What's the Best Laser for Skin Resurfacing?

My dermatologist offers a laser treatment for skin "resurfacing" which is different from the laser at my favorite medispa. Are all lasers the same? How do I make sure they use the right one?

Doctor Answers 76

Fractional laser is NOT the best.

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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,  do not have academic affiliation, publish sparingly, 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, N-lite, Cool-touch, Smoothbeam, Fotofacial, 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 wavelength lasers (old lasers in new boxes) with scanner handpieces re-purposed to treat 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 (sometimes with a "pebbly" texture from improperly-spaced polka-dots). 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 dual-wavelength 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. The results are much more uniform than any fractional polka-dot treatment, multiple treatments are not necessary, and healing doesn't take any longer than most fractional treatments. Smoothness and outcomes are superior, and downtime is certainly less than any multiple-session protocols!

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!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

CO2 lasers are the gold standard!!

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In our practice we are very happy with the Active FX fractional CO2 laser. It provides our patients with most of the benefits of the CO2 laser without the downsides. However, no laser will be as successful at obtaining the fabulous results of a well done CO2 laser. But then again, those patients suffered from long recovery periods and very obvious hypopigmentation ("bleaching") problems.

When you are deciding on what laser to use, you have to ask yourself 3 questions:

  1. What level of results do I want?
  2. What downtime can I tolerate?
  3. How much do I want to pay?

Light therapies (BBL, IPL, etc.) are cost-effective, short downtime procedures. However, they require multiple trips, are very operator dependent, and can cost a lot after a while.

Fractional technologies (erbium and CO2) can provide more significant improvements, but have levels of recovery measured over 4-10 days. Patients usually need one or two treatments, but the treatments are significantly more expensive.

Full ablation technologies (erbium and CO2) create the best results but have downtimes in the 2-3 week range with long-standing redness. They are painful enough to often need IV sedation and a trip to the OR significantly raising the cost of treatment. One treatment is usually all that is necessary though.

I hope this helps you.

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 reviews

"Best" depends on patient's goal

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There are many different types of laser and light devices on the market that can treat a variety of conditions. The most common complaints are wrinkles, irregular skin pigmentation, laxity and loss of youthful glow. When determining the appropriate treatment plan, the physician must take into account the patient's goal as well as his/her acceptable downtime. In addition, multiple treatments may be required for targeted results and this should be taken into consideration by the patient. The potential risks should also be fully explained to the patient to align expectations. In general, the lasers that give more impressive results tend to have higher risks associated. Be weary of anyone who claims their laser is the "best". I hope you find this helpful. Good luck.

For skin resurfacing there are two main types of lasers,...

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For skin resurfacing there are two main types of lasers, carbon dioxide (CO2) and erbium.

  • CO2 skin resurfacing is the most aggressive and produces the most dramatic results but also requires longer healing times.
  • Erbium resurfacing is gentler and produces good results with quicker recovery.
  • There are lasers, such as the Derma K laser, which combine the advantages of both CO2 and erbium into one laser.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Combined Fractional Erbium Laser Resurfacing is a Very Effective Technique

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The BEST Laser Resurfacing technique is the one done by the best, experienced, most knowledgeable doctor. It is NOT the Laser but the doctor who is using the laser that is most important for the best result.

An excellent laser physician can achieve excellent results with any of the popular lasers whether flat beam or fractional-so choose your doctor very carefully-this is your most important decision.

After 17 years of doing Laser Skin Resurfacing I am currently using a Combined Non ablative and ablative Fractional Erbium Laser Resurfacing technique.

My reasons are :

  • Good results equal to the old "gold standard" CO2
  • None of the problems-delayed healing, loss of pigment, long recovery, scarring etc seen with the old CO2
  • Ability to treat darker skin types
  • No demarcation lines
  • Quick recovery back to work-5-7 days

See link below for more infor4mation.

I've read through all the answers on this page and they...

