There are few things in the beauty world that invokes the outer world’s imagination than lasers do. Let’s face it, lasers look like some sort of Sci-Fi weapon. They also work in a way that many of us struggle to understand and may have a down time that makes users look like they’ve recovered from something terrible. However, they’re a tried and tested treatment that can truly elevate your skin’s texture and appearance. We’ve written an in-depth guide to laser skin treatments to dispel the myths and promote the facts about laser skin therapies. In this article we explore how lasers work, the different types of lasers, their benefits and risks. We explore laser skin resurfacing, tightening and how laser treatments can enhance your complexion. We also discuss alternatives and treatments that can compliment laser as well as how to choose laser treatments for every skin type and concern.
A Brief History of Lasers
Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Lasers were first developed in the 1960s. The concept began with the theories of Albert Einstein and later Theodore H. Maiman successfully created the first working laser in 1960. The medical community quickly realised the potential of lasers and initially used them for ophthalmologic procedures like retinal surgeries.
In the late 1960s, Dr. Leon Goldman, often referred to as the father of laser medicine, began to experiment with lasers for skin treatments. His pioneering work laid the foundation for the use of lasers in dermatology. The 1980s saw the introduction of the CO2 laser for skin resurfacing. It became a popular choice for treating scars, wrinkles and other skin concerns. The Erbium YAG laser soon followed. It could provide similar results with less thermal damage.
The mid-1990s brought the first laser hair removal treatment. The introduction of the Nd:YAG laser made hair removal safer and more effective, especially for darker skin tones. The FDA approved the first laser hair removal device in 1997, and the procedure quickly became popular.
Since their invention, laser technology has continued to evolve, with the introduction of non-ablative lasers, fractional lasers, and IPL (Intense Pulsed Light) systems. These innovations have expanded the range of skin conditions and skin types that laser can treat. This has made laser treatments more accessible and customisable to individual needs.
How Laser Skin Treatments Work
Lasers work by emitting a powerful and precise beam of monochromatic light. Different lasers can selectively target different components within the skin, such as water, pigment or blood vessels. For this reason, lasers are generally divided into two main types; ablative and non-ablative lasers. Fractional laser is not a different category. Rather it is a method of delivering laser treatment. As such ablative and non-ablative lasers can be used to perform fractional laser therapy.
Ablative Lasers
These types of laser are used in skin resurfacing procedures. They remove the top layer of damaged or aged skin to reveal the fresh, healthy skin underneath. The term “ablative” refers to the way they work. Ablative lasers emit a wavelength that is readily absorbed by water in the skin. As the laser energy is absorbed, it vaporises the targeted cells on the surface layers of the skin. This removes the damaged outer layers and stimulates the production of collagen and new skin cells. As such, ablative lasers cause resurfacing and tightening of the underlying skin to regenerate leading to smoother and younger looking skin. It’s a highly effective method for treating wrinkles, scars and hyperpigmentation. CO2 and Erbium lasers are a type of ablative laser skin resurfacing and tightening treatment.
Ablative lasers are effective in treating deep wrinkles, scars and uneven skin tone. Due to the way they work, you can sometimes see significant results in just one treatment. The downside is that recovery time can be extensive and can sometimes take up to several weeks. There is also higher risk of side effects such as infection, scars and post inflammatory hyperpigmentation. People with skin of colour are especially at risk of these. Ablative laser skin resurfacing treatments also generally require anaesthesia or more extensive numbing.
Non-Ablative Lasers
These lasers work on the underlying layers of skin without damaging the surface. Unlike ablative lasers, which vaporise the top layers of skin, non-ablative lasers work beneath the surface skin layer. They stimulate collagen production and tighten underlying skin without wounding or removing the outer layer of skin. This process helps to fill in wrinkles or lines and enhances skin tone and texture. Non-ablative lasers can lead to firmer and younger looking skin. The most common types of non-ablative lasers are Nd:YAG Lasers and Pulsed-Dye Lasers.
