The following is a summary covering a range of machines and the skin conditions they address. Selecting which one to use depends mostly on the physician you see, what machines they may own or lease, and their skill with those particular machines.
CO2 Pulse Laser (trade names Feather Touch or Ultra Pulse): This is one of the
oldest types of ablative machines around. Although it can create more lasting and noticeable results than any other laser, it is also associated with the most risk and potential skin damage. The skin can take one to two weeks to heal and can be red for one to two months afterward. Risks of scarring, skin discoloration, and uneven texture must be weighed against the intended outcome, although these side effects are rare when the doctor is experienced with this kind of procedure. (Sources: Dermatologic Surgery, April 2004, pages 483-487; InternationalJournal of Dermatology, June 2003, pages 480-487; and Lasers in Surgery and Medicine, May 2003, pages 405-412.)
Erbium:YAG Laser: This ablative laser is far less invasive than the CO2 Pulse laser and is considered effective for minor or superficial wrinkling. However, if the intensity of the machine is increased, deeper wrinkling can also be treated. Another option is the Variable Pulse YAG Laser, which alternates frequency with pulses that heat the skin and cause ablation that resurfaces the skin almost as effectively as the CO2 laser but with fewer side effects. (Sources: Dermatologic Surgery, August 2004, pages 1073-1076; Archives of Dermatology, October 2003, pages 1295-1299; and Archives of Facial Plastic Surgery, October-December 2002, pages 262-266.)
A combination of CO2 and Er:YAG laser treatments is now gaining popularity. In this treatment, the Er:YAG laser is first used to remove the epidermis, followed by use of the CO2 laser to achieve contraction of the underlying collagen. This produces the collagentightening benefits of CO2 therapy but with minimal damage to surrounding tissues. (Sources: Department of Otolaryngology/Head and Neck Surgery at Columbia University and New York Presbyterian Hospital, www. entcolumbia. org/laserskinresurf. htm; and Dermatologic Surgery, February 2000, pages 102-104.)
Long-Pulsed YAG Laser (trade names CoolTouch and Lyra): This nonablative laser is often used for treating wrinkles and reducing the appearance of acne scars. As is true with any nonablative laser resurfacing, it takes several treatments to achieve very subtle results.
The CoolTouch has a built-in cooling device that protects the top layer of skin but it can still feel like a rubber band snapping against the face as it is used. Types of the Long-Pulsed YAG Laser can be used for hair removal and removing surfaced capillaries. (Sources: Lasers in Medicine and Science, April 2004, pages 219-222; Seminars in Cutaneous Medicine and Surgery, December 2002, pages 288-300; and Laser Abstracts from the 14th Annual Congress of the American College of Phlebology).
Q-Switched Ruby Laser: This laser is minimally ablative and is primarily used to selectively remove skin pigment, as in freckling, sun-damage spots, and actinic keratosis, without damaging the surrounding tissue. It is also useful for removing birthmarks. It usually takes several treatments to see the desired results. One of the popular uses for the Q-Switched Ruby laser is cosmetic tattoo removal. Many physicians have noted that eliminating impulsive tattoo designs, as well as the poor work done by inexperienced or poorly trained aestheticians who tattoo lip liner, eyeliner, and eyebrows on women, now constitutes a large portion of their laser work (Sources: Dermatologic Surgery, November 2008, pages 1465-1468; and American Journal of Clinical Dermatology, February 2001, pages 21-25).
Pulsed Dye Laser, Short – and Long-Pulsed: This nonablative laser gives impressive results in removing surfaced capillaries on the face, port wine marks, hypertrophic scarring (thick or raised scars), and hemangiomas (red dots on the surface of skin). It doesn’t cause skin damage but it almost always causes temporary bruising. Several treatments may be required (Source: Dermatologic Surgery, January 2004, pages 37-40).
Long-Pulsed Alexandrite Laser (trade names GentleLASE and Cool Pulse): This nonablative laser is another option for hair removal, and for removing surfaced capillaries and leg veins. This machine can quickly cover large areas of skin. (Sources: Lasers in Surgery and Medicine, May 2002, pages 359-362; and Dermatologic Surgery, July 2001, pages 622-626.)
