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Resurfacing Lasers Including Halo, Fraxel and C02

Everything you need to know about Resurfacing Lasers like the Halo, Fraxel, Ultraclear, Clear and Brilliant, LaseMD, Erbium and C02. To learn more, check out my recent feature in Cosmopolitan "My Honest Review of The $$ Halo Facial Laser."

What Are Resurfacing Lasers?

Lasers work by releasing a specific wavelength of energy that is absorbed by a specific target in the skin.  Different laser wavelengths are absorbed by different targets. There are wavelengths for red, brown and even water. Resurfacing lasers are the group of lasers that target water in the skin, causing a controlled injury.  When the skin heals from this injury its texture and often brown pigment are improved from the cell turnover stimulated by the laser. They do not help with red and can make skin have redder undertones if the patient is already prone to being pink.  The stronger or more aggressive the resurfacing laser, the greater possible improvement to the skin, longer recovery and the higher the risk of complications including unwanted pigmentation and scarring. 

Resurfacing lasers can be broken down into non-ablative (less aggressive) vs ablative (more aggressive). Non-ablative can be further divided into more vs less powerful.  All of these lasers drill very small holes into the skin stimulating your keratinocytes (the cells that make up your epidermis or top layer of the skin) to turn over, improving brown, dull skin and texture.  The more powerful resurfacing lasers are able to reach past your epidermis-- into your dermis-- activating fibroblasts to make more collagen thereby helping with laxity and wrinkles. 

What Does a Resurfacing Laser Treatment Do for the Skin?

They help with:

1. Skin discoloration
2. Splotchy complexion
3. Sun damage
4. Rough skin texture
5. Scarring
6. Age spots
7. Large pores
8. Fine lines and wrinkles

How much they help depends on the laser and settings being used. Resurfacing lasers have LOTS of variables allowing the provider to really tailor treatments. Your results will depend on the selected settings as well as how many treatments you do. A gentle treatment means less pain, downtime, lower risk of complications but also less impressive results.  A gentle laser does not have the power to do what an aggressive laser can do. HOWEVER, you can turn down an aggressive laser and make it behave like a gentler laser. Of the aggressive lasers out there, the CO2 is the most powerful, and then the Erbium (both are ablative).  Then there are non-ablative options like the Fraxel Dual and Icon. Even gentler resurfacing lasers are the Clear and Brilliant and LaseMD.

Non Ablative Lasers 

Less powerful

Examples: Clear and Brilliant, LaseMD, 3D Miracle with Ultraclear

• Pros: Least amount of down time, improvement to epidermis of skin, safer for darker skin types
• Cons: Less dramatic results, duration of results is generally shorter

More powerful

Examples: Fraxel Dual, ScitonHalo

• Pros: Longer lasting results
• Cons: More downtime

Ablative Lasers

Most Powerful

Examples: Sciton Halo, Ultra Clear, Fraxel Repair, Deka Dot, Lumenis Ultrapulse, Lutronic Core, Alma Pixel C02

• Pros: Most significant improve texture and pigmentation 
• Cons: Higher risk of scarring and hyperpigmentation, longer recovery, more discomfort

Of note, the Halo is a combo laser-- with two wavelengths that are delivered at the same time. 

1. 1490nm - A fractionated, non-ablative diode laser similar to the Fraxel Dual laser wavelengths (1550nm and 1927nm.) This laser is used to treat the epidermis of the skin, brown spots and superficial texture concerns
2. 2940nm- A fractionated, ablative erbium laser that goes deeper into the dermis to stimulate collagen production, providing longer lasting results with texture, brown and fine lines

What are resurfacing laser treatments like?

You will arrive before your appointment to have photos taken and have topical numbing medicine applied to the areas being treated. The laser treatments take 30 minutes to 1 hour, depending on the laser being used how many areas are treated. After the laser, your provider will provide you with post care instructions and what to expect as you heal.  The more aggressive and laser and settings the longer your recovery will take. 

Unveiling Laser Options: Exploring the Different Skin - Targeting Lasers with a Dermatologist

 

Get to Know Halo™ | Sciton

 

On Average, How Many Treatments Do People Need With a Resurfacing Laser?

Totally depends on the treatment goal of the person. Often people get multiple treatments but it is important to note 3 or even 5 gentle treatments is not the same thing as one aggressive treatment. This is because the gentle lasers are not able to activate the dermis of the skin where collagen is produced.

How Does Halo Compare to Fraxel? What About Clear and Brilliant?

If it is turned up, the Halo can be more aggressive than the Fraxel Dual, which is more aggressive than a Clear & Brilliant.  The Fraxel Repair is a CO2 laser. The CO2 laser, when using strong settings, is the most aggressive of them all.

Who is the Ideal Candidate for the Halo laser? And Is There Anyone Who Isn’t a Candidate?

It is a great laser and most people with sun damage, skin dullness, large pores, texture issues, fine lines will see improvement from it. It will not make a dramatic difference with laxity or deeper wrinkles. Anyone at risk of making unwanted pigmentation has to proceed with caution. This is primarily in skin of color and people with melasma.  It doesn’t mean you cannot get the treatment, it just means you need to be educated about the risk of unwanted pigmentation and ensure your provider is familiar with treating your skin type.  

Sometimes individuals at higher risk can be pretreated with topical and oral medication (like tranexamic acid) to decrease the risk.  Further, oftentimes lower energy laser settings are used, which results in less build up of heat and tissue damage that can trigger hyperpigmentation. I CO2 laser people with type IV skin (Asian descent) for acne scarring but my settings have to be lower than for people with type II skin even if they have the same amount of scarring. 

How To Make Sure Things Go Well and Top Do's And Don’ts While Healing After a Resurfacing Laser.

• Have a consultation, ask your questions, ask to see before and afters, confirm you are a good candidate. 
• Start slow, do a gentle resurfacing laser before an aggressive one to see how you do, learn about the experience, the way your skin heals and more about your provider.
• Make sure you have enough time to recover, plan for it, even if that means waiting a year. Clear your calendar so you are not stressed.  No travel to sunny spots while you recover.
• Make sure you know how to take care of your skin during the recovery. This is why I created my Essential Line, to give my patients safe, effective options to aid in the healing process.

I give all of my laser patients a post procedure skin care kit with Doctor Rogers Restore Healing Balm, Face Wash, Face Cream and written instructions about what to do to help your skin in the days to weeks after your procedure. Here is an example of what I give my patients after a non-ablative Resurfacing Laser Treatment like Fraxel Dual 1550/1927, Icon 1540nm, Halo

1st Evening, Before Bed

1. Gently cleanse skin with Doctor Rogers Face Wash.
2. Apply a layer of Doctor Rogers Restore Healing Balm to treated areas.
3. Sleep with a generous layer of Doctor Rogers Restore Healing Balm. Use a clean, old pillowcase because ointments can stain. 

Days 2 to 3 

Morning 

1. Cleanse skin with Doctor Rogers Face Wash.
2. Apply Doctor Rogers Restore Healing Balm mixed 50/50 with Doctor Rogers Face Cream.
3. Apply zinc-based SPF and wear a hat if going outside, but stay inside and away from the sun if possible.

Evening 

1. Cleanse skin with Doctor Rogers Face Wash.
2. Apply Doctor Rogers Restore Healing Balm mixed 50/50 with Doctor Rogers Face Cream to all treatment areas.
3. Protect and hydrate eyelids, lips and any raw or puffy areas with Doctor Rogers Restore Healing Balm. 

Here is a video that walks you through my healing after an ablative C02 lasering.

My CO2 Laser Experience: Post-Treatment Transformation and Recovery Tips by an Expert Dermatologist