Is the Erbium laser really 'too weak' to help with wrinkles?

Question

Hi, a dermatologist gave me some rather controversial information. He told me that he stopped using Erbium because, due to the fact that it is "too cold and doesn't heat up the deep layer of the skin enough, it is also not helpful in smoothing out wrinkles", He did say that it was (because of it) very safe though, and then proceded to recommend the Genesis laser (non-ablative). Is this actually a scientific fact? The erbium laser is used widely. Thanks.

Andrew Campbell, MD · Answer

That is a very strange answer your Dermatologist gave you because the Erbium laser is one of the most powerful lasers used in aesthetics. The Erbium laser is THE most efficient laser available in that almost ALL of the energy that hits the skin is immediately absorbed and used to vaporize the skin. And the fact that he mentioned heat into the skin is also interesting because we DON'T want heat in the skin. We want vaporization to a depth that will cause a tremendous amount of new dermal collagen and wrinkle reduction. We DON'T want heat. Deep heat causes all kinds of complications like scarring, prolonged redness and prolonged healing as well as contributes to loss of natural pigmentation. The Erbium laser doesn't add deep heat, it just does exactly what we want it to do, vaporize the skin as deep as we want to go. In experienced hands, the erbium laser is the absolute gold standard for laser resurfacing. There is no non-ablative or fractional laser that can even come close to the results I can get with an Erbium laser. No matter how deep and how many wrinkles, they can be successfully treated with an Erbium laser.

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. The erbium laser works well for improving sun-damage, irregular skin pigmentation, fine lines/ wrinkles and decreased skin elasticity. There definitely is a tightening effect, but not to the degree where one can see a “pulling” of the skin. Make an appointment with an experienced oculofacial surgeon for a detailed evaluation and proper guidance tailored to your needs. Good luck!

Jason Emer, MD · Answer

Wrinkles can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like RF treatments, lasers, microneedling/PRP or sculptra to get increased collagen, tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Is the Erbium laser really 'too weak' to help with wrinkles?

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