Fractional Laser Resurfacing: This method is intended to offer the best of both the nonablative and ablative systems, that is, significant improvement with low risk and minimal downtime. “Fractional” refers to the way the laser light is emitted to small areas of skin at any one time, pinpointing tiny sections smaller than a human hair and wounding the underlying collagen, which stimulates more production. An effective treatment regime is three to five sessions spaced two weeks to a month or longer apart. (Sources: www. mdlive. net/xfractional. htm; Photodermatology, Photoimmunology, and Photo-medicine, August 2005, pages 204-209; Archives of Facial Plastic Surgery, November-December 2004, pages 398-409; Journal of Cosmetic and Laser Therapy, May 2004, pages 11-15; and Lasers in Surgery and Medicine, May 2004, pages 426-438.)
Intense Pulsed Light (IPL): This is a “light” modality that uses high-intensity pulses of light that do not involve lasers; it is considered to be exclusively nonablative. Though the IPL’s beam of light is similar to lasers in many ways, its range is limited when it comes to the depth of resurfacing it can produce. This technique is not meant for those with extensive sun damage and skin discolorations, but it can reduce surfaced capillaries or veins, port wine marks, hemangiomas, and brown spots, as well as tighten the skin to some degree. The number of side effects is minor, but it can take several treatments (typically four to six) to see the desired results. There are a range of IPL machines, including PhotoDerm VL, PhotoDerm PL, PhotoDerm HR, EpiLight, and Quantum. (Sources: Plastic and Reconstructive Surgery, May 2004, pages 1789-1795; Lasers in Surgery and Medicine, February 2003, pages 78-87; and www. emedicine. com, “Non-ablative Resurfacing,” June 30, 2003.)
PhotoDerm VL (for vascular lesions): Light pulses are directed at spider and varicose veins as well as vascular birthmarks. The tissue targeted is the red pigment (hemoglobin) in the blood, which is heated by the light pulses that destroy it without affecting the skin or other tissue.
PhotoDerm PL (for pigmented lesions): Light pulses are directed at “age spots,” freckles, flat pigmented birthmarks, and other types of discolorations. The tissue targeted is the melanin in the skin’s surface. The melanin is heated by the light, and the resulting damage or destruction removes the skin discolorations.
PhotoDerm HR and EpiLight (hair removal): Light pulses are directed at the hair follicle, causing the hair to fall out and preventing further growth, although this method is not permanent.
Radio frequency (RF) resurfacing involves neither a laser nor IPL. Rather, it is a form of electromagnetic energy very similar to microwaves. It is considered a nonablative resurfacing treatment. The RF treatment passes radio frequency electricity through the skin to heat up tissue. This is supposed to make the tissue contract and, as happens following any injury to skin, it then begins making collagen. The most popular RF machine is known as Thermage. Another device, called the Aurora, uses IPL and RF together for a unified procedure, supposedly to give patients the best of both modalities. (Source: Journal of Cosmetic Dermatology, January 2002, page 142.)
You may have heard claims that RF treatments are painless and have no adverse effects or complications, yet the research, though extremely limited, demonstrates otherwise. First, RF is considered by some as one of the most painful nonablative procedures, requiring localized anesthesia because it intensely heats up the skin (Source: Cosmetic Dermatology, December 2003, pages 28-34).
A study published in Lasers in Surgery and Medicine (November 2003, pages 232-242) reported that “fifty percent (41/82) of subjects reported being satisfied or very satisfied.” Keep in mind that means 50% of the subjects were less than satisfied or were unhappy with their results. Further, second-degree burns did occur and “Three patients had small areas of residual scarring at 6 months.” Scabbing and edema (skin swelling) occurs in some patients and though it does resolve, it can take six months to do so. Technically, the improvement measured in this study saw an average lift of 0.5 mm. Half of one-millimeter is 0.019 of an inch. That may not be exciting for what can be a costly procedure.