Thank you for your question. You’d like to know what the risks of fully ablative CO2 lasers are, and if risk are greater than other types of lasers.This is certainly an interesting question as there is a lot of confusion surrounding this topic. Over the years, there has been a number of lasers that claim to yield similar results, and doctors will always have their own personal preferences. As someone who has been using lasers since the very first ablative CO2 laser came out in the mid-90s, I have had opportunities to use different lasers throughout my practice, so I can give you my perspective on these devices based on my extensive experience with them. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic surgeon, practicing for over 20 years in Manhattan and Long Island.To define the solution, you must define the problem. When people want to see dramatic improvement in their skin, people will opt for either chemical peels or lasers. Chemical peels were used for these problems before lasers were introduced, so they follow the same treatment and risks.Chemical peels fall into three categories: superficial, medium depth, and deep. With chemical peels (particularly with medium depth and deep peels), once you’ve applied it, it reaches a certain depth, and then that’s it. A physiological response referred to as “frosting” or “frost” from medium depth can often be seen from these types of deep peels.Lasers can also reach similar depths, with the added advantage of thermal energy, which has value in terms of contraction of the skin. In addition, a deep CO2 laser can probably give you the most benefit in terms of addressing common problems such as lines, wrinkles, etc.The golden rule with regard to these treatments is straightforward: the deeper you go, the more dramatic and significant your results will be. However, alongside that is the deeper you go, the higher the risks for complications and problems. Therefore, it is important to have some type of balance.In my practice, I’ve combined modalities. I’ve taken the benefit of a CO2 laser, but instead of using a fully ablative laser, I use a fractional CO2 laser. A fractional CO2 laser means that there are skipped areas in between the dots that are made during laser treatment. This means that more skin is left intact, which means better and faster healing. Repeating this process makes the laser less fractional and more ablative, though you can control the depth and energy delivery. This is particularly great for patients who don’t have a lot of free time, and want to return to their normal activities with a week or two weeks, at the very least.I combine my fractional CO2 laser treatment with platelet-rich plasma, which is a concentration derived from your own blood. Platelet-rich plasma, or PRP, improves skin quality and texture by stimulating blood supply and collagen, so essentially, you are using your body’s own adult stem cell response to improve your skin. Combined with the less invasive fractional CO2 laser, you get the best of both worlds and diminished risk. Naturally, for very deep lines, you have to be aggressive and you have to be ready for the healing process.I have visited a lot of my colleagues and have watched them do facelifts and laser treatments, and many of them believe in a fully ablative CO2 laser, for which they get very nice results. Ultimately, you need to ask yourself what you’re willing to tolerate and what kind of outcome you’re looking for.In my practice, I do this balanced approach, and have high satisfaction from my patients. I also think that because the type of people that I take care of are usually very time-crunched with extremely busy personal and professional lives, so there just isn’t a lot of time for recovery. We’ve developed a strategy of smaller procedures with quicker recovery, easier to fit into their lifestyles, and still get really great results.So I hope that was helpful and I wish you the best of luck!
