Which Laser Treatment is Best for Facial Rejuvenation and Skin Tightening?

Facial rejuvenation via skin resurfacing has been available in many forms over the years. The original cosmetic treatments consisted of chemical peels (believed to have been used by the Ancient Egyptians) and dermabrasion. These modalities work very well but are not without risk.
The next generation of resurfacing was achieved with abalative lasers, the earliest of which was the CO2, and later erbium modalities. The extended downtimes of lasers and risk (most particularly CO2) has lead to a decline in usage, despite potentially great results. Since then, newer fractionated and non-ablative lasers have also been introduced and ceratinly have both positive and negative features.
For the last two years in my practice, I have incorporated a newer, non-laser modality for facial rejuvenation and skin tightening known as Nitrogen Plasma Skin Regeneration (PSR), made by Rhytec. The PSR can be used in both a low energy (PSR-1) or high energy treatment (PSR-3).
The principle of how it works is based on excitation of Nitrogen gas, which forms an ionized form of Ntrogen known as plasma (similar to the principle in "Plasma" TV sets). The energy is then released on the skin, causing a controlled area of injury on the skin. The skin is left on as a biological layer for 3-5 days, and then peels away. An initial rejuvenative result is obtained, followed by further skin tightening over the course of the next year (caused by increased collagen deposition and remodelling).
The benefit of the PSR is less redness, less downtime, less risk of scarring, and less risk of hypopigmentation than with conventional lasers such as the CO2. A PSR will achieve 70-80% of the wrinkle reduction and skin tightening result of the CO2, depending on the skin type and the extent of skin damage.
Patients must consider the combination of results, downtime, and risks when assessing facial resurfacing. There are many modalities available, many of which work well. Understanding the potential upsides and downsides is essential to being happy with the ultimate outcome.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Fraxel and/or CO2 are best for skin resurfacing, but Erbium is a good alternative. I always combine lasers with microneedling/PRP for more robust outcomes. For skin tightening, I recommend a combination of Ultherapy with radiofrequency treatments and Sculptra for skin tightening. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer