improving fine lines and large pores. It works similarly to Fraxel, but treats even less of the skin—just 20%—with very little downtime (a day of pinkness and sandpapery texture). Many dermatologists praise the mild-mannered Clear + Brilliant for its ability to improve melasma in certain patients without inciting rebound hyperpigmentation. (Derms vary in their approach to treating the stubborn brown patches, with some believing that “melasma is best treated with a series of chemical peels, along with use of appropriate topical products at home,” says Dr. Hayre.) For tackling brown and red tones simultaneously, Dr. Lupo likes IPL, or intense pulsed light—but stresses that this broad spectrum of light is safe and appropriate only for patients with light skin tones.
Number of treatments recommended: three to six
What it costs: $700 per session, on average
For deep lines and wrinkles, try: CO2 lasers
For deeply etched lines, Dr. Lupo recommends a CO2 laser, which is the most intensive treatment in the laser resurfacing category. “It works by ablating tissue into the dermis, causing a wound that requires healing with new collagen,” she says. She also gives patients the option of ablative or non-ablative CO2 laser treatments (the latter doesn’t impact the skin’s surface). When choosing between the two, says Dr. Lupo, her deciding factor is the downtime, which is longer with ablative lasers.
Number of treatments recommended: One CO2 treatment if fully ablative; two if non-ablative
What it costs: $2,700 per treatment, on average
For acne scars, try: fractional lasers or RF microneedling
While there are a ton of different options for treating acne scars, Dr. Lupo is a fan of either RF microneedling (which pairs radiofrequency with microneedling) or the non-ablative Fraxel 1550 Restore laser. “Both of these are excellent and safe for all skin types,” she says. “This is important, because most of my severe scarring patients are [Fitzpatrick] skin type III to VI”—the most melanin-rich on the spectrum. Each works by injuring skin under controlled conditions, which stimulates collagen production.
Number of treatments recommended: anywhere from one to six for both, depending on the severity of the scarring
What it costs: $1,700 per session, on average, for fractional laser; RF microneedling is an average of $850 per session.
For sagging skin, try: tightening machines
There are three solid ways to treat lax skin nonsurgically: with radiofrequency energy, ultrasound, or a blend of both. “All improve mild to moderate facial sagging by heating the dermal layer deep in the skin, to contract collagen,” says Dr. Lupo. Her favorite device for this is the Exilis, which combines radiofrequency and ultrasound for, in her experience, better lifting and tightening than with either type of energy alone.
Number of treatments recommended: one or more, depending on severity
What it costs: $1,400 on average for a series of four treatments.
