Laser Skin Resurfacing
Types of Laser Skin Resurfacing
Ablative lasers remove the outer layers of skin in a controlled manner, allowing new, healthier skin to grow in its place. The two most common ablative lasers are CO2 (carbon dioxide, 10,600 nm) and erbium YAG (2940 nm). CO2 lasers penetrate deeper and produce more tissue tightening, while erbium lasers remove tissue with less heat and faster healing. According to StatPearls (NCBI), ablative laser resurfacing treats photoaging, facial wrinkles, acne scarring, actinic keratoses, and seborrheic keratoses.
Ablative resurfacing delivers dramatic improvement in fewer sessions. Results from ablative laser resurfacing can last 5 to 10 years, according to StatPearls (NCBI). Recovery requires 7 to 14 days of wound care, during which the treated skin appears raw, weeps, and gradually re-epithelializes (grows a new outer layer).
Non-ablative lasers (1320 nm, 1450 nm, 1540 nm wavelengths) heat the dermis (the deeper skin layer) without removing the epidermis (the outer layer). This stimulates collagen remodeling beneath intact skin, which means less downtime. According to the Skin Therapy Letter and Medscape, non-ablative resurfacing treats mild to moderate photoaging with one to three days of redness and minimal disruption to your daily activities.
Non-ablative results are more subtle per session. Most patients need three to six treatments to achieve their desired improvement. The trade-off is clear: less dramatic results in exchange for a much easier recovery after each session.
Fractional lasers, available in both ablative and non-ablative versions, create thousands of tiny treatment columns while leaving the surrounding skin intact. The untreated tissue between columns speeds healing. According to a study in PMC (PMC3580982) and additional research (PMC7028380), fractional photothermolysis has become the standard of care for most photoaging indications because it balances effective results with manageable recovery.
Fractional ablative treatment requires four to seven days of downtime, while fractional non-ablative treatment involves one to three days of mild redness. Your doctor selects the fractional approach based on the depth of your skin concerns and how much recovery time you can accommodate.
A 2021 systematic review of 1,093 patients in Dermatologic Therapy (PubMed 33084193) found that ablative lasers had fewer overall complications than non-ablative when excluding transient events (2.56% vs. 7.48%). Ablative lasers carry greater short-term morbidity (longer healing, more intense redness), but the long-term complication rate was lower in this analysis.
Your doctor discusses the specific risks for each approach based on your skin type, medical history, and treatment area. Complications are uncommon with proper patient selection and technique.
Candidacy and Patient Selection
Your Fitzpatrick skin type (a classification based on how your skin responds to UV light) guides which laser your doctor recommends. Patients with lighter skin tones (types I through III) can receive most laser types with low risk of pigment changes. According to StatPearls (NCBI), patients with darker skin tones (Fitzpatrick IV through VI) should receive erbium YAG rather than CO2 laser to reduce the risk of discoloration.
Your doctor evaluates your skin type, the severity of damage, and the area being treated. The periocular region (around the eyes) requires lower energy settings than the cheeks or forehead because the skin is thinner and closer to critical eye structures.
Isotretinoin use within the past 6 to 12 months is a contraindication for ablative resurfacing because the medication impairs skin healing. Patients with a history of keloid scarring, prior radiation to the treatment area, or immunosuppression require careful evaluation before proceeding. Your doctor reviews these factors during your consultation.
Active skin infections, open wounds, and inflammatory skin conditions in the treatment area must resolve before resurfacing. Your doctor may prescribe antiviral medication before treatment if you have a history of cold sores, as laser energy can trigger a herpes simplex outbreak.
Laser resurfacing improves skin quality, texture, and tone, but it does not stop aging. Sun exposure, genetics, and lifestyle factors continue to affect your skin after treatment. Your doctor helps you understand what degree of improvement is realistic for your specific concerns and skin condition.
Patients with deep wrinkles, significant laxity, or structural concerns like excess eyelid skin may benefit more from surgical procedures. Laser resurfacing works well on its own for surface-level damage and complements surgical results when combined with eyelid or brow surgery.
Recovery and Aftercare
Ablative resurfacing requires 7 to 14 days of healing. During the first few days, the treated skin appears raw and weeps. You apply a healing ointment as directed to keep the area moist. A new outer skin layer forms over the first week, and residual redness fades over the following weeks to months.
Most patients return to work after one to two weeks, depending on the treatment intensity and their comfort with visible redness. Mineral makeup can cover residual pink tones once your doctor clears you.
Non-ablative resurfacing involves one to three days of mild redness and possible swelling. Most patients return to normal activities and apply makeup the next day. Some patients experience mild peeling for a few days after certain non-ablative treatments.
Non-ablative fractional treatments fall between the two extremes, with two to five days of redness depending on the settings used. Your doctor tells you what to expect based on the specific laser and parameters selected for your treatment.
Strict sun protection is required after any laser resurfacing procedure. Wear SPF 30 or higher broad-spectrum sunscreen daily, avoid prolonged sun exposure for at least four to six weeks, and wear UV-protective sunglasses when outdoors. Sun damage to freshly resurfaced skin can cause pigment changes and reduce the quality of your results.
Your doctor may recommend specific skin care products to support healing and maintain your improvement. Retinoid products, antioxidant serums, and moisturizers can complement laser results when introduced at the appropriate time after treatment.
Laser Resurfacing Questions
Your doctor recommends the approach based on the severity of your skin concerns and your available recovery time. Ablative treatment produces more dramatic results in fewer sessions but requires one to two weeks of healing. Non-ablative treatment involves minimal downtime but needs three to six sessions for full effect.
Laser resurfacing improves skin quality and provides mild tightening, but it cannot remove excess skin or reposition fat pads. If your concern is drooping eyelids or bags under your eyes, your doctor may recommend blepharoplasty (eyelid surgery), possibly combined with laser resurfacing for the best overall result.
Your doctor applies topical numbing cream or injects local anesthesia before ablative treatment. Most patients feel warmth and mild discomfort that is well tolerated. Non-ablative treatments are even more comfortable, with most patients needing only topical numbing or no anesthesia at all.
Laser resurfacing treats sun damage and aging changes at any adult age. Patients in their 40s through 60s most often seek treatment for accumulated photoaging. Younger patients may pursue resurfacing for acne scarring or early sun damage. Your doctor tailors the treatment to your specific skin condition regardless of age.
Ablative resurfacing often achieves significant improvement in one to two sessions. Non-ablative resurfacing builds results over three to six sessions spaced weeks apart. Fractional approaches fall between the two. Your doctor recommends a treatment plan at your consultation based on your goals and skin condition.
Plan your treatment during a season when you can avoid sun exposure easily, such as fall or winter. Arrange your schedule to allow adequate recovery time, especially for ablative procedures. Your doctor may recommend stopping certain skin care products and medications one to two weeks before your appointment.
Start Your Laser Resurfacing Consultation
Your eye doctor can evaluate your skin and recommend the laser resurfacing approach that best addresses your concerns. Schedule a consultation to discuss your goals, review your candidacy, and plan your treatment.