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Ablative vs Non-Ablative Lasers

Laser therapy tends to be a topic that gets confusing, quickly.  Just Google CO2 laser, erbium laser, fractional laser, IPL, BBL, nano peel and you will see what we are talking about.  One of the easiest ways to differentiate lasers is between ablative and non-ablative.

Ablative Lasers

Ablative lasers can remove skin from just the epidermal (first) layer or both the epidermal (first) layer and dermal (second) layers of the skin.  Ablative lasers can remove 100 percent of the skin or just a percentage or fraction of the skin.  Fractional laser are ablative lasers.  However, fractional laser does not remove 100 percent of the skin during treatment.  Fractional lasers are essentially creating microscopic channels in the skin, not dissimilar to aerating your lawn.

One of the first-generation ablative lasers was the carbon dioxide laser or CO2 laser.  This laser was able to address numerous skin issues in a single treatment such as: skin tone, texture, pores, and removing fine lines and wrinkles.  However, CO2 ablative laser sometimes came with a lot of downtime, extended redness, and a higher incidence of adverse effects such as permanent hypopigmentation of the skin.  This tended to be common in the perioral area.

Today, the erbium ablative laser is very common and what we utilize in our offices.  Erbium can provide similar results to CO2, reduce the amount of side effects, and reduce downtime.

Why are ablative lasers popular?

Ablative lasers are excellent at targeting collagen and elastin fibers that live in the dermal layer of the skin.  Stimulating collagen and elastin fibers are one of the most important aspects of laser therapy.  Collagen and elastin are what help plump up the skin and allow it to return to its original position after being stretched.  Some ablative lasers can stimulate collage for 9 to 12 months post-procedure.

Ablative lasers can also help with pore size, tone and texture of the skin, and give the skin an overall brilliant appearance.

What is the downtime like for ablative lasers?

Downtime varies from a few days to a few weeks depending on the actual treatment being completed.  A “nano peel” that only targets the first layer of skin may cause a sunburn like appearance that heals in just a few days.  A fractional treatment may take 5 to 10 days and a 100 percent full ablative procedure maybe take up to three weeks to heal.  And a scar treatment with fractional laser may only take a couple days to heal.

What are some side effects of ablative lasers?

Side effects can occur with ablative lasers.  This may depend on the depth of treatment, the aggressiveness of the treatment, and even the skin type of patient.

Potential side effects can include, but are not limited to pain, reddening of the skin, swelling, pigment changes (including increased pigmentation – skin darkening/reddening and decreased pigment – skin lightening or whitening).  Pigment changes lasting 1-6 months or longer are rare but may occur.

Non-Ablative Lasers 

Non-ablative lasers use pulses of light to heat up the skin, but do not actually remove any tissue or skin during the treatment.  Downtime is easier and recovery is quicker compared to ablative lasers.

Why are non-ablative lasers popular?

Non-ablative lasers are popular because they can treat a wide variety of skin issues without the downtime typically associated with lasers.  Treatments with IPL or Broadband Light can target a variety of concerns such as brown spots caused by UV sun damaged, cherry angiomas, telangiectasias, and even help reduce the redness caused by rosacea.

What is the downtime like for non-ablative lasers?

Downtime is minimal for non-ablative lasers.  Most patients can have the treatment done and wear make-up the next day or if they have the treatment in the morning, they can return to work the same day.

What are some side effects of non-ablative lasers? 

Side effects can occur with non-ablative lasers.  This may depend on the aggressiveness of the treatment and the skin type of patient.  Potential side effects can include, but are not limited to pain, reddening of the skin, blistering, swelling, pigment changes (including increased pigmentation – skin darkening/reddening and decreased pigment – skin lightening or whitening).  Pigment changes lasting 1-6 months or longer are rare but may occur.

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