Lasers, Intense Pulsed Light, and Resurfacing Procedures

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Without question lasers and various light-emitting devices can help reduce signs of aging and fade signs of sun damage. With so many laser treatment procedures available, knowing the basics about each is essential to making the best decision for your concerns.
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A Sea of Light

Issues involving cosmetic corrective procedures are complicated enough, but when the topic turns to lasers, intense pulse light (IPL), or other forms of resurfacing, what you will find is a clutter of complex, technical information that is hard to decipher. We're here to help you cut through the confusion and get the facts so you can make an informed decision.

The issue of which laser or light treatment to get is further complicated by enthusiastic physicians making unrealistic claims and promises.  Physicians (usually dermatologists) can get just as swept up in claims made for lasers as consumers, so it's important to find a dermatologist who is clear about the pros and cons—and forthcoming about the improvements you can reasonably expect to see.

What Does Laser Mean?

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. In essence, lasers work by generating a concentrated and penetrating stream of pulsed bright light that can be controlled and strategically directed over the skin. Resurfacing the skin with lasers can work as ablative or non-ablative procedures depending on the type of laser utilized. An ablative laser literally vaporizes and removes deep wrinkling and scars from the surface of skin and penetrates deeper into skin tissue, reorganizing and stimulating production of collagen and elastin fibers in the process.

Ablative vs. Non-Ablative Laser Procedures

Lasers, IPL, or resurfacing machines are either ablative or non-ablative treatments. Non-ablative treatments target the lower layers of skin (dermis), while leaving the skin's surface (epidermis) unharmed and intact. Ablative laser resurfacing targets both the surface and the lower layers of skin by injuring or "ablating" the surface of skin. Lasers can perform either ablative or non-ablative resurfacing, while IPL and various resurfacing are considered non-ablative methods that provide results similar to ablative procedures, albeit in a slower manner. Which system you choose depends on the results you are looking for and how much risk you are willing to take.

Ablative lasers can:

  • Make a significant difference in the appearance of deep wrinkles and surface wrinkles.
  • Help significantly fade skin discolorations.
  • Erase years of sun damage by replacing damaged skin with healthier, new skin.

Risks from ablative procedures include:

  • Swelling, scabbing, and oozing.
  • Bleeding, flaking, and redness.
  • Significant irritation that requires a longer time to heal.
  • Long-term skin discoloration and scarring.

For ablative resurfacing with a laser, the quality of the postoperative techniques is as important as the skill of the physician during the procedure. After ablative laser treatment, the skin oozes, crusts, and needs to be cleaned and dressed for about two weeks before you look even vaguely normal. Because the top layer of skin has been stripped away, the raw, exposed skin needs to be cleaned and treated very carefully. Patients need to make sure they follow post-op care instructions precisely, because inconsistency or incomplete care can cause infection, delay healing, and increase irritation.

Non-ablative resurfacing has none of the side effects associated with ablative resurfacing. However, non-ablative resurfacing doesn't produce the same dramatic or impressive results as ablative resurfacing does. Not only are the results subtle, but multiple treatments are required for the most noticeable outcome. The advantage for non-ablative resurfacing is its minimal downtime; women can reapply makeup before leaving the doctor's office and return to work the same day.

Non-ablative lasers can:

  • Remove some skin discolorations, particularly superficial brown spots.
  • Improve and potentially eliminate redness from rosacea and broken capillaries.
  • Improve minor wrinkles and fine lines.
  • Stimulate collagen production (after repeated treatments).

Risks from non-ablative procedures include:

  • Swelling and potential bruising (this fade within days).
  • Enhanced redness or a sunburn-like reaction (this is temporary).
  • Temporary darkening of treated spots (these lighten as they heal).

There Isn't a Best Laser

Above all else, you need to know that despite what you're likely to hear, there isn't a best laser or light-emitting treatment for everyone. Which one is used depends on several factors, including your concerns, what the research reveals in terms of efficacy and safety, and the fact that more than one type of laser is equally suitable for the same concern. There isn't a single best laser or light-emitting treatment; rather, there are several options and each has its pros and cons.

Types of Lasers, Light-Emitting, and Resurfacing Devices

The following is a list of the more popular lasers and light-emitting machines in use for cosmetic resurfacing: (Note: The cost of the various procedures can vary so dramatically from doctor to doctor and city to city that there is no way for us to provide reliable cost estimates for these treatments.)

CO2 Pulse Laser (trade names Feather Touch or Ultra Pulse): This is one of the oldest types of ablative machines around. Although it can create more lasting and noticeable results than any other laser, it is also associated with the most risk and potential skin damage.

The skin can take one to two weeks to heal and can be red for one to two months afterward. Risks of scarring, skin discoloration, and uneven texture must be weighed against the intended outcome, although these side effects are rare when the doctor is experienced with this kind of procedure.

Erbium: YAG Laser: This ablative laser is far less invasive than the CO2 Pulse laser and is considered effective for minor or superficial wrinkling. However, if the intensity of the machine is increased, deeper wrinkling can also be treated. Another option is the Variable Pulse YAG Laser which alternates light frequency with pulses that heat the skin and cause ablation that resurfaces the skin almost as effectively as CO2, but with fewer side effects.

