Our ability to reverse the signs of skin aging is advancing rapidly. Some of the most exciting developments have come in laser-based technologies. But with so many types out there, it can be confusing to wade through the options to find the approach that’s best for you.
In this article, I’ll break down the basic types of therapy available, the pros and cons of each, and the specific signs of aging they target best. Plus, we’ll look at an emerging technology that’s so effective it’s transforming how dermatologists approach skin rejuvenation.
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Table of Contents
Basic Info
So how does laser skin rejuvenation work?
It begins with damaging our skin. That sounds like the exact opposite of what we’d want to do. But it is very controlled damage that happens as areas within our skin absorb laser light and heat up. And the magic is in how our bodies react.
The damage triggers our wound-healing response. Our bodies first work to remove damaged tissues. Then cells in the skin begin making new collagen and elastin. These are both crucial elements of healthy skin that our bodies make less of as we age. New collagen production can continue for months after treatment, leading to firmer, younger-looking skin.
The process is similar to exercise, where small amounts of muscle damage lead to stronger tissue. Similarly, precise laser damage prompts the skin to rebuild itself stronger than before.
The key is that the damage must be carefully controlled. We want to damage specific areas in the skin without harming nearby tissue. The first attempts at using lasers to counter signs of aging were in the 1980s. But the technology wasn’t precise. This sometimes led to too much damage, which caused scarring and other side effects. Since that time, we’ve developed techniques for more accurate targeting and control. This has made the technology safer and more effective.
Ablative Technologies
And that brings us to the laser technologies in use today. There are two broad types: ablative and nonablative. Let’s look at how they work and what they can do for you.
Ablative laser treatments are more aggressive. They remove the top layer of the skin while also stimulating changes at deeper layers.
The first widely used ablative laser was the CO2 laser. It’s powerful, so it has the potential to produce strong results. At first, though, it often did too much damage, leading to scarring. But researchers developed new ways of controlling the laser beam so it wouldn’t stay in one place too long. They also figured out that turning the laser on and off rapidly instead of just leaving it on helped, too.
So today’s CO2 lasers are an effective way to address fine lines and wrinkles and to tighten skin. As one study put it, they have been the gold standard in skin rejuvenation technologies [1].
One analysis looked at 259 patients with fine lines treated with a CO2 laser. There was an incredible 90% improvement on average [2].
Another common type of ablative laser is the Er laser. Developed in the 1990s, it uses a different wavelength of light that doesn’t go as deep. It causes less damage in non-targeted tissue. This results in a shorter recovery period, usually three to eight days, and a lower risk of complications.
Er lasers are excellent for treating fine lines and superficial skin issues. But they may require multiple treatments to achieve similar results to CO2 lasers. One study found it took at least 5 passes with an Er laser to achieve results comparable to 2-3 passes with a CO2 laser [3].
1. Pros of Ablative Laser Treatments
- Aggressive treatment for dramatic results
- Usually just one treatment
2. Cons of Ablative Laser Treatments
- Higher risk of adverse effects
- Longer recovery time
Because the treatment is more aggressive, there are also higher risks of adverse effects. Those can include scarring and unwanted changes in skin pigmentation. Ablative treatments also have a longer recovery time. In rare cases, skin redness can persist for up to a year after treatment with CO2 lasers [4].
And it’s specifically these drawbacks with ablative treatments that led scientists to look for a new approach. They wanted less aggressive ways of rejuvenating skin that might produce good results without the side effects.
Nonablative Technologies
That brings us to nonablative technologies. So how do these compare to the ablative treatments we’ve looked at? And one of them we’ll consider is the popular red light treatment.
Nonablative means they don’t remove the surface of the skin. It stays intact. Instead, these lasers penetrate below the surface and heat tissue to promote changes like increased collagen production. Sometimes they work by causing damage. Other approaches stimulate changes by heating tissues but not damaging them.
There are many different forms of nonablative treatments. Each deploys a distinct technology for a unique profile of effects. Here we’ll consider some of the most common.
3. Intense Pulsed Light (IPL)
First up is Intense Pulsed Light. Strictly speaking, it’s not a laser treatment. Lasers emit primarily one wavelength of light. In contrast, this treatment uses broad-spectrum light. It targets freckles, age marks, and small red veins in the skin. It’s particularly effective for that last one, which is a common problem in skin aged by the sun.
The best part? The downtime is minimal.
A patient can often have the procedure done in their lunch break and return to work immediately afterward. There might be some redness for a few hours or a day, but it’s generally well-tolerated.
However, multiple sessions are usually required for optimal results. And it’s not as effective for deep wrinkles or significant skin laxity.
4. Radiofrequency Devices
If we want to target skin wrinkles and laxity, radiofrequency devices are a good option.
These use electrical currents or light waves to heat the layers below the surface of the skin. This stimulates collagen production and results in tighter, smoother skin. These treatments can be delivered through different types of devices, which offer different depths of penetration.
This method provides immediate skin tightening by causing collagen to contract. It also stimulates new collagen creation with continued improvement over time. It's suitable for all skin types, and discomfort is minimal, making it a popular choice. Radiofrequency devices are ideal for targeting skin wrinkles and laxity with minimal discomfort.
