Fractional laser is NOT the best.
I risk the disagreement of many of my colleagues who have and use fractional lasers in their practices, but I would be able to submit evidence that this is indeed a correct statement. First, I will state that there is nothing WRONG with fractional lasers or resurfacing--they do make nice changes in the skin and are generally appreciated by patients who have these procedures. BUT. . .laser surgeons who charge a lot, and promise even more, can risk the wrath of patients who feel their fractional laser results are not a good value for what they paid, or who required more healing time than "advertised."
I have taught laser surgery, including resurfacing, for over twenty years, nationally and internationally (Korea, Canada, Caribbean), and have performed thousands of laser cases in my practice. (I am in private practice, and do not have academic affiliation, rarely publish, but have taught nearly a hundred laser courses and thousands of physicians of various specialties over these years). Now, just the facts, Ma'am.
Ablative CO2 laser resurfacing came first, gave great (dramatic) results, but fell somewhat out of favor as hypopigmentation (skin color lightening) occurred a year or so after treatment. Wrinkles, spots, and sun damage still gone, but line of demarcation where treatment stopped, and lighter skin color where treatment was done. Bummer!
Ablative Erbium-YAG laser resurfacing came next, but treated much more superficial layers, so skin healed faster, with less redness, but with less dramatic changes. If the doctor promoted this as "better than CO2" and charged as much, patients were unhappy, but not because the laser had a "problem" other than milder results. Bad doctor "marketing!"
By the time that third-generation combination CO2/erbium-YAG lasers came along about ten years ago, the herd of dermatologists, plastic surgeons, and other laser doctors had moved on to the "non-ablative" lasers or therapies such as Thermage, Cool-touch, Smoothbeam, and many others. These all "worked" to varying degrees, but usually with very minimal results. Prices dropped, and so did most of the hype, and "the herd" of doctors that need the "latest and the greatest" moved on to Fractional lasers.
Fractional lasers started with Erbium wavelengths, and treated the skin in tiny polka-dots. Bridges of intact skin were left untreated, which is said to promote faster healing and less down-time (partially true). Actually, less skin treated = less result, which required multiple treatments, which = more procedures, more healing and MORE cumulative downtime. Oh, and the total cost adds up to a tidy sum usually! The results are real, but with superficial layer and polka-dot treatment came mild results. More, give us more!
The next fractional lasers returned to CO2 wavelengths, which penetrate deeper, and still treated skin in tiny polka-dots. Fortunately, unless the energy was turned up too much, or the polka-dot density too tight, hypopigmentation changes were limited, and the results were indeed better. Still only in the fraction of the skin treated, still requiring more than one treatment for results that could approach that of well-performed third-generation combination CO2/Erbium-YAG ablative resurfacing (which very few doctors even had then, or have today), and still adding up to a tidy sum for only "fractional" results. BTW, it still takes a week to heal fractional laser treatments, and if you add up the time for multiple procedures, doctor's visits, and cost, HOW can this be "LESS DOWNTIME"?
So at the risk of being contrarian, I would submit that a properly-performed ablative CO2/Erbium-YAG full-face laser resurfacing remains the BEST one-time laser resurfacing procedure available. With proper skin care, I routinely have patients healed in 7-10 days, and with minimal (truly) redness easily covered with standard make-up. I even purchased a second CO2/Erbium-YAG laser for parts--they are no longer available. But the marketplace delivers what the public (and their doctors) demand. I know from all the courses I have taught over the years, that many, if not most, of the doctors that use lasers don't even understand the basic laser biophysics of how laser energy interacts with tissues--they just want to know "what is the basic setting, where is the trigger, and how much can I charge?"
Enough said, my soapbox is sagging! Caveat emptor!
Reverse the Aging Process with Laser Resurfacing
Laser resurfacing works on a wide variety of different issues often in just one treatment and can reverse the aging process in experienced hands. It improves:
1) fine lines and wrinkles
3) sun spots
5) precancerous spots
6) acne scarring (which may require more sessions).
In our East Bay practice in San Francisco, where we are able to provide dermatology, laser, and plastic surgery services all under one roof, we are fortunate to have several types of lasers to target superficial, medium, and deep lines and wrinkles and are able to treat a wide variety of different locations such as the face, neck, chest, and hands. Due to our expertise in ethnic skin, we can even treat some ethnic skin patients safely, but caution should be stressed in inexperienced hands. This is a very popular treatment and the prime cadidates are middle aged fair skinned individuals who grew up in the baby boomer generation who may have experienced sunburns, sun damage, and even precancers or skin cancers. Although there is some downtime with this procedure, patients are thrilled that laser resurfacing is both an effective treatment and preventative procedure to help skin look its best despite the years of sun damage.