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I've read through all the answers on this page and they are excellent. In the interests of saving time, let's go through the bullet points:

  • The right laser depends on what you are treating (redness, brown spots, wrinkles, laxity, etc.)
  • The laser should be used by a physician with adequate training, experience, and credentials
  • Sometimes laser is not the best option, therefore it is important to see a physician who has different options and can offer you the one that is right for you. Sometimes a chemical peel or dermabrasion is a better choice
  • Different doctors have different lasers. Unfortunately, the truth of the matter is that nobody can afford to buy all the available lasers and have them all sitting in their offices. Hopefully your doctor has a good machine and even more importantly, sound judgment.
  • The same technology, for example, fractionated CO2, now is available from different manufacturers. Active FX and Deep FX has a fair representation on this page, and I believe, it is currently the best option for fractionated CO2 resurfacing. It is good for lines, wrinkles and some scars.
  • To make sure your doctor is using the right laser on you, look at some before and after pictures of prior patients, and make sure you have an extensive conversation with your doctor about all the options and their risks and benefits.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

The Best Laser For Skin Resurfacing

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Many lasers are available for skin rejuvenation. The ideal laser treatment for you would depend on your concerns, your skin color and the amount of downtime and recovery you are willing to experience. In my Raleigh, North Carolina Plastic Surgery Practice I use the following modalities for skin rejuvenation:


  1. IPL, second generation intense pulsed light . This device can safely remove irregular pigmentation, dark spots and red splotchy skin from the face neck chest hands or any area of the body.
  2. Laser Skin Tightening with the GentleYag long pulsed Nd:Yag laser. This laser provides skin tightening to all areas of the face and body with no downtime. It can even help smooth out acne scars.
  3. Melasma Treatment with Gentlelase Alexandrite Laser. This laser treatment is best for individuals with light to medium skin. After treatment witht his laser, the skin will become very rough and dry and eventually slough off, leaving skin that is even in color.
  4. Rosacea and spider veins of the face can be treated and often eliminated with the V-Beam Pulse Dye Laser
  5. Co2 resurfacing provides a true skin resurfacing. In the early days of laser resurfacing the treatments were aggressive and the downtime considerable. Today, most plastic surgeons provide a more conservative CO2 laser resurfacing treatment. The treatment still requires downtime and a commintment to avoid the sun but the results can be beautiful. I often use CO2 resurfacing in conjunction with other facial rejuvenation procedures. I particularly like the effects of CO2 resurfacing around the eyes.
  6. Dermabrasion: I don't often perform dermabrasion, but on occassion, I think dermabrasion is the best treatment for very deep lines around the mouth. This is a treatment, like CO2 resurfacing that requires fairly significant downtime and a commitment to avoid the sun.
  7. Light or mild resurfacing treatments like microdermabrasion and light chemical peels are performed by aestheticians in my medical spa. Regular medspa treatments can be used to maintain beautiful skin and they can help prepare the skin for deeper treatments.

In order to find the best laser ftreatment for you, look for a plastic surgeon with significant experience in aesthetic lasers treatments, aesthetic plastic surgery and non-surgical aesthetic enhancement treatments.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Best Laser for Skin Resurfacing

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I would agree that there is no "best" laser for all problems and all patients... The laser I would recommend would really depend to a large extent on your skin type, skin history, and your goals for improvement.

For wrinkles, brown spots, and acne scarring, my favorite tool is the Mixto SX laser because by combining the benefits of the Carbon Dioxide modality with modern, Micro-fractional technology, I believe it offers "the best of both worlds", if you will.

You can achieve the results of the best CO2 lasers, but with the more comfortable, shorter and easier recovery associated with fractional lasers. The micro fractionation also lowers risks significantly.

For more aggressive rejuvenation, more focus is now...

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For more aggressive rejuvenation, more focus is now being directed to the myriad of laser treatments now available which can essentially dial in depth of penetration and very closely define downtime while still providing dramatic results. An example of this is the new fractioned lasers which can essentially treat facial aging using a grid pattern which leaves normal skin in-between treated areas. The result is less downtime and much faster healing.

One of the lasers that is showing a significant amount of promise in this area is the Lumenis ACTIVE FX laser. This device delivers a grid treatment pattern using the pulsed carbon dioxide laser leaving normal, untreated areas in-between. The results so far have been dramatic and even show promise in treating acute and chronic scars.

Best Laser for Resurfacing

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Thanks for the great question. As with any treatment, there are different types of laser and different brands of each type. In addition, different laser types and intensities will be more or less appropriate for different skin types.  The gold standard for resurfacing is CO2 laser, though this is most commonly delivered today as a fractional CO2 (meaning that less than 100% of the surface area is hit with the laser). The key to a great resurfacing result is choosing the right settings for your goals and skin type, and careful, attentive management of preoperative preparation and postoperative care. This will likely include use of tretinoin and/or hdroquinone, as well as sunscreens and non-comedogenic moisturizers. Best of luck moving forward!

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.