Non-ablative laser treatments are suited for individuals looking for gradual improvements with minimal down time. They are less painful and better for a wider range of skin tones and types compared with ablative lasers. However, the results may be less dramatic and multiple sessions are usually necessary to achieve the desired outcome. As such, they work best for mild to moderate skin issues such as fine lines, wrinkles, hyperpigmentation and minor scars.
Fractional Lasers
Fractional laser treatment is a method of delivering lasers in a way that breaks up the energy into thousands of tiny beams to treat only a fraction of the skin in the area. This is why it’s called “fractional”. This technology targets damaged skin cells, stimulates collagen production whilst also leaving healthy skin cells intact. Fractional laser treatments can use either ablative or non-ablative lasers like the ones discussed above. There are also new machines that offer a hybrid of ablative and non-ablative lasers delivered fractionally.
Ablative fractional lasers remove the outer layers of skin, along with treating a fraction of the deeper skin. They offer more dramatic results but come with a longer recovery time. Non-ablative fractional lasers work beneath the surface skin layer without wounding or removing it. They offer a milder approach with less down time.
Fractional lasers offer a more targeted approach to skin rejuvenation. They offer the flexibility to choose between more aggressive ablative options or milder non-ablative treatments depending on your skin type and needs. By treating only a fraction of the skin, they offer a balance between effectiveness and recovery time. However they are better suited for treating isolated skin problems such as for example discrete areas of hyperpigmentation or scars. Depending on the severity of the concern and the type of laser, several treatments might be necessary to achieve the desired results.
The Different Types of Lasers and Their Uses
There are several different types of lasers that are popular in skincare and beauty. Each of these has specific uses, benefits and risks. Below are the most common types of lasers used in skin treatments.
CO2 Lasers
Carbon dioxide (CO2) are a type of ablative laser that offers versatility and precision in treating a variety of skin concerns. One of the primary uses of CO2 lasers is in skin resurfacing. By removing the top layers of the skin, these lasers effectively target deep lines and wrinkles, hyperpigmentation and uneven skin texture. They also play a significant role in scar reduction. These lasers break down scar tissue and promote collagen production. This results in a smoother complexion. Laser skin tightening is another benefit of CO2 lasers. By penetrating the deeper layers of the skin and heating the collagen underneath, the lasers cause the skin to contract. This tightening effect reduces sagging and increases skin elasticity to create firmer looking and feeling skin.
Beyond these cosmetic applications, CO2 lasers are also used in medicine. They can remove unwanted warts, moles and skin tags. They are also sometimes used to treat pre-cancerous growths, papillomas and rhinophyma.
Although CO2 lasers have a wide range of applications and provide significant advantages, they also carry higher risks and greater down time. As such, they require skilled handling by a trained professional. This ensures that the laser is used properly for the correct skin types and conditions.
Erbium YAG Lasers
Erbium YAG (Yttrium Aluminum Garnet) lasers are another type of ablative laser used in cosmetic dermatology for skin resurfacing. They represent a gentler alternative to CO2 lasers and are well suited for those seeking a less invasive treatment option. The key advantage of Erbium YAG lasers is their ability to target the epidermis (the skin’s outer layer) and the upper dermis (the skin’s deeper layer) with minimal heat damage to the surrounding tissue. This makes them highly effective in treating moderate lines and wrinkles, hyperpigmentation and superficial scars.
Since Erbium YAG lasers are less aggressive than CO2 lasers, the recovery time is normally shorter and the risk of side effects like post inflammatory hyperpigmentation or infection is reduced. Patients with a darker skin tone, who might be at greater risk of pigmentation changes with other lasers, may find Erbium YAG lasers more suitable. However, Erbium YAG lasers may require more treatment sessions to achieve the desired results compared to the more intense CO2 lasers.
