Laser Skin Resurfacing: Ablative laser vs fractional vs non-ablative

History of dermatological lasers

The word LASER was first coined by a PhD student, Gordon Gould, in 1957; it is an acronym that stands for “Light Amplification by Stimulated Emission of Radiation”. Although studying and experimenting for years, he did not have the financial backing needed to realize it; other people started working on the concept in the same years: Charles Townes and Arthur L Schawlow working at Bell Labs, Gordon Gould at Pentagon and four other groups working at Bell Laboratories. In the end, Theodore Maiman of Hughes Laboratory from California created the first working laser on May 16, 1960.

In 1961 Dr. Leon Goldman, dermatologist and head of the Department of Dermatology at the university of Cincinnati, started researching the possible medical applications of this new technology. At the same time he was given the task to study the safety of this type of device by the National Institute for Occupational Safety and Health. His studies and findings earned him the title of “Father of Laser Medicine and Surgery”.

How laser works

• Ablative Laser Skin Resurfacing: this type of treatment works by emitting high energy beams of light that vaporize the water inside the cells, causing thermal damage. The skin layers treated are destroyed and the depth of treatment depends on the type of laser used and the amount of energy set. With each subsequent laser pass, further tissue ablation occurs.
• Fractional Laser Skin Resurfacing: this treatment works similarly to ablative lasers; the difference is that in the fractional resurfacing the skin is targeted in a pattern. Small columns of skin are targeted, spaced from each other, leaving columns of healthy untreated skin in between.
• Non-Ablative Laser Skin Resurfacing: the non-ablative treatments work differently than the previous ones; instead of targeting the skin’s surface and destroying it, the energy produced by this type of lasers penetrates the skin and stimulates the production of new collagen at a deeper level.

Indications of laser skin resurfacing

Scars, fine lines, wrinkles, sagging skin, uneven skin tone, hair removal, pigmentation disorders, vascular lesions (telangiectasias), benign skin lesions, warts, moles, tattoo removal, skin cancer, …

Different types of laser

• Ablative:
  1. Carbon Dioxide Laser (CO₂ Laser) – 10’600 nm
  2. Erbium :Yttrium-Aluminum-Garnet Laser (Er:YAG Laser) – 2’940nm
• Non-ablative:
  1. KTP 532nm Green Lasers
  2. Argon Laser 488-514nm and Argon Pumped Continuous Wake Dye Laser (515-590nm)
  3. Pulsed Dye Laser – 585-595 nm
  4. Nd:YAG 1’320nm
  5. Diode 1’450nm
  6. Er:Glass 1,540

The advantages of ablative lasers is that they lead to the best clinical outcome and require a single treatment. The disadvantage is the prolonged recovery time and increased side effects.

Non-ablative lasers have little to no postoperative recovery and minimal risk of side effects. Their effect is more subtle though and multiple sessions are usually required.

After the procedure

Laser resurfacing is typically an outpatient procedure, meaning there is no need for an overnight stay. The treatment usually lasts between 30 and 120 minutes, depending on how large the areas to treat are.

A bandage will be placed on treated areas and skin will be kept clean by using gentle cleansers and moist by using ointments and creams that will be advised by your treating physician. Applying cold packs helps with swelling, discomfort and itching. After the first healing period, a moisturizer will be advised as well as the use of SPF. Sun avoidance is a very important part of the recovery process to achieve good results. Older ablative lasers, using higher energy settings and dealing more damage to the treated areas, might require up to 3 weeks of skin care post-treatment. A pinkish / reddish colored skin is normal and should get back to your regular skin tone in two to three months.

Possible Complications

Possible complications are collateral burns from laser’s heat, erythema, itching, scarring, pigmentation disorders and infections.

Tips & tricks

• Stronger lasers lead to most sensational results. They require more downtime though and aftercare will be longer. There is also a higher chance of complications.
• Strictly follow the preoperative and postoperative regimen advised to you to achieve best results and reduce side effects and risks to the minimum.
• The operator’s experience and technique influence the outcome. The best choice of laser depends on the operator’s expertise, the clinical indication, the patient’s expectations and the patient’s individual characteristics.
• Fall and Winter are the best times for laser treatment. This is because we spend more time indoors and daytime hours are shorter so there is less sun exposure following the treatment.
• While having a dark skin type does not preclude this type of treatment, there might be safer and more effective treatment options available. Consult your provider to be advised.
• Some medications and conditions influence the results. This will be discussed in your pretreatment consultation.

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