A combination of CO2 and Er: YAG laser treatments is also done. In this treatment, the Er: YAG laser is first used to remove the epidermis, followed by use of the CO2 laser to achieve contraction of underlying collagen. This produces the collagen-tightening benefits of CO2 therapy but with minimal damage to surrounding tissues.

Fraxel (similar devices include Affirm, Active-Fx and Lux 1540): Also known as fractional photothermolysis, this procedure creates hundreds to thousands of microscopic, pixelated thermal (heat) injuries to skin, with the goal being to stimulate collagen production for smoother, firmer skin. The pinpoint injuries this light treatment causes do not affect surrounding skin, so you can get impressive results with less down time and less risky side effects (when compared to CO2 laser resurfacing). Fraxel treatments are worth considering if you have superficial acne scarring.

There is generally minimal downtime associated with fractional resurfacing. You may notice lingering redness or brown spots for a month or so afterward, but these vanish in time. For best results, a series of 2–4 treatments is typically recommended.

Thermage and Titan: These two treatments use different systems to achieve the same result, which is tightening of lax collagen while stimulating new collagen production for firmer, smoother skin. Thermage operates via radiofrequency (sound waves) while Titan operates via infrared laser.

Both of these treatments are potential non-surgical options for sagging skin, especially if you have them done at the first signs of sagging. Advanced sagging doesn't respond well to either Thermage or Titan. Neither procedure is a reliable substitute for a face-lift, and any tightening you get will be a gradual process, with some initial results often seen but full results can take as long as six months to be visible.

Comparing the two, Titan requires 3–4 treatments for results that are possible from just one Thermage treatment. Titan is generally regarded as the more painful of the two procedures because the latest Thermage device has a built-in cooling tip and also allows the operator much more control over the intensity of each pulse. Thermage does not require any downtime, and most people will experience some minor swelling and perhaps some pinkness (these side effects go away in days).

Long-Pulsed YAG Laser (trade names CoolTouch and Lyra): This non-ablative laser is often used for wrinkles and reducing the appearance of acne scars. As is true with any non-ablative laser resurfacing, it takes several treatments to achieve very subtle results.

The CoolTouch has a built-in cooling device that protects the top layer of skin but it can still feel like a rubber band snapping against the face as it is used. Types of the Long-Pulsed YAG Laser can be used for hair removal and removing surfaced capillaries.

Either treatment needs to be repeated every year or two to maintain the results and help discourage further sagging.

Q-Switched Ruby Laser: This laser is minimally ablative and is primarily used to selectively remove skin pigment, such as freckling, sun-damage spots, and actinic keratosis without damaging the surrounding tissue. It is also useful for removing birthmarks. It usually takes several treatments to see the desired results. Some cases of dark circles have been treated with this laser, but there isn't much research to go on.

One of the popular uses for the Q-Switched Ruby laser is cosmetic tattoo removal. Many physicians have noted that impulsive tattoo designs or the poor work from inexperienced or poorly trained aestheticians who tattoo lip liner, eyeliner, and eyebrows on women is so rampant that eliminating these constitutes a large portion of their laser work!

Pulsed Dye Laser, Short- and Long-Pulsed (trade name: Candela VBeam): This non-ablative laser gives impressive results in removing surfaced capillaries on the face, port wine marks, hypertrophic scarring (thick or raised scars), and hemangiomas (red dots on the surface of skin). It doesn't cause skin damage, but it almost always causes temporary bruising. Several treatments may be required.

Long-Pulsed Alexandrite Laser (trade names GentleLASE and Cool Pulse): This non-ablative laser is another option for hair removal and removing surfaced capillaries and leg veins. This machine quickly covers large areas of skin.

Intense Pulsed Light (trade names: Lumenis, Quantum, Palomar Starlux): Not a true laser but still a light-emitting device, Intense Pulsed Light (IPL) is a good “starter” option that can work very well to treat superficial brown spots, redness and broken capillaries (hallmarks of rosacea), and, with repeated treatments, provide collagen stimulation. A series of 3–6 treatments is typically needed for optimum results, and these are usually spaced 4–6 weeks apart. This procedure has no downtime, though you may notice minor swelling, tenderness, and possibly some bruising, which fades within days.

Remember, regardless of the device you and your dermatologist opt to use, be sure you're fully informed on what to expect and what is required of you before and after the procedure. And of course, none of these treatments will provide great results if you're not diligent about using a great skin-care routine that includes daily sun protection!

Sources:  Cosmetic Dermatology, Second Edition,  Baumann, Leslie MD, 2009; Dermatologic Surgery, August 2004, pages 1073-1076; Dermatologic Surgery, April 2004, pages 483-487; Lasers in Medicine and Science, April 2004, pages 219-222; Dermatologic Surgery, January 2004, pages 37-40; Archives of Dermatology, October 2003, pages 1295-1299; Lasers in Surgery and Medicine, May 2003, pages 405-412; International Journal of Dermatology, June 2003, pages 480-487; Archives of Facial Plastic Surgery, October-December 2002, pages 262-266; Seminars in Cutaneous Medicine and Surgery, December 2002, pages 288-300; Lasers in Surgery and Medicine, May 2002, pages 359-362; Dermatologic Surgery July 2001, pages 622-626; American Journal of Clinical Dermatology, February 2001, pages 21-25; Dermatologic Surgery, February 2000, pages 102-104; and Laser Abstracts from the 14th Annual Congress of the American College of Phlebology.


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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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