FAQ: Laser Treatments for Skin Resurfacing


Cortex CO2 laser

  1. What is the best laser for skin resurfacing?

The carbon dioxide laser (also knows as CO2) is the gold standard for laser resurfacing.  It is the most effective laser for skin tightening, collagen stimulation, improving fine wrinkles, and helping to reverse the signs of aging and years of sun damage.  More specifically, fractionated CO2 is the most cutting edge technology.  Fractionation involves breaking up the CO2 laser beam into many small separate columns of laser energy.  This treats the skin and penetrates into the deep layers to provide long-lasting results, but between each column of laser energy is an untreated area of skin.  This allows a much faster recovery and dramatically reduced risk of problems that were seen with the old version of CO2 laser treatments.

Erbium (or erbium:YAG) lasers are also highly effective for skin resurfacing.  Both the CO2 laser and the erbium laser focus their energy on the skin cells in the outer layer (epidermis) and the deeper layer of the skin (dermis).  This is in contrast to other types of lasers that are specifically designed to treat different issues like red spots, blood vessels, or tattoos for example.

  1. What is the difference between ablative and non-ablative laser skin resurfacing treatments?

In the most basic terms ablative lasers remove or break down skin cells, mostly in the outer layer where you shed old skin cells.  Non-ablative lasers do not remove any of the surface skin cells.  Instead, they typically work by more gently heating into the deeper layers to induce new skin growth and collagen production.

Ablative treatments come with some more down time and more potential for side effects if performed inappropriately.  However, the results are typically more impressive than with the less invasive non-ablative options.  Non-ablative treatments usually require a series of several treatments to gain modest results.

CO2 laser

Combination treatment with CO2 and erbium laser

  1. How long do I have to wait after treatment to expose my skin to the sun?

Patients are advised to have strict sun avoidance for 1-2 weeks after a laser resurfacing treatment.  Once the skin begins to heal from the treatment you can get back into your normal outdoor activities, but all patients are advised to use sunscreen and consider wearing a hat to protect their skin from excess sun exposure for several months after laser treatments.  The same general advice is applicable after chemical peel treatments also.

  1. What is the recommended aftercare for laser skin resurfacing?

CO2 laser aftercare

Aftercare instructions for CO2 laser

Each case is different, but there are a few general guidelines to keep in mind regarding aftercare for the majority of laser skin resurfacing treatment options.  Avoiding direct sunlight in the early stages of healing is very important.  Keeping the skin moist and cool also helps to speed recovery.  Cool compresses can be applied for any warmth or minor discomfort (similar to a sunburn) in the first 1 or 2 days.  For the first 2-4 days most patients will use a gentle cleanser and apply an occlusive ointment such as Aquafor® to the skin.  With more thorough ablative treatments there may be some crusting that develops on the skin.

It is very important not to pick at these areas.  Instead, continue to wash the face as directed and apply moisturizer to let the skin heal on its own.  After the first few days of early healing the skin may begin to have some flaking and peeling.  At this time, patients can switch from Aquafor® to a lighter facial moisturizer, and as the skin begins to heal powder makeup can then be used.  Your regular maintenance skin care regimen including the use of Retin-A® can be restarted within 1-2 weeks after most laser treatments.

  1. Do I need a skin analysis to define the best laser treatment for my skin?

Absolutely.  Making the appropriate diagnosis and then understanding the limitations of certain types of laser treatments is critical.  Laser skin treatments are not a one-size-fits-all approach.  With modern laser technology most physicians have a range of treatment options and the ability to customize multiple laser settings to match the desired results and downtime that are the best fit for each individual patient.

  1. Can laser skin resurfacing be used to treat stretch marks?

The 585-nm or 595-nm pulse dye laser (PDL) is a very good option for stretch marks.  Fractionated CO2 and erbium:YAG laser treatments have also been shown to be effective for some stretch marks.  Similar to treating acne scars, a series of treatments is typically needed for the best results.

  1. When can I see results from laser skin resurfacing?

There are immediate results with the majority of laser treatments, but most patients will have improvements in the skin that continue over a period of several months depending on the type of laser treatment.  For example, with fractionated CO2 laser resurfacing, most patients notice an immediate tightening effect on the skin right after the treatment.  As the skin heals over the next 1-2 weeks there is a healthy glow as new skin cells regenerate.  The treatment into the deeper layers of the skin with fractionated CO2 technology then stimulates your body to produce new collagen which leads to gradual continued improvements in skin tone over the next 4-6 months.

  1. How long do the results last and how often do I have to repeat the treatment to maintain the results?

The results last forever, but what the treatments do is to turn back the clock to help improve the effects of skin aging and sun damage.  The aging process keeps on going though!  Some people benefit from a series of initial treatments, and many patients will have additional laser skin treatments over the years.  Staying on a good daily regimen of quality skin care with exfoliators, cleansers, and moisturizers as well as avoiding excess sun exposure are the best ways to continue to keep your skin looking as good as possible.

Cortex CO2 laser
  1. What type of laser skin resurfacing is best for darker skin?

Laser treatments should be approached very cautiously for patients with darker skin, and any treatment should be very conservative.  Patients with darker skin have an increased risk of potential problems with permanent lightening or darkening of the skin after treatment.  In general, non-ablative laser treatments are the most appropriate for darker skin types.

  1. What is the recommended laser treatment for sun damage and dark spots?

Sun damage and uneven pigment can be treated with fractionated CO2, erbium:YAG, fractionated erbium, and Nd:YAG lasers.  The thulium laser and Q-switched alexandrite laser are specifically good for isolated brown spots.  The most effective method for treating brown spots in the setting of other aging skin and sun damage is to combine laser resurfacing treatments with quality medical grade skin care including the use of hydroquinone.  Melanin is the brown pigment in the skin, and hydroquinone is a topical cream that is applied and works by reducing the activity of the cells that produce melanin to decrease the brown pigmentation.

  1. Does it hurt?

This is a very important concern.  Most patients are anxious before their treatment, but there is minimal discomfort when the right steps are taken. There are several options for increasing your comfort level including topical numbing cream, cold compresses, use of a cold air chiller to cool the skin, optional numbing shots, and optional oral medications to relax you and help with any discomfort.  These are adequate to provide a pleasant experience for the vast majority of patients, but some doctors also choose to perform the more aggressive resurfacing procedures under anesthesia occasionally.

  1. How much does laser skin resurfacing cost?

Laser skin resurfacing treatments have a wide range of options in the choice of technology and how each treatment is customized.  Some patients choose to have a single treatment, but most benefit from a series of laser sessions.  In general, laser skin resurfacing is not covered by insurance, and the cost typically ranges anywhere from $1,000 to $5,000 depending on the best treatment regimen selected after discussing the options with your doctor.


Dr. David Rodwell specializes in facial cosmetic surgery and non-surgical procedures including laser treatments.  To learn more about your options and what to expect after these treatments call our office at (843) 628-1415 to schedule a private consultation.