Nd:YAG Lasers
Nd:YAG (Neodymium-Doped Yttrium Aluminum Garnet) lasers are versatile and widely used type of non-ablative laser. They effective in treating various skin conditions and are suitable for all skin types, including darker skin tones. The Nd:YAG laser emits a wavelength of 1064 nm, which can get deeper into the skin. This allows it to target the underlying structures more effectively, making it a good choice for treatments such as hair removal, tattoo removal, spider veins and pigmentation issues like hyperpigmentation and melasma. Crucially, they can treat several skin conditions simultaneously.
The main uses of Nd:YAG lasers:
- Hair Removal: Nd:YAG lasers are especially effective for hair removal on darker skin tones. The laser energy is absorbed by the melanin in the hair follicle, leading to its destruction without damaging the surrounding skin.
- Tattoo Removal: these lasers are able to shatter the ink particles in the skin without harming the nearby tissue. This makes them a popular choice for tattoo removal.
- Vascular Lesions: Nd:YAG lasers are used to treat spider veins and other vascular lesions, as they can target the haemoglobin within blood vessels.
- Pigmentation Issues: this laser can also be used to treat dark spots and other pigmentation problems like rosacea.
- Skin Tightening: some Nd:YAG lasers are used for non-invasive skin tightening. This is because they can stimulate collagen production within the skin.
The Nd:YAG laser’s versatility comes from its ability to be modified with different hand pieces and settings. This allows practitioners to tailor treatment to individual patient needs. They also tend to be less painful compared to other laser types. Additionally, the risk of scars or post inflammatory hyperpigmentation is lower even in skin of colour. However, the Nd:YAG lasers are not without draw backs. They are less effective in treating more advanced signs of skin ageing, tightening lax skin, hyperpigmentation and scars compared with ablative lasers. Also, multiple treatment sessions may be needed for optimal results.
Pulsed-Dye Lasers
These lasers operate at wavelengths that specifically target blood vessels, making them highly effective in treating vascular lesions, such as birthmarks, rosacea, spider veins, and broken capillaries in the face. The name “pulsed-dye” refers to the manner in which the laser energy is delivered. Short bursts or “pulses” of light are used to selectively target the haemoglobin within blood vessels without affecting the nearby tissues. The absorbed energy causes the blood vessels to coagulate and be reabsorbed by the body. This gets rid of or reduces the appearance of the vascular lesion.
A huge advantage of Pulsed-Dye Lasers is that they can provide effective treatment without damaging the surrounding skin. This makes them better for delicate areas, including the face and neck. For this reason, they are often used to treat vascular birthmarks in children. However, Pulsed-Dye Lasers may cause some temporary side effects. These include bruises, swelling or redness. The treated area might also feel warm or tender for a few hours following the treatment. Whilst these side effects are generally short lived, they are important to consider.
Alexandrite Lasers
Alexandrite lasershair removal
In addition to hair removal, Alexandrite lasers can effectively treat hyperpigmented lesions such as sun spots, age spots, and freckles. The melanin pigment is broken down and reabsorbed by the body. Some clinics even use Alexandrite lasers for tattoo removal, especially for green and blue ink, and to treat spider veins and other vascular lesions.
Whilst Alexandrite lasers offer potent and effective treatment, they aren’t suitable for all skin types. Skin of colour may be at risk of post inflammatory hyperpigmentation or scars. This is because the laser targets melanin in the skin itself. Compared to other lasers like Nd:YAG, Alexandrite lasers may offer quicker treatment times and greater effectiveness on certain skin types for hair removal. However, they are not as versatile as some other lasers and may not be suitable for darker skin tones.
Fraxel Lasers
Whilst not a unique type of laser, Fraxel is a specific brand name that’s become synonymous with fractional laser resurfacing. The Fraxel laser works by producing thousands of tiny columns of microscopic treatment zones in your skin, leaving the surrounding skin untouched. This “fractional” treatment allows the skin to heal much faster than if the entire area were treated at once. It uses the body’s natural healing process to create new, healthy, tighter tissue to replace damaged skin.