Goals of fractional CO2 laser skin resurfacing
The fractional CO2 laser is used to reverse the effects of facial skin aging and sun damage to the skin. The laser will have the effect of skin tightening, filling in lines and wrinkles, improving discoloration of the skin (brown spots), and improving the tone/texture of the skin itself. It also improves the appearnce of large pores.
Results will vary based on the type of fractional CO2 laser used (they are NOT all the same), and based upon the physician performing the treatments. Be sure to use a physician with experience in the procedure and see before and after photos prior to proceeding.
Laser skin resurfacing results
Laser resurfacing helps remove aged or sun-damaged skin in order for younger healthier skin to grow in its place. Although there are a few risks such as infection or laser scarring, some possible benefits it can offer your skin includes new collagen production, removal of wrinkles and lines, and tighter, smoother skin. Skin rejuvenation would result in clearer skin with an even skin tone as well as reduction of poor sizes.
Laser resurfacing results
Laser Skin resurfacing, like a fine meal, will depend on what your hungry for and what's on the menu. Most resurfacing procedures are useful, to varying degrees, for such conditions as wrinkles, texture, color, lines, skin tightening, and acne scars.
Currently, most resurfacing can be divided into Ablative resurfacing procedures (what we think of classically as "resurfacing") and Non-Ablative procedures. Further, Ablative resurfacing is now divided into Traditional resurfacing versus Fractional resurfacing.
Traditional Ablative resurfacing, with the CO2 or Erbium lasers, are still our most powerful, and risky, procedures. Because of risks and downtime, they are performed much less commonly today.
Fractional Ablative resurfacing, again with the CO2 or Erbium lasers, has become the resurfacing procedure of choice for most experienced laser surgeons who wish to achieve significant results. The results approach those of Traditional Ablative procedures, but with much less risk and down time. Multiple treatments may increase results.
Non-Ablative resurfacing offers the benefits of little to no down time, minimal risk, but also significantly less results.
Be sure you and your physician properly discuss your goals, tolerance for downtime and risks, and costs. An experienced laser surgeon can guide you to the best procedure for the results you want.
Laser Resurfacing Results
Results will depend on the following: technology being used, physicians experience, and your skin type/texture. Definitely have a consultation with the physician prior to any laser treatment. At that time the physician can tell you what you can expect. The downtime can be discussed at the consultation, depends on how aggressive you want to go. Laser skin resurfacing targets tone, texture and tightening.
Outcome of laser resurfacing depends on physician and patient skin type
For best results, you should learn about Fractional CO2 Laser resurfacing and seek out a board-certified dermatologist or plastic surgeon who has performed more than 50 cases of your skin type. Pre-op and post-op skin care routines are critical to achieve best results and minimize post-treatment pigmentation and thus must be customized according to your skin types and priorities.
Results for Laser Resurfacing.
The short answer is that you could look like nothing was done or you could look 10-15 years younger. It all depends on which procedure you choose, how the procedure is performed, what the downtime is and how experienced the practitioner is. CO2 resurfacing is generally accepted to have the most dramatic results, but also the lengthiest and most difficult recovery. Second to CO2 is fractional and Erbium resurfacing procedures. Lesser still are non-ablative (no downtime) procedures. Generally speaking, the more pain involved (recovery time) the more potential gain.
Many types of resurfacing
The term "resurfacing" formerly had one definition: full carbon dioxide resurfacing. But this is no longer the case. While full-face carbon dioxide is still largely considered to be the "gold standard" by which other therapies are judged, the vast majority of current resurfacing treatments are not done this way. I personally still believe carbon dioxide is the most effective type of laser for tissue tightening, acne scars, and wrinkles.
However, ablative resurfacing can be done with erbium:YAG, plasma gas, even chemicals such as trichloroacetic acid. Fractionating the laser beams make down time shorter, sometimes with results very similar to full resurfacing. Basically fractionating means that a fraction of the skin is treated so that you can heal faster and with lower risk. There are also a myriad of non-ablative resurfacing methods which involve no down time at all.
Each patient has different needs, and multiple therapies may be appropriate for the same condition. I take into consideration the patient's presenting complaints, schedule and budget before deciding which treatment(s) I think the patient should pursue.
Many different variables for laser resurfacing results
Expected results from laser resurfacing depends on many things: skin type, degree of wrinkling, physician approach, type of technology. You should visit with an experienced physician regarding approach, desired result, and expectations as they will vary widely.
You can count on some sort of down time and exfoliation, swelling, and persistent redness prior to any results in tone, texture, and tightening, as Co2 lasers vaporize tissue, and cause thermal contraction of skin.
I encourage you to seek out a board certified dermatologist with resurfacing experience in order to be better informed.