If I had a dollar for the number of times I’ve heard about the magical powers of laser skin resurfacing, I might be able to pay for said treatment. Okay, that might be hyperbole, but I’ve heard a lot of rave reviews. The procedure is known for smoothing skin, improving the appearance of fine lines and wrinkles, reducing scars, and boosting your complexion. Basically, your skin will look refreshed and renewed. It all sounds good, right?
But I was still a bit skeptical—it is a procedure, after all, and I wanted to know more about it. Was it really the “gold standard” like a lot of people say it is? Is it worth the money and time? Well, I asked the experts—a dermatologist and an aesthetic nurse practitioner, to help me figure it all out.
“Laser resurfacing is the act of improving the texture, tone, and tautness of the skin through laser and heat energy,” explains Corey L. Hartman, MD, FAAD, founder of Skin Wellness Dermatology. “It is one of the most high-impact procedures to erase sun damage, tighten skin, and prevent skin laxity. Historically, the most popular and oldest form of laser skin tightening involves laser resurfacing, which can be achieved via carbon dioxide, erbium, or thulium lasers that create epidermal damage and deliver heat to the dermis, which stimulates collagen production and causes peeling and redness to the skin’s surface.”
And how does it work, exactly? SkinSpirit aesthetic nurse practitioner Jeff Wheaton, RN, says it’s a process in which damaged skin is either removed in a deep fashion or superficially in order to allow new, undamaged skin to emerge. “The laser heats up the skin at a target temperature window to contract the collagen, and the micro holes made in the skin are repaired with the body generously depositing collagen in the areas,” he adds.
There’s not just one type of laser procedure. They vary, and some are better suited for certain skin types and needs. Hartman broke down the most common ones for us:
CO2: “Carbon dioxide lasers very precisely remove thin layers of skin with minimal heat damage to the surrounding structures,” Hartman says. “Carbon dioxide lasers treat wrinkles, photodamage, scars, warts, keloids, and more. The chromophore [part of a molecule responsible for its color; it absorbs light] is water, and therefore, patients should hydrate in preparation for the treatment.”
Hartman adds that ablative lasers, like the CO2 laser, work by traumatizing the skin. But don’t worry. It’s in a good way. “It removes the thin outer layer of skin (epidermis) and heats the underlying skin (dermis). This stimulates the growth of new collagen fibers,” he says. “As the epidermis heals and regrows, the treated skin appears clearer, smoother, and tighter.”
Fraxel: Hartman explains that this treatment uses microscopic columns to laser energy to treat only a fraction of the tissue at a time, leaving the area around it intact. “This allows swift healing and triggers the natural healing processes of the body to replace damaged or old cells with new, healthy, fresh, glowing skin,” he says. This type of treatment is effective for wrinkles and fine lines, acne scars, sun damage, excessive pigmentation, sun spots, actinic keratosis, and more. It’s also safe for men and women of any age and skin color.
Erbium: “An erbium laser provides a milder and less invasive treatment option than a carbon dioxide (CO2) laser,” Hartman says. “The CO2 laser is able to remove deeper layers of damaged skin than the erbium laser. However, an erbium laser treatment provides those whose skin damage is not as severe—or who would simply prefer a more rapid laser skin resurfacing recovery—with an excellent alternative.”
In this treatment, the erbium laser precisely ablates the outermost layer of the skin (epidermis) to reveal underlying skin that’s smoother and younger-looking, Hartman adds. “The procedure also activates collagen to promote further tightening of the skin. An erbium laser skin resurfacing treatment is performed as an outpatient procedure with the use of a local or topical anesthetic,” he says.
Those who have fine lines and wrinkles, sun damage, acne scars, large pores, or aging skin are all good potential candidates for laser skin resurfacing. But people will darker skin tones might want to take note. “Resurfacing lasers should be used with caution in those with darker skin tones because of the potential damage to the epidermis that can result in hyper- or hypopigmentation,” Hartman says. “Radiofrequency microneedling devices are safe and effective for all skin types. Patients with sagging skin are ideal for RF microneedling, while those with fine lines and wrinkles and pigment alterations from chronic sun damage are best suited for resurfacing with devices like the CO2 laser, erbium, and Fraxel.”
One of my other questions was how often you’d have to get it done, and would you be stuck in a cycle of having to get it done all the time? It all depends on what you are trying to improve with laser resurfacing. Wheaton says it can be done once a year or more depending on the type of settings chosen. “Collagen production peaks at about six to seven months, and plateaus for another six to 12 months. Then production starts to fall off. At that time, another treatment can be performed,” he explains.
You might need to get the procedure done yearly to erase accumulated sun damage and tighten the skin, Hartman adds. But in some cases, you might not need the treatment again. “When used for acne scarring, stretch marks, and keloids, a series of treatments is usually necessary to achieve the result, and then no more treatments are necessary,” he says.
Hartman says because the chromophore for all resurfacing lasers is water, he asks patients to hydrate enough in advance of the procedure. “Since these procedures are among those with the longest downtimes after the treatment, I give my patients the aftercare instructions at the time of the consultation so that they can adequately prepare,” he adds.
Wheaton advises patients to avoid the sun and use appropriate skin creams in the lead-up to their appointment. “Creams that build collagen, like from TNS, Alastin, and SkinBetter, are great collagen-prep creams and can be used to assist in prolonging collagen production. Antioxidants like C E Ferulic and Alto Defense are great, as are the post-treatment creams by SkinMedica.”
During the treatment, you will probably experience some discomfort. “Although the skin is prepped with potent topical numbing cream, there can still be a sensation of heat associated with all resurfacing procedures,” Hartman says. “Sometimes a mild sedative, like alprazolam or nitrous oxide may be given to help ease the discomfort. The skin is vulnerable after the treatment as it heals, but the pain is usually associated with the treatment itself.”
After the treatment, Wheaton says patients might experience sun sensitivity and their skin might be a mild pink hue for several weeks or less (depending on how aggressive the treatment was).
To help with any discomfort, make sure you follow your provider’s aftercare instructions. Hartman says emollient ointments, topical steroids, and mineral sunscreen are important as the skin heals post-treatment. And you can also use ice packs to help with swelling.
Since laser skin resurfacing is a big procedure, I wondered if there were skincare products that could achieve similar results. I had an idea that no product could mimic what you can get with a legit procedure, but I was curious to see if people with milder skin concerns could get away with just using good products. I mean, after all, it’s not exactly the cheapest treatment—according to the American Society of Plastic Surgeons, the average cost could be $2509 for ablative and $1445 for non-ablative.
Well, it turns out, there’s no OTC product that can get even close to those results. Both experts called it the “gold standard.” “There are no skincare products, OTC or otherwise, that will yield the results of laser resurfacing,” Hartman reiterated. “Laser resurfacing is the gold standard for skin tightening and correction of pigment. There is downtime for a reason. The results are worth it.”
Well, there you have it. My advice if you’re intrigued by all of this? Talk to your dermatologist to see if you’re a good candidate and what your options are. And do more research!