Erbium or CO2, Fraxel or Ablative?

Hi Kathi.  The "waxy" appearance you describe was typically associated with traditional "full field" ablative CO2 laser resurfacing.  This is the type that used general anesthesia, a surgery room setting and 2 weeks of recovery.  The reason for this waxy appearance is that traditional CO2 was a more pronounced (and 100% surface area) controlled burn.  Even though it often improved wrinkles and acne scars, it left the skin slightly scarred (a smooth scar) and that is the reason for the waxy appearance.  

More recently (the last decade), there has been a fairly consistent switch to fractional laser resurfacing.  This is because fractional resurfacing only ablates (destroys) a fraction of the skin during the resurfacing process (22% for us).  Because the process leaves much of the skin intact, there are more treatments usually required than traditional CO2.  At the same time, it is much easier to avoid that waxy look as well.  

There are several types of fractional laser resurfacing including CO2 and Erbium.  We are partial to the Erbium wavelength and use the Sciton profractional.  The reason is because the high power of the machine allows us to go deeper and with larger holes.  This leads to better results because of the more pronounced healing response associated with the depth and size of the fractional holes.  

We would encourage you to go to several consultations and to choose a practitioner that you feel confident with.  Ask for before and after pictures and try to ascertain whether or not the expectations are realistic (before and after pictures). 

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.

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.

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!

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!!

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.  

 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.