5. Infrared Light Devices
Another powerful tool in our arsenal is infrared light devices. These devices use a wavelength of light that penetrates deep layers of the skin. The mechanism is just like radiofrequency devices. It heats collagen fibers, causing them to contract and stimulating new collagen production.
Also like radiofrequency devices, infrared treatments are particularly effective for treating skin laxity and fine wrinkles. The recovery time is minimal.
These devices are not effective for treating pigmentation or improving the appearance of small blood vessels. They’re best for those looking to tighten and improve skin texture.
6. Photodynamic Therapy
The final option before discussing red light therapy is photodynamic therapy. In this therapy, a chemical is applied to the skin that light activates. Often intense pulsed light is used. This process destroys damaged skin cells and promotes new cell growth, making it effective for both acne and photoaging. It’s best for those with early signs of photoaging.
7. Red Light Therapy
Now let’s have a look at red light therapy. This therapy involves using low-intensity red light to penetrate the skin, stimulating cellular activity. It works by shining specific wavelengths of light, typically between 600 and 650 nanometers, which are absorbed by the skin's cells.
Unlike with traditional laser techniques, it doesn’t work by heating up tissue in the skin. Instead, the light is absorbed by the mitochondria. This stimulates energy production and enhances several processes related to skin appearance, including collagen production, blood circulation, and healing.
That’s the theory, so does it work? Multiple randomized controlled trials have shown that it can be useful in the treatment of acne [6], [7]. Which is why the clinical guidelines recommend it for acne treatment.
What about for fine lines and wrinkles? A 2022 meta-analysis suggested that the small trials we have to date are positive, but the improvements in skin wrinkles are gradual [8].
I agree with the Cleveland Clinic’s review, which states that red light therapy is still an emerging treatment that’s generating growing interest. But at this point in time, there’s not enough evidence to support most uses [9].
I’m waiting for more research to be done before jumping on the red light bandwagon.
8. Pros of Nonablative Technologies
- Lower risk of adverse effects
- Shorter recovery time
9. Cons of Nonablative Technologies
- Not as powerful
- Several treatments needed
Generally speaking, nonablative techniques don’t give us the same results we can achieve with ablative lasers. For example, one study compared CO2 laser to intense pulsed light and found the CO2 laser improved wrinkles significantly better [10]. And nonablative treatments usually require several sessions to realize their full potential.
Fractional Technology
But what if we had a way to combine the effectiveness of ablative treatments with the low recovery times of nonablative ones? Well, it turns out we do.
Scientists developed a novel approach where the laser treats columns of skin separated by places left untreated. This way, some of the tissue is damaged, and some is left alone. These are called fractional lasers because only a fraction of the surface area is treated.
With this approach, there’s less total damage. And the undamaged skin near the damaged areas speeds healing and recovery.
This means fewer adverse effects. Compared with traditional ablative lasers, complications from fractional ablative laser resurfacing are less severe and less frequent [11].
Crucially, fractional lasers seem to be nearly as effective as nonfractional lasers in some cases [12]. And the recovery time is shorter. Patients can expect a few days instead of a couple of weeks.
Fractional technology is also used in nonablative lasers. The idea here is the same — to try to achieve much of the same impact with fewer side effects and a more rapid recovery.
Summary
We’ve covered a lot of ground in this article. So let’s summarize.
First, we looked at ablative lasers. These vaporize the top layer of the skin and heat tissues below the surface. This stimulates collagen production and skin regeneration. They are the most aggressive treatment type.
Pros:
- Aggressive treatment for dramatic results
- Usually just one treatment
Cons:
- Not as powerful
- Several treatments needed
Finally, we looked at fractional lasers. These come in both ablative and nonablative forms. They work on just a fraction of the skin, limiting adverse effects and recovery time while remaining very effective.
Advantages of Fractional Lasers:
- Reduce risks and adverse effects
- Shorten recovery time
- Results comparable to nonfractional approaches
What’s the best approach for you? That will depend upon a variety of factors, including the signs of aging you’re trying to address, your skin type, your willingness to experience a longer recovery time, and your budget. But this overview should give you some necessary background information as you enter into that conversation with your healthcare provider.
References
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10608664/
2. https://pubmed.ncbi.nlm.nih.gov/8823015/
3. https://pubmed.ncbi.nlm.nih.gov/10206045/
4. https://www.uptodate.com/contents/ablative-laser-resurfacing-for-skin-rejuvenation
5. https://www.uptodate.com/contents/ablative-laser-resurfacing-for-skin-rejuvenation
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896818/
7. https://dermnetnz.org/topics/lasers-lights-and-acne
8. https://onlinelibrary.wiley.com/doi/full/10.1111/phpp.12841
9. https://my.clevelandclinic.org/health/articles/22114-red-light-therapy
10. https://academic.oup.com/qjmed/article/114/Supplement_1/hcab093.014/6379282
11. https://www.uptodate.com/contents/ablative-laser-resurfacing-for-skin-rejuvenation
