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.

My recommendation is to ask yourself few questions before deciding what type of laser to use.

• How much improvment would I be happy with? As we age it is not only skin that relaxes, rather underlying fat and muscle. The best lasers, radiofrequency, and light technologies cannot effect underlying tissues in any significant manner. To my experience, these technologies can give 50% improvement at best. If you have to stand in front of the miror and pull on your face or neck to get your satisfied result then lasers might not be the way to go. You need to lift the loose fat and muscles through lift procedures.

• How many times do I want to do this? The final result from the best lasers, radiofrequency, and light technologies are usually noticable when done multiple times.

• Do I want immediate results or can I wait? The final result from the best lasers, radiofrequency, and light technologies are not usually noticable immediately. You have to be patient. If you want immediate result then surgery might be a better option for you.

• How much downtime can I afford? Lasers have the advantage of having less downtime per each procedure when compared to surgical procedures. However, when you sum up all the downtimes from multiple laser treatments then they may come equal to the surgical procedures.

• How much money can I afford? Lasers have the advantage of being less expensive per each procedure when compared to surgical procedures. However, when you sum up all the fees for multiple laser treatments then they may come equal to surgical procedures.

• How long do I want my result to last? The result from the best lasers, radiofrequency, and light technologies usually last much shorter to their surgical counterparts. You have to be ready to redo them much sooner than you expect.

Active FX utilizes CO2 and is effective for overall skin rejuvenation. Active FX and other skin lasers help more with the quality of the skin than wrinkle reduction. It is very effective for reducing or eliminating the brown spots caused by sun damage.

Active FX also improves the tone and texture of the skin reducing pore size and plumping the skin through collagen stimulation. The collagen remodeling can continue to improve for 4-6 months after one treatment. Most often, only one treatment is required.

Active FX and Fraxel are limited as to what they can do for wrinkles. There is mild improvement to wrinkles but for those who wish wrinkle improvement the treatment would need to be deeper or more aggressive using the Max FX which increases the risk of hypopigmentation. This deeper treatment would result in longer down time as much as 3-4 weeks with the skin staying red longer.

There are different Fraxel treatments ranging from the original Fraxel (now called Fraxel Restore the treatment you had) which require 3-5 treatments 2-4 weeks apart to a newer CO2 Fraxel called Fraxel Repair. In choosing which treatment to have, make sure that you are comparing Active FX to other CO2 lasers such as the Fraxel Repair. Then, the decision regarding which one to use becomes based on your level of confidence in your provider after your consultation.

You should be fully informed about the specifics of your treatment and the expected downtime, as this will vary based on the settings used for your treatment. The settings for each patient's Active FX treatment depends on several factors including, but not limited to, the individual patient's skin type, areas of concern, and amount of downtime they are willing to have. We also use the Aluma to help tighten loose skin on the face and body. It uses radiofrequency, has no downtime and is not painful. It can be done alone or as a maintenance program 6 months to a year after the Active FX. To find a provider you can access information from www.surgery.org

The best treatment bar none for skin tightening and acne scars is the CO2 laser resurfacing depending on your skin type. All other lasers only offer nominal improvement.

The disadvantage is the longer down time, but it is by far the best treatment for acne scarring.

A recent article in Archives of Facial Plastic Surgery by Shan Baker, MD et al. substantiates this, as well as an article I published a number of years ago in the same journal.

Source: Archives of Facial Plastic Surgery, July 2008

Hi L,

Fractionated CO2 lasers are the best current choice, and will likely be the best facial rejuvenating and moderate skin tightening technology. Fraxel re:pair laser treatment is a much more aggresive, and deeper treatment than the superficial Active FX.

When Deep FX is added to Active FX, then the combination treatment results in very impressive skin tightening and rejuvenation. Both Fraxel repair laser treatment and the combined Active/Deep FX treatment give excellent results. The price point for the two technologies should be very close. Good luck and be well.

Dr. P

As with all other aspects of cosmetic medicine, we are always trying to balance safety with efficacy. We want a treatment that will solve the problem but that has minimal side effects or complications.

The best laser treatment for facial rejuvenation and skin tightening from the standpoint of effectiveness is old fashioned CO2 laser resurfacing. Unfortunately, it is also the riskiest and has the most downtime. Think Samantha in Sex And The City. Slightly less effective, but much safer and with less downtime, is fractionated CO2 laser resurfacing like Active and Deep FX and Fraxel Re:pair. Less effective still, but also safe, are the other Fraxel treatments like Re:store.

I am personally familiar with Active FX and can comment only on its use. I have not used any other fractionated CO2 lasers.

The recommended treatment and the intensity of the fractionated CO2 laser settings are determined by the nature and the severity of the patient's area of cosmetic concern and the patient's tolerance for downtime and risk. In this case, downtime means several days of redness and the need for vaseline like skin treatments followed by several more days of redness that can be covered with makeup. A patient with fine to moderate wrinkles around the eyes and/or mouth may benefit from Active FX with energy and intensity settings keyed to the extent of the wrinkles and the patient's willingness to spend 3 to 5 days with a red face. For more severe wrinkles in a patient who is willing to have a red face for a week, more aggressive settings and multiple passes over the problem areas may be indicated.

The most important aspect of this is that the treatment be customized for the individual patient with his or her goals and tolerance for downtime and risk as the guideposts.

Combining this with fillers to replace lost volume and a nueromodulator like Botox will also improve the overall results.

The eye, hand and brain of the operator need to be connected.

Hands down the best laser for overall skin rejuvenation is a CO2 laser. I prefer the Affirm CO2 laser which will help with overall tone, tightening and texture.

Believe it or not, one can achieve great facial rejuvenation and tightening without using lasers. Lasers are just given so much attention in the media. However, there are many ways to rejuvenate and tighten the face other than lasers including chemical peeling, botox, injectable fillers and non-invasive surgical procedures. Since you asked about lasers, there are some lasers that are designed more specifically to tighten and there are others that are designed to resurface fine lines and wrinkles.

As another physician mentioned, Fraxel is given a lot of hype because they do intense marketing and promoting. But there are a lot of other lasers out there that can give great results. And again, a lot can be achieved without lasers as well. I recommend that you find a dermatologist, ENT or facial plastic surgeon who is board-certified in his/her field, who has experience and a good reputation, and who gets excellent results with whatever procedures and techniques that physician chooses to utilize. Hope this helps.

If you are looking for tightening and rejuvination, I do not think that Fraxel is the correct choice. Depending on your need for wrinkle correction, you may need a more invasive laser with a deeper peel.

I would recommend either CO2, Erbium/Yag, or Pearl lasers. These will cover all of the points that you are interested in addressing, each with their own positives and negatives and unique downtimes.