Erbium or CO2, Fraxel or Ablative?

I am sixty, fair, and my skin is not too bad. All of the above have been recommended, all for different reasons. I know I do not want white, waxy looking skin as many of my friends have. I prefer wrinkles to that look. I wouldn't mind some tightening, but mostly I want to look natural, not "done". Which of the above do you recommend?

Doctor Answers 6

Erbium, CO2 and Fraxel

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The waxy white, waxy appearance you describe can be the resolt of deep phenol peels or fully ablative CO2. These problems are avoided with fractionated treatments.

To get a natural look, I would recommend a fractionated CO2 treatment. There is nothing better for improving skin texture and wrinkles. I like to combine this with a deeper radiofrequency treatment, ePrime, that can stimulate your skin to start making new collagen, elastin and hyaluronic acid. The result is more volume and elasticity along with the nice effects of resurfacing.

Fractional CO2 is the best!

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I do lots of laser resurfacing and love the results of a fractional CO2. I think the tightening effects are by far better than what a fraxel treatment can achieve. A fully ablative CO2 laser treatment is often too harsh and results in that waxy look that you fear. There is some downtime with the fractional CO2 but less than with the ablative treatments. You will love the results though!

Ravi Dahiya, MD
Washington Facial Plastic Surgeon
4.7 out of 5 stars 61 reviews

Laser tx for wrinkles

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 I think all of the options will produce some skin tightening and improvement in skin texture and fine lines.  The most aggressive of these is the fractionated CO2.  I have used this laser on many patients with great natural looking results.  There is usually a week downtime associated with this treatment.  The white waxy look you mentioned was probably form the older phenol type peels, and not associated with the lasers you mentioned.  I would make sure you are seeing a board certified dermatologist or plastic surgeon to do your procedure and look at photos of the doctors work. I hope this helps.  Lana Long, M.D.

Lana Long, MD
Cincinnati Dermatologic Surgeon

Which laser is best?

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The best laser for your face is dependent on your unique skin anatomy and your goals.  Each laser(C02 and eribum) and each modality (fully ablative and fractionated) offer distinct advantages and disadvantages.  I typically use a combination of laser therapies to maximize results while minimizing complications.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

What laser is best at improvement with a natural looking result

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Kathi:  I have been using medical lasers since 1985 and feel your pain.  Each and all of these options can work on you, so the bottom line is really technique.  It is the expertise and judgment of the one holding the laser at least as much as which machine they are using.  There are some basic differences in how each of these interacts with the skin, but that may be neutralized with technique.  Unfortunately, when physicians invest in this equipment, they will try to use whatever they have on everyone that comes in for a laser treatment.  Try to see some results before you decide.  Good luck!!

Myles Goldflies, MD
Seattle Plastic Surgeon

Laser treatment for wrinkles

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Please consult an experienced dermatologist or plastic surgeon who specializes in laser treatments.  The ablative fractional laser will improve your wrinkles more than the erbium or non-ablative Fraxel Restore.  You will have about one week's downtime and will not have a waxy appearance.  If you do not want as much downtime, the non-ablative Fraxel Restore laser is a good choice but you will require more treatments.  

Martie Gidon, MD, FRCPC
Toronto Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.