Fraxel laser is a common method to treat wrinkles and fine lines, skin tightening, scars, hyperpigmentation, sun damage and actinic Keratosis. Generally, Fraxel lasers can be both ablative and non-ablative. Non-ablative Fraxel lasers (like the Fraxel DUAL 1550/1927) boost collagen growth and improve skin tone and texture with less down time. Ablative Fraxel lasers (such as Fraxel re:pair) can achieve more dramatic results but require a longer recovery period.
Although Fraxel is generally considered a safe procedure, it does have potential risks and side effects. Temporary swelling and redness can occur, and there might be a risk of scars, infection, or pigmentation changes, particularly if post-procedure care instructions are not followed carefully.
Hybrid Fractional Lasers
These are a relatively new innovation in laser technology that combines both ablative and non-ablative wavelengths in a single pass. This approach allows for a dual treatment, targeting different skin depths and addressing multiple concerns simultaneously. The ablative laser skin resurfacing wavelength can work on superficial skin issues, while the non-ablative wavelength penetrates deeper to stimulate collagen production. Here are some examples and features of Hybrid Fractional Lasers (HFL):
- Halo Laser: this is one of the most well known HFLs. It combines a 1470 nm non-ablative laser with a 2940 nm ablative Erbium YAG laser. It resurfaces the skin in order to treat wrinkles, pores, pigmentation and improving overall skin texture. Halo lasers offer a bespoke treatment to precisely target specific concerns. This has the benefit of being more effective than non-ablative lasers but reduced down time compared with purely ablative lasers.
- ProFractional-XC Laser: this laser combines an ablative Erbium YAG laser with a non-ablative coagulation process. It’s design allows for collagen stimulation at the deeper levels. This helps to treat scars, wrinkles and improving skin texture. It is adjustable for different depths and recovery times. This allows for a bespoke treatment approach.
Hybrid Fractional Lasers offer a versatile and adaptable approach to skin treatment. By allowing for the simultaneous application of different laser types, practitioners can address both surface-level and deeper skin issues in a single session. This multi-faceted approach often leads to more satisfying outcomes with potentially less downtime than more aggressive single treatments.
Intense Pulsed Light
Whilst not a laser treatment, Intense Pulsed Light (IPL) is worth a mention here as people often assume it is. Unlike traditional lasers, which use a single wavelength to target specific skin structures, IPL generates multiple wavelengths, usually between 500 and 1,200 nanometers. It is possible to filter this broad spectrum to target various chromophores (colour-containing parts) in the skin. This allows it to address a diverse range of skin conditions.
The pulsed nature of IPL offers control over the depth and intensity of the treatment. This enables it to work on skin rejuvenation, hair removal and acne. It can handle pigmentation issues like hyperpigmentation, redness, melasma, and rosacea. It can also targets melanin in the hair which makes it better for hair removal or reduction. Furthermore, specific wavelengths of IPL can even target and destroy acne-causing bacteria.
IPL is extremely versatile. It offers a less painful experience compared to traditional lasers, with minimal down time. However, IPL is not a laser and its scattered light approach makes it less precise in targeting specific skin structures. Also, not all skin types respond equally well to IPL. As such it maybe less effective and people with darker skin tones might face higher risk of post inflammatory hyperpigmentation.
How to Choose The Right Laser for Your Skin
Choosing the right laser for your skin is an intricate process that requires careful consideration of various factors. The type of laser and treatment modality chosen will depend on your skin type, concerns, and desired outcomes. Broadly speaking, the main types of laser skin treatments are:
- Laser Skin Resurfacing: this technique employs ablative skin resurfacing lasers to remove damaged skin layers, to promote new growth and a smooth complexion.
- Laser Skin Tightening: this approach uses non-ablative lasers to heat the underlying skin layers, to boost collagen production for firmer, younger looking skin.
- Hair Removal: laser treatments are highly effective for permanent hair reduction.
- Treatment of Pigmentation and Scars: lasers can target specific pigments in the skin, reduce the appearance of scars, sun spots, and melasma.
Below is a a general overview of how to figure out which laser skin treatments might be best for you. We haven’t included hair removal in the below as that will be covered in a separate blog post.
What Are Your Skin Concerns?
