Lazer Treatment - Best New Technology

Is there anything new trend-wise with lasers for skin resurfacing and acne?

Doctor Answers 8

Conservative CO2, plus fractionated laser for areas other than the face

As a patient, you may hear that the CO2 laser causes whiteness, that it causes a prolonged healing time and that the fractionated CO2 laser systems give similar results with no down time or minimal down time, and therefore fractionated laser is superior to the "old" CO2 laser. You will get white from the "old CO2 laser".

These statements are false. Here is why.

Fractionated laser with the CO2 laser works by giving small pulses of light to the skin, causing injury to the epidermal layer and the dermal layer. The "claim to fame" for the fractionated lasers is that they leave bridges of uninjured epithelium between areas of injured tissue. This enables the face to "reepithelialize" quicker. The reason is that the face reepithelializes by the epithel ial cells replicating and migrating from islands of uninjured tissue. Therefore to form a shield of epithelial cells, this occurs more quickly with the fractionated laser system. The advantage is quicker healing. The disadvantage is that all those bridges that didn't get lasered don't get tightened either. There can be a patchy appearance to the face since the face was not uniformly blanketed. I see many patients who were unhappy with their fractionated lasers because the results were not what they expected and they still had 4-5 days of down time. So they had the treatments repeated again and again, incurring additional down times and additional expense.

When the CO2 laser is used on common density settings, the tissues are largely "blanketed" by CO2, and the epithelial cells residing in the pilosebaceous units and hair follicles etc. perform the same reepithelialization function, just more slowly. A tug of war begins. If epithelization can occur within a reasonable amount of time, say less than a week, scarring almost never occurs in the face. We know this from decades of burn research, and the study of laser injury is burn biology. For an explanation of the boiology behind burn injury, you may wish to read my chapter in "Current Medical Diagnosis and Treatment, Burn Therapy 2009"

The CO2 can be set to many different settings, let's just say low medium and high for the sake of explanation. The high setting occurs when 3 or 4 passes are done on the face. The injury is relatively deep. Lots of the dermis is injured. The results are fantastic. However characteristic loss of pigment occurs as the pigment elements are progressively wiped out the deeper the laser goes. And there may be long term pigment cell death as well (apoptosis). This is the laser settings that most of the panelists are referring to. We never laser this deep, because of the undesired effects.

However, the CO2 laser can be "turned down" to 1 or 2 passes on more conservative settings. The time to reepithelialization averages 5-6 days. Almost never is it more than 7 days. This also means that the redness and depigmentation (and risk of scarring) is also greatly reduced. Our incidence of "milkbeard" deformity and scarring with our current conservative CO2 system is zero. And our patients generally have a single treatment and are back in public feeling comfortable within 7-10 days, often sooner. We tell them in advance some wrinkles will be left behind, and the reasons why aggressive laser resurfacing would not make them look better.

The benefits of fractionated laser seem to be on areas other than on the face. CO2 is not commonly performed in darkly skinned patients, the hands, chest, decollete, where fractionated laser may be safer.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Latest trends in lasers

Undoubtedly, the latest and really exciting trend in skin laser treatment is the development of fractional laser technology, in particular fractional CO2 resurfacing. CO2 lasers have been around for a long time and have proved to be a fantastic tool for facial skin resurfacing - removing lines, wrinkles, pigmentation, and skin tightening. Unfortunately, sometimes patients took months to recover, and sometimes removing too much pigment left obvious "laser stigmata".
The new technology has allowed us to maintain the efficacy of the CO2 laser and minimize the downtime and the risks. It is becoming the new gold standard in the skin resurfacing. Among the many new lasers, Active/Deep FX by Lumenis is one of the most powerful and safest machines. The combination treatment allows us to choose the precise settings for each patient to successfully treat lines, wrinkles, sun damage, pigmentation, old scarring and acne scars. It improves skin texture and tone, and dramatically rejuvenates the appearance. The downtime for this treatment is about a week, and it is quite worth the results that the patients get.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Fraxel Re:pair

The latest trend in laser treatment is fractionation of the laser beam, which delivers the laser on the skin in a pixel-like fashion allowing for minimal downtime, rapid healing, and now with CO2 fractionation, maximum results. Fraxel re: pair has been the leader in developing this technology.

Good luck, and be well.

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Laser Treatment

We offer the Sublative Laser. This is effective on all skin types and tones, Sublative rejuvenation is a deeper treatment that fights fine lines and wrinkles, eradicates acne scars, and improves overall texture. Sublative rejuvenation harnesses the power of energy currents to penetrate the skin and stimulate collagen production (while keeping the outer layer of skin intact). Depending on the selected course of treatment, downtime can vary from two to five days—which can be customized to fit your schedule and your needs.

Dennis Gross, MD
New York Dermatologist
4.4 out of 5 stars 5 reviews

Fraxel For Acne Scars

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
4.8 out of 5 stars 107 reviews

Pearl Laser is one of the newest exciting lasers

We have recently added one of the newest and most exciting lasers that is on the market. Pearl Laser by Cutera. The Pearl laser is excellent for treating modest sun damage including dark spots, freckles, delicate wrinkling and large pore size.

I have found that the Pearl Laser (unlike the Fraxel) is less painful during the treatment process. The Pearl Laser on a scale of 1 to 10 is about a 2 to 3 for the majority of my patients.

A full Pearl Laser treatment for the face takes only 15 to 20 minutes. However, we do have the patient arrive 45 minutes before the treatment to have a topical numbing cream applied to the area being lasered. Patients are red for about four days. After the fourth day usually you will peel for about a 24 hour period. After you have peeled you are free to apply regular moisturizer and makeup.

The price of the Pearl Laser treatment for a full face on an average is $1,500.00. Your only additional cost would be your numbing cream and post-operative cleanser and moisturizer.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Latest Trends in Laser Treatment

While laser technology continually changes, the two most significant trends are:

  1. Less intense treatments that shorten healing time and make it more convenient/less painful for patients to have treatments.
  2. The combination of modalities to provide optimal treatment.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

One of the most exciting technological advancements in...

One of the most exciting technological advancements in the treatment of not only crow’s feet, but also deeper lines, pigmentation abnormalities, textural problems, acne scarring, sun damage and pre-cancerous skin lesions has been the use of Plasma technology.

Portrait PSR (Plasma Skin Regeneration) is not a laser, radio frequency or light–based treatment. It works both on the surface as well as below the skin surface to generate new collagen. Portrait PSR is clinically proven to smooth away superficial and deeper wrinkles and enhances skin tone and texture. The results of this painless, 20-30 minute treatment are seen almost immediately and continue to improve for many months afterwards.

Rodger Wade Pielet, MD (in memoriam)
Chicago Plastic Surgeon
5.0 out of 5 stars 2 reviews

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.