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

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  There is no "best" laser for facial resurfacing.  IMHO, it is more important to choose a well-trained expenienced surgeon for this technique than for seeking out the lastest, most hyped and marketed, and expensive laser.  The same results can be achieved with judicious use of chemical peels as with the most expensive laser tecnique.  Take a look at the results and photos of the Hetter Facial Resurfacing Procedure that I have on my website.  I am absolutely certain that these results would compare favorably to any laser out there!

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.

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

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

Laser resurfacing is a non-surgical procedure that uses laser beams to treat skin concerns like wrinkles, scars, and discoloration: How it worksLaser resurfacing uses short pulses of laser beams to heat the skin and create a controlled injury. The skin's melanin and water absorb the light energy from the laser, which then destroys the surrounding tissue. The body's healing response is triggered, which can improve the skin's color, texture, and tone. What it can treatLaser resurfacing can treat a variety of skin concerns, including: Acne scars Birthmarks Discoloration Fine lines and wrinkles Skin growths Tattoos Types of lasersThere are different types of lasers used for laser resurfacing, including carbon dioxide (CO2) and erbium lasers. A doctor will determine which type of laser is best for your skin. Recovery timeRecovery time after laser resurfacing can be up to two weeks. Laser resurfacing is most commonly used on the face.

By combining two different laser technologies, this 3D treatment tells your fibroblast cells to stimulate and create new collagen. This is crucial as we age because we stop producing natural collagen, resulting in laxity and fine lines. 3D is able to reverse these signs of aging for a beautiful, natural improvement.
The laser treatment is painless for most people and the applicator can be adjusted to reduce any discomfort. You feel a warm sensation then a cold sensation, and the entire treatment takes about 30 minutes.
There is no redness or recovery time and you can return to normal daily activities immediately.