- Wrinkles and Fine Lines: ablative skin resurfacing lasers like CO2 or Erbium YAG lasers might be suitable.
- Hyperpigmentation and Uneven Skin Tone: IPL or fractional lasers like Fraxel can target these issues.
- Acne Scars: non-ablative lasers like Nd:YAG or fractional lasers are often used.
What is Your Skin Type?
- Light Skin Tones: most lasers can be used, but specific issues may call for specific lasers.
- Medium and Darker Skin Tones: special care should be taken to avoid post inflammatory hyperpigmentation. Nd:YAG or fractional non-ablative lasers might be better.
How Much Downtime Can You Tolerate?
- Short Recovery: non-ablative and fractional lasers usually have a quicker recovery time.
- Extended Recovery: ablative skin resurfacing lasers may require more downtime but often provide more dramatic results.
Find The Right Person & Place for Your Treatment!
Consultation with an experienced dermatologist or other licensed medical professional is absolutely vital to determine the most suitable laser treatment for your specific needs. They will examine your skin, consider factors like skin type, age, specific concerns and overall health to help choose the best treatment for you. Make sure that you clearly express your desired results as this will allow the specialist to tailor the treatment accordingly. Also clarify the risks, how they will reduce these, how many treatments to expect and the cost of this up front.
Do your homework about the facility. Check that they use FDA-approved lasers and that the technicians are trained and experienced in laser treatments.
How to Prepare for Laser Treatments
Preparing for laser treatments is not just about the day of the procedure, but it often begins weeks or even months in advance. Start with a consultation with a skilled professional. Make sure that you understand the procedure, including the type of laser being used, what it entails, the expected results, potential risks and the estimated recovery time. Your practitioner should review your medical history, including any medications and allergies to ensure the treatment is suitable.
Pre-treatment skincare is vital. Patients are normally advised to stay out of the sun for at least four weeks before the treatment and might be asked to avoid active skincare products such as retinoids and exfoliating acids. You should also avoid waxing and plucking in and around the treated area. Some clinics will recommend a specific skincare protocol to prepare your skin for the procedure.
On the day of treatment, clean your skin and wear comfortable clothing. Avoid jewellery near the treatment area. Also set realistic expectations. Make sure you understand the recovery process and know what to expect post treatment in terms of redness, swelling, and other potential side effects.
What to Expect During the Procedure
To start the laser treatment procedure, the treatment area is first cleaned. Following that is applying a numbing cream or local anaesthesia to ensure your comfort. Patients are usually given safety goggles. This shields their eyes from the laser’s intense light. The laser device is then specifically adjusted for the patient’s skin type and concern. Throughout the procedure the device will move across the target region to deliver the treatment. This can feel like a gentle pricking or warm sensation.
The length of the procedure varies. It depends on treatment area and device used. In general it can range from a few minutes for small areas to over an hour for larger treatments, such as full face resurfacing. Your practitioner might use cooling techniques during or after the laser treatment to soothe your skin. You might need to apply a balm post-procedure to help with healing.
You should get follow-up appointments, aftercare instructions and the schedule for repeat treatments at the end of the procedure. Ensure you strictly follow your provider’s aftercare instructions and notify them immediately if you have any unexpected side effects or concerns.
Downtime and Recovery For Laser Skin Treatments
Downtime and recovery after laser skin treatments depend on a number of factors. The most important ones are the type of laser, the treatment area and your specific skin condition and overall health. Here’s an overview of what you can generally expect:
- Ablative Lasers: recovery from ablative lasers can take some time. These treatments remove layers of skin, so redness, swelling, and peeling are common afterwards. It may take several weeks for the skin to heal, and diligent aftercare, including moisturisers and sun protection, is vital. Scarring and infection are potential risks. Downtime is usually 1-2 weeks but can be longer.
- Non-Ablative Lasers: these are less invasive and, as such, generally require less down time. You might get mild redness or swelling, but these usually subside within a day or two. You can often return to your regular activities immediately following the procedure.
