When it comes to acne scars, wrinkles, and hyperpigmentation, even the most expensive and promising topical solutions can only go so far. Once you've reached that limit, you might consider turning to treatments, like micro-needling, Botox, and—the reason you came to this article—laser skin resurfacing. But if the idea of getting your face or body zapped with a laser leaves you with more questions than comfort, let us help. Below, dermatologist Arash Akhavan, MD, FAAD, the founder and director of The Dermatology and Laser Group, and cosmetic dermatologist Paul Jarrod Frank, MD, chief medical officer and founder of PFRANKMD and the author of The Pro-Aging Playbook, share everything you need to know about laser skin resurfacing. Keep reading to find out exactly how you can address your areas of concern with the wave of a magical wand (or in this case, a laser handpiece).
What Is Laser Skin Resurfacing?
Think of laser skin resurfacing as a broad term that encompasses lots of different kinds or types of lasers. There are tons of different ways to categorize lasers (for instance, CO2 vs. erbium, fractional vs. non-fractional, and nanosecond vs. picosecond), but Frank says lasers can generally be broken down into ablative and non-ablative.
Ablative means that the laser is tuned in such a way that it’s going to vaporize the surface of the skin, according to Akhavan. The ablative laser is a more robust laser that will create more injury, which means more downtime and more risk is associated with it but also potentially better results from one treatment.
The non-ablative laser is going to generate heat below the surface of the skin and will be gentler and less risky—especially to those who have a little bit of pigment to their skin—but Akhavan adds that the results will be a bit milder.
Despite the fact that there are many different lasers with different wavelengths, Akhavan says they all work by activating your body’s own natural mechanisms to heal something. "There are different ways of doing it, but they’re all operating, in the end, through the same pathway of creating injuries that’ll get your body to form new collagen and new skin in response," Akhavan explains.
Now for the million-dollar question: What's the cost? Frank says the lasers that are quicker, easier, and have the least downtime (like a day or so) are going to be cheaper, while the lasers that are much more intense and require more anesthesia or sedation and take more assistance in recovery will cost more. Where you're located can also affect the cost as well as the person providing the treatment. In general, Frank recommends seeing a board-certified laser specialist, such as a dermatologist or a plastic surgeon. For the lighter, non-ablative procedures with little downtime, nurses and physicians assistants are appropriate, but Frank stresses that you want to make sure someone has the skill and experience to determine who’s a good candidate and what's going to be the best type of resurfacing laser for them. With all of the above factors taken into consideration, treatments for laser resurfacing can range from as little as $400 up to $7,500.
Benefits of Laser Skin Resurfacing
- Minimizes the appearance of scars
- Lightens hyperpigmentation
- Removes sun damage
- Reduces fine lines and wrinkles
- Tightens loose skin
The idea is the same, regardless of which laser type or brand you’re using: the column of light is creating a little micro-injury in the skin to create new skin. A helpful analogy Akhavan uses to explain this process is the healing of a paper cut. When you get a paper cut on your finger, you can see it there for a week, but after that, the cut’s no longer there. The skin completely healed over it because when that injury happened, the wound-healing pathway was activated, and the signaling occurred, which told the cells to produce new skin and new collagen.
Now, let's apply that same concept to laser skin resurfacing. With the laser, Akhavan says they create an injury much smaller than a paper cut—a tiny, tiny injury—but your skin cells surrounding it don’t know if the injury is from a papercut, a fall, or a little microscopic cut from a laser. In other words, they operate the same way. That same wound-healing pathway is going to be activated, and they’re going to create an abundance of new, fresh skin on the surface and new collagen below, which will help with whatever collagen deficit you’re trying to treat (like wrinkles, an acne scar, a stretch mark, or loose skin).
How to Prepare for Laser Skin Resurfacing
Prior to your appointment, inform your doctor of any medications you're taking and avoid sun exposure and products, ingredients, or treatments that can cause your skin to be sensitive. But before you jump too far ahead, it's important to first consider whether or not you're a good candidate for laser skin resurfacing.
