YAG LASER

Pros

• Many RealSelf members report only mild to moderate discomfort during either type of YAG laser treatment. 
• Side effects are rarely serious, with redness, mild swelling, and puffiness being the most common.
• Recovery time after an Nd:YAG laser treatment is usually minimal. 
• Er:YAG lasers can be used to treat skin on the face, neck, chest, and hands, and they don’t interfere with dermal fillers.
• The Nd:YAG is considered by many providers to be the best option for laser hair removal for people with deep skin tones. (Another good option is the Motus AX, the first high-speed alexandrite laser that’s safe for all skin tones).

Cons

• While the Er:YAG laser allows for a speedier recovery than more aggressive ablative treatments, like the CO2 laser, you’d still need about a week of social downtime as the treatment area turns darker and crusts (depending on the energy settings). Your skin could look inflamed for weeks or even months after your procedure. However, notes Dr. Tanghetti, “in the low-power mode, the erbium laser creates a superficial removal of the skin with minimal downtime.”
• YAG lasers carry the risk of postinflammatory hyperpigmentation (overly pigmented spots on the area treated).
• Like most laser hair removal options, the Nd:YAG laser will not remove red, blonde, or gray hair. 
• Depending on your aesthetic goals, you may require a series of treatment sessions with YAG lasers, to achieve an optimal outcome. Tattoo removal, for instance, often takes a series of sessions with an Nd:YAG, while improvement in the signs of aging may be seen after one or two treatments. “Deeper wrinkles require more treatment, while shallow scars and wrinkles may be completely erased after just one erbium laser treatment,” says Dr. Butterwick. 
• Lasers aren’t recommended for women who are pregnant or planning to get pregnant. 
• YAG lasers aren’t as effective for tattoo removal as PicoWay or PicoSure lasers.
• Both ablative and non-ablative treatment may trigger the herpes virus. Your doctor can prescribe an antiviral medication, if you’re at risk.

RealSelf Tip: “When treating vascular lesions in the long-pulsed mode, care must be taken not to use too much energy or more than one pass which can overheat a blood vessel and cause scarring,” says Dr. Tanghetti. Seek an experienced provider to avoid this kind of complication.

The price you pay will depend on the type of YAG laser used, your provider’s level of experience, their practice location, and how many treatment sessions you have.

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

The ideal candidate depends on the type of YAG laser being used.

Erbium laser resurfacing: Ideal candidates have fair to light skin tones (Fitzpatrick skin types I–III). Patients with brown, dark, or rich skin tones are at risk for hyperpigmentation issues and may need to consider other resurfacing options, such as microneedling or radiofrequency treatments (like Thermage). The laser can be used to target localized areas of concern, such as fine lines around the mouth or eyes, or can be used to treat the entire face. The recovery with erbium resurfacing is easier than with the CO2 laser, so it’s ideal for someone who wants less downtime.

Nd:YAG treatment: People with fair to light skin tones usually have the best response to treatment with the Nd:YAG laser, but with longer wavelengths and pulse durations that lower the risk of skin damage, the laser can be safe and effective for people with brown or deep skin tones. Picosecond mode can also be used with less risk of PIH. Consult with an experienced laser provider who can determine the right course of treatment for you. 

Keep in mind when consulting with providers that the right device should depend on which one will actually produce the best result, based on your concerns and skin tone, says Dr. Butterwick. It’s important to schedule an in-person assessment with a board-certified dermatologist or plastic surgeon who offers a wide range of treatment options. “This will allow for the customization of your procedure that will give you the best possible outcome,” says Dr. Butterwick.

There are two types of YAG lasers. 

Er:YAG lasers (aka erbium lasers) are resurfacing devices that have a range of applications. They can treat fine lines and wrinkles, acne scars, surgical scars, skin laxity, and pigmentation irregularities like brown spots. 

The Er:YAG is an ablative laser, so you can expect an intense session that removes the surface layer of your skin, to reveal fresh skin and stimulate a healing response. “The erbium YAG laser delivers wavelengths of laser light into the dermal layers, to eliminate damaged tissue and smooth away wrinkles and other signs of skin damage,” explains San Diego dermatologist Dr. Kimberly Butterwick. “The laser energy is absorbed by water in your skin cells, so it can transform the condition of your skin at a cellular level.” The heat generated by the laser results in collagen shrinkage and stimulates the formation of new collagen, which further tightens the skin over time. 

One advantage of the erbium laser is that, due to its high affinity for water, it can specifically target—and precisely remove—the tissue you’re treating, with minimal damage to the surrounding skin. The new skin cells that form during healing give skin a tighter, younger-looking surface. “This is an intense treatment, designed to produce dramatic rejuvenation effects,” says Dr. Butterwick.

Neodymium:YAG lasers (commonly called Nd:YAG) are non-ablative, meaning the top surface of your skin is left intact while the laser heats only the lower layer. Like erbium lasers, they’re versatile and used to treat a variety of concerns, including the following.

• Vascular lesions: Larger vessels or visible spider veins that aren’t treated with sclerotherapy injections can be treated with YAG lasers, says Dr. Harold Kaplan, a facial plastic surgeon in Torrance, California.
• Pigment irregularities: “There are a number of lasers that we currently use for the treatment of hyperpigmentation, or dark spots. Certainly, the Nd:YAG is one of them. Although it’s not for everyone, it does work for a large majority of our patients,” says NYC dermatologist Dr. Bobby Buka.
• Hair removal: Many doctors on RealSelf say the Nd:YAG laser is their go-to laser for patients with highly pigmented skin. Just don’t expect miracles—laser hair removal is rarely permanent. “The best you can expect from laser hair removal treatments is for 70% of the hairs to be totally removed,” says Las Vegas dermatologist Dr. Victor Rueckl. “The remaining hairs should be finer.”
• Tattoo removal: Lasers deliver high-intensity energy into the outer layer of skin, to break up the pigment into smaller ink particles that the body metabolizes. 
• Skin rejuvenation: While newer lasers have become more popular for skin resurfacing, the Nd:YAG laser can gently treat the skin, in a non-ablative manner (not removing the top layer), to stimulate collagen production and improve the appearance of wrinkles and fine lines.