- Fractional Lasers: as these create microscopic wounds and leave nearby tissue untouched, there is usually quicker healing. Downtime normally ranges from a few days to a week. To speed up healing, avoid harsh skincare products and sun exposure for a few days.
- IPL (Intense Pulsed Light): this is not a traditional laser but a broad-spectrum light that targets pigmentation and vascular issues. Recovery is minimal, with possible mild redness or warmth in the treated area. You can usually resume regular activities immediately.
- Hybrid Fractional Lasers: These lasers combine ablative and non-ablative wavelengths. This allows for a customised approach. Recovery may vary widely based on the settings used, from minimal down time with non-ablative settings to several weeks with ablative ones.
Risks of Laser Treatments
Laser treatmentslaser treatments
The main risks and side effects of laser skin treatments are:
- Burns and Scarring: lasers can cause burns or scars if not used properly. Scars might be temporary or permanent.
- Pigmentation Changes: hypopigmentation (lightening of the skin) or hyperpigmentation (darkening of the skin) can occur after laser treatment. This is especially likely to occur with the wrong type of laser or not following post treatment care instructions.
- Infection: although rare, infections can happen, particularly with ablative skin resurfacing lasers that remove layers of skin. This is why proper care and hygiene after the treatment are crucial to prevent this.
- Redness and Swelling: these are common side effects, particularly with more aggressive laser treatments. They usually resolve within a few days to a week.
- Peeling, Blistering and Crusting: this is especially likely to occur with ablative lasers. It usually goes away as the skin heals.
- Eye Injury: lasers can cause serious eye injuries if you don’t use proper eye protection during the procedure.
- Activating Cold Sores: if you have a history of herpes or cold sores, laser treatments might activate them. Let your practitioner know before hand as they may prescribe a prophylactic treatment.
- Unsatisfactory Results: to avoid disappointment, always remember that results vary between individuals. Sometimes you might not get the desired results or the effects might not last as long as you hoped.
- Increased Sensitivity: some people may experience higher skin sensitivity or have an allergic reaction to the skincare products used during or after the treatment.
- Reactions in Tattoos: lasers can react with tattoo ink, leading to fading or changes in the colour of the tattoo.
- Rare Side Effects: in rare cases, other problems like numbness, milia (small cysts), or fat loss in the treatment area might occur.
Alternatives to Laser Skin Treatments
Laser treatmentsprofessional skin treatments
Chemical peels work by resurfacing the skin and can help treat fine lines, scars, hyperpigmentation as well as acne. Microneedling and skin injections like Profhilo can boost collagen and elastin production. These are useful for treating scars, skin laxity, fine lines and skin texture. Anti-ageing injectables like dermal fillers and neurotoxin injections like Botox can target wrinkles and lost face volume.
Topical skin treatments, can also provide a good alternative or enhance the effects of laser treatments. Prescription skincare like Tretinoin and Hydroquinone provide an effective solution for hyperpigmentation, acne, scars as well as skin ageing. Regular use of exfoliating acids, humectants, anti-oxidants and ceramides will also help improve the overall appearance and health of your skin.
Constant innovation and adaptation mark the history of lasers in skin and hair treatments. From the first ruby skin resurfacing laser to the diverse range of laser technologies available today, the field has advanced rapidly, providing an ever growing array of solutions for skin and hair concerns. Laser skin treatments offer a versatile, targeted, and effective approach to various skin conditions. Understanding the different types of lasers and how they work provides insight into this advanced technology and how it might serve your skincare goals. As always, start by seeking professional advice to ensure that you get the safest and most effective type laser skin treatment tailored to your unique skin needs.
Always remember that skincare is first and foremost personal. Our virtual clinic offers safe and effective prescription-strength treatments containing ingredients like Tretinoin and Hydroquinone where appropriate. We provide custom made treatments for conditions like acne, hyperpigmentation, melasma and skin ageing. Book a virtual consultation with one of our doctors today and take your first step towards great skin.
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Authored by:
Aesthetic Doctor & Medical Director BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611