Unfortunately, your skin's pigment does play a huge role. The lighter your skin is, typically, the more energy can be safely introduced into your skin without the risk of causing scarring in the form of pigment change. "Skin responds to injury by either producing excess pigment in certain areas or less pigment in certain areas, so it can cause color changes in your skin," Akhavan explains. "When we get to darker skin types, we can still treat with lasers, but we have to turn the settings so far down to make it safe that sometimes it’s actually worth it to go to a different procedure that wouldn’t have these risks associated with it." Akhavan adds that for those with darker skin types such as Type V or VI skin (skin is typed from Type I to Type VI in dermatology), he would opt for micro-needling or another modality as opposed to a laser. With that being said, each case is different. You and your dermatologist should discuss the pros and cons of using laser skin resurfacing on your specific skin tone and type.
Laser treatments also might not be the best option for those who have melasma (a chronic pigment condition that's triggered by both sunlight and heat). As Akhavan explains, the heat that the laser generates is going to create further pigment, so in the long run, laser skin resurfacing can actually make the problem worse. "We have to be really careful with the devices we choose for our patients with melasma because heat is one of the instigating factors," Akhavan says. For these patients, Akhavan recommends trying a picosecond laser that has less heat and less damage or opting for micro-needling instead.
Other universal factors for all non-invasive, non-surgical procedures, including laser resurfacing, are age and health, which should be helpful when deciding when to start lasers. "The younger you are, and the healthier you are, the better you can repair from injuries, including these micro-injuries we’re creating from the lasers," Akhavan explains.
What to Expect During Laser Skin Resurfacing
How long each treatment takes as well as the level of pain varies, depending on the laser and what you're treating (like wrinkles, acne scars, or sun damage) because certain things are tougher to treat than others. In general, you can expect ablative lasers to be more painful and take longer than non-ablative lasers. Frank says for most non-ablative lasers, topical anesthesia is fine, but ablative lasers may require injection nerve blocks.
At-Home vs. In-Office
According to Akhavan, at-home skin resurfacing lasers can be mildly effective if used very regularly (think multiple times a week) for many months. "They should only be used in conjunction with a dermatologist's consultation to make sure you don't have conditions, such as melasma, that can potentially worsen with the treatment," Akhavan notes. If you're looking for something that will give you a better result in a shorter amount of time, an in-office treatment is the better option.
How many treatments it takes before you see results from an in-office procedure depends on the pigment of your skin, your age, how severe of a problem you’re treating, and what problem you’re treating. Akhavan says as a best-case scenario, someone might see improvement after one treatment, but typically, for the average patient, they’re going to need somewhere between three to 10 sessions. While some things can disappear entirely (fine lines), others (like stretch marks) never completely resolve.
"For any form of laser skin resurfacing, there’s no laser procedure that is without risk," Frank says. "Patients with darker skin or who are tan are going to be the most susceptible to complications, which is why it’s essential to see a board-certified laser specialist."
And as far as downtime, you guessed it—it depends on the laser. Akhavan says for more intense treatments, you could be out for weeks with really red, swollen skin and even pinpoint bleeding, and then pretty pink for another couple of weeks after that, but some lasers only have a downtime of about three hours. Peeling and flaking is also very laser-dependent and would be more common with the ablative than the non-ablative lasers, but Akhavan says it can happen with either, depending on how much damage was done on the surface of the skin.
Following your treatment, give your skin a break and avoid anything irritating, like harsh creams or peels. Because your new skin coming in will be more sun-sensitive, sunscreen is imperative. If you're really red and swollen the next day, Akhavan recommends avoiding makeup until it's just a little pink, and the surface of the skin has healed.
Before and After
While the results can vary, Akhavan says if you’re treating fine lines around the eyes or mouth or fine, small acne scars, you’re going to have great results and can potentially get rid of them completely.
The Final Takeaway
Akhavan says although laser skin resurfacing works for everything, the smaller the injury, the better the results. "You’re getting the collagen generation no matter what, it’s just going to require fewer treatments and have better results with a better defect that you’re trying to treat," Akhavan adds. A few laser treatments might set you back a few thousand bucks, but the results are worth it, and they last. And as for wrinkles or anything else aging-related that might creep up over time? Well, you could always go in for a re-up if you want it.