Nd:YAG lasers can be used in three modes: Q-switched, long pulse, or picosecond. Q-switched lasers produce extremely short bursts of energy, which translates into massive amounts of power. When it comes to tattoo removal, this peak power helps break up the most stubborn ink color—with the exception of green, which is more effectively handled in picosecond mode—without harming surrounding skin. This reduces discomfort, side effects, and downtime.

Q-switched lasers are also used to treat pigmented lesions, like brown spots (they target dark concentrations of melanin and fracture it into tiny pieces that are carried away by the immune system or peeled off the skin’s surface) and vascular lesions, like broken capillaries (the laser’s light energy heats up the vessels, causing them to swell and be destroyed).

In long-pulsed mode (meaning the amount of time targeted tissue is exposed to laser energy), Nd:YAG lasers are widely used for hair removal in patients with dark skin, particularly those whose hair is very coarse and dark. They’re considered “pigment-friendly,” so they’re the most effective and safest way to remove unwanted hair in these patients without causing side effects like scarring, burning, and discoloration. Dr. Kaplan says it’s the only laser he typically recommends for patients with Fitzpatrick skin type V or VI (the deepest skin tones).  

For light skin tones, as well as medium or fine hair, Nd:YAG lasers are considered to be less efficient at targeting hair follicles. Prior to treatment, your laser provider should do a test spot, to see how you respond, before proceeding with the full treatment, says Dr. Amy Paul, a dermatologist in Grand Junction, Colorado. 

In picosecond mode, the Nd:YAG laser has an even higher peak power than the Q-switched [setting] and breaks up tattoo particles more rapidly and effectively, explains Dr. Emil Tanghetti, a dermatologist in Sacramento, California. With modifications, this mode can also deliver mild resurfacing. “When used with a fractional optic, [a lens] which splits the beam into small, even higher-power energy zones, the device causes localized areas of plasma formation in the skin and superficial dermis. “These small zones stimulate a repair response which can stimulate the production of new collagen and elastic tissue as well as eliminating unwanted pigmentation.”

Related: Your Guide to Safe and Effective Hair Removal Lasers for Fair, Medium, and Deep Skin Tones

RealSelf Tip: While a YAG laser may be an option to treat a particular concern, it may not necessarily be the best option. For instance, while an Nd:YAG laser can treat some vascular birthmarks, in many practices, pulsed-dye lasers are considered the gold standard for this concern. “It’s important to choose a practice that has the correct technology, pursues best practices, has experience with your concern, and tailors the treatment plan based upon the condition as it changes throughout the treatment plan,” says Dr. Kaplan.

An Er:YAG ablative laser treatment is usually done in a doctor's office. You’ll begin the treatment with local anesthetic, to numb your skin, and you may be sedated. A topical anesthetic cream is frequently offered before erbium YAG laser treatments, since this procedure can be uncomfortable otherwise.

Your doctor applies the ablative laser in order to remove the outer layer of your skin and heat the inner layers, triggering your body’s natural healing response. This can take anywhere from 30 minutes to two hours, depending on the area. 

Afterward, your doctor will apply a thick ointment and often a dressing (gauze or bandages), to discourage infection. You’ll need a ride home, especially if you’ve been sedated.

Prior to Nd:YAG treatment, your doctor will apply a numbing cream to your face. Some people prefer additional pain medication (either over-the-counter or a prescription like Valium) as well.

Once your face is numb, your doctor applies a water-based gel, to protect the skin, before gliding the laser across the area. This can take 15 minutes to two hours, dependent on the extent of work requested. 

RealSelf Tip: A week before a YAG treatment, avoid using any retinols, benzoyl peroxide, glycolic or salicylic acids, or astringents; these can irritate the skin when coupled with a laser. If you have cold sores, your doctor will prescribe an antiviral medication as well as an antibiotic prior to your treatment.

Related: 7 Things Doctors Wish Patients Did Before Their Laser Treatment

Your healing time will depend on the type of laser and the energy level used as well as the number of times the laser passes over the area. 

After Nd:YAG laser treatment, you may experience some mild swelling, redness, itching, or scabbing at the treatment site. Side effects shouldn’t keep you from your daily activities, but you may want to prepare for “social downtime” of five to seven days, suggests Dr. Kaplan. Some patients also have bruising, which can last for 7–14 days. 

Dr. Andrew Kaufman, a dermatologist in Thousand Oaks, California, says, “Some superficial, non-ablative procedures will be healed in three days, whereas deeper procedures with an ablative laser, to remove fine lines, blotchy pigmentation, superficial wrinkles, and superficial acne scars, may take around 10 days—and that’s assuming everything heals as expected and there are no complications, like infection or delayed healing.” Once the skin is healed, it may remain red for several weeks or months. Usually, makeup can be applied to hide this redness. 

During the healing period, it’s critical that you avoid direct sunlight on vulnerable skin, says Dr. Butterwick. “Even when your skin seems like it’s healed, sun protection is absolutely necessary, to maintain the positive results from your treatment.” 

In some cases, results will last for years. “It’s difficult to call any result permanent, but deep full-field (unfractionated) erbium results are long-lasting,” writes Dr. Jason Pozner, a plastic surgeon in Boca Raton, Florida, in a RealSelf Q&A. “I have some results well over 10 years that still look great.”