Three top doctors and their patients share their experience with popular laser treatments.
Laser Treatment: Picosure
Doctor: Richmond, VA plastic surgeon Ruth Hillelson, MD
What is Picosure?
“It’s the world’s first picosecond laser for skin rejuvenation, and its 755-nanometer wavelength targets collagen and elastin by using pressure wave technology. Key issues it addresses include the targeting of fine lines, large pores and pigment. It also causes a noticeable change in skin texture, radiance and smoothness as well.”
Who is the ideal candidate?
“Any patient with realistic expectations who is willing to embark on a program of skin health and beauty; however, those with deep lines and perioral wrinkling might benefit from another technology.”
How many treatments are needed?
“Usually, three will provide optimal results. The recovery is quick: I had it on a Monday and lectured on that Tuesday. Two hours of pinkness/redness followed by a healthy glow for the duration of the day is the norm. Brown spots will darken slightly for a few days, but this is very manageable to cover with makeup. Wearing sunscreen is always a must. I enjoy ISDIN Eryfotona Actinica, as well as the brand’s Mineral Brush powder for touch-ups during the day.”
Patient: Debbie D.
What concerns were you hoping to treat?
“I wanted a treatment that would help erase my sun damage and stimulate collagen production.”
What was the treatment experience like?
“Numbing cream was applied 45 minutes prior to the procedure, and because of this, the procedure was virtually painless, at least for me. I feel like it will depend on the individual’s pain tolerance. The procedure took about an hour from start to finish.”
How did your skin look and feel afterward?
“My skin was a little red, but went away after a day. Dr. Hillelson explained that this varies and will depend on the person’s skin tone. I used Iridesse Nutrient with Genesis Factor ($130) developed by Dr. Hillelson, and I was extremely impressed with the results after about two to three days. My skin was smoother and softer, and my brown spots had faded. It really improved the overall look of my skin, and I would highly recommend it if you want a noninvasive procedure to treat hyperpigmentation on your face.”
Laser Treatment: Fraxel DUAL
Doctor: Miami dermatologist Dr. Deborah Longwill
What is Fraxel DUAL?
“This laser was created to selectively treat all types of skin using microscopic laser rays that channel through the skin, producing collagen remodeling. Each channel allows surrounding tissue to repair and heal, thus promoting new skin growth. Multiple treatments are necessary for best results—typically four to six, spaced six to eight weeks apart—but the downtime is minimal.”
What key concerns does it address?
“It treats and improves aging skin, fine lines, pigmentation, and acne scars, and it evens out skin tone. It can be used anywhere there is aging or damaged skin, like the face, neck, chest, hands, arms, and legs. Most patients are candidates, except those who suffer from rosacea, broken capillaries or active acne.”
What post-op care is required?
“All retinoids, glycolic acid and salicylic acids should be stopped for at least a week, and gentle cleansers without fragrance are best for cleansing. A light, fragrance-free moisturizer can help with dryness, and sleeping on a slight elevation will help with swelling. Diligent sun avoidance is necessary, too, and sun protection should include mineral sunblock containing zinc or titanium dioxide—there are some good tinted ones.”
Patient: Carolyn G.
What concerns were you hoping to treat?
“From my teenage and even adult years, I had scarring from acne. Pregnancy brought along melasma; the sun gave me spots, and then came the fine lines, and yes, even wrinkles from maturing skin.”
What was the treatment experience like?
“To prepare for the laser, I stayed away from any retinoids, glycolic acid, benzoyl peroxide, or abrasive scrubs for at least 14 days. Before the treatment, lidocaine was applied to my whole face for 45 minutes, and I felt a tingling sensation. Time for the treatment: I wore goggles to protect my eyes, and I felt different sensations depending upon the area. Where the skin is thinner, like on my forehead or near my nose, I felt more of a ‘snapping’ to my skin, like a rubber band snap. The laser also has a built-in cooling fan that helps alleviate the heat, which I found a lot more tolerable than earlier fractional lasers I had experienced. The treatment took 10 to 15 minutes, and there were two passes of the laser on my skin.”
What did the recovery entail?
“Moisturize and protect! I used Avène Cicalfate+ Cream ($42) and Solaire Mineral Tinted SPF 50+ ($32)—stay out of the sun. I spritzed Avène spring water ($19) on regularly to keep my skin moist during the redness and peeling, and I also used Regime Extremolyte Stem Cell Serum from Doctor’s Daughter Skincare ($108) to add moisture and rejuvenate my skin.”
Laser Treatment: Erbium (Er:YAG)
Doctor: New York dermatologist Julie Russak, MD
What is the Erbium laser?
“This is an ablative laser that takes off the superficial layer of skin, which carries much of the skin’s pigmentation and dead, sun damaged cells. In addition to treating pigmentation on the face, neck, chest and hands, it also stimulates collagen remodeling by heating the deeper layers of skin, which is why we see improvement in fine lines, wrinkles and acne scarring. The Erbium laser targets water in the skin, so the laser is more effective if the skin cells are hydrated. Therefore, we recommend drinking a lot of water in the days prior to treatment, and skipping that morning cup of coffee the day of.”
Who is an ideal candidate?
“Patients with pigmentation, dull skin, lines and wrinkles who have Fitzpatrick skin types 1 through 3. This laser is not recommended for skin types 4 through 6 due to the risk of hyperpigmentation.”
Are multiple treatments necessary?
“This depends on how much damage the patient has. You will see dramatic results after one treatment, but usually three treatments, spaced one month apart are recommended for optimal results.”
Patient: Amanda N.
What concerns were you hoping to treat?
“My overall complexion and dullness.”
What was the treatment experience like?
“I had topical numbing cream on my face for 20 minutes beforehand, so the laser itself wasn’t painful at all. The only discomfort was the hour afterward when my face felt extremely hot. The treatment only took an hour total, which includes the time for numbing before and icing after.
What did the recovery entail?
“The rest of that first day, I kept a thin layer of Aquaphor ($6) on. The second day, I had no discomfort, but my skin was still very red and I had to keep Aquaphor on to protect it. On the third day, the redness started to go away and brown, scab-like marks began to show. At this time, my skin felt very, very tight. This continued into the fourth day, still using Aquaphor. The fifth day is when my skin began to peel—A LOT. Those brown spots were starting to fall off and I used SkinCeuticals Epidermal Repair ($24) to help with the peeling. I also applied SkinCeuticals Physical Fusion sunscreen ($35), which is tinted and looked pretty normal. On day six, my skin had very little peeling left—only a little around my forehead, sideburns and nose—and on day seven, I was back to normal with porcelain skin!”
Skin Deep
Our readers most-asked questions about laser treatments, answered by the pros.
Are some lasers more intense than others?
“Laser resurfacing means that some or all of the superficial skin is burned off to varying degrees of depth,” says Scottsdale, AZ facial plastic surgeon Kelly Bomer, MD. The two types of laser resurfacing are ablative and nonablative: Ablative remove the top layer of skin, while nonablative work by heating up the underlying skin tissue (without harming the surface) to incite collagen production. Some lasers, like HALO, offer a combination of both types and provide a balance between shorter downtime and good results.
What is the best laser for beginners?
According to Washington, D.C. dermatologist Tina Alster, MD, the “gateway” treatment for those who have never had laser skin resurfacing is Clear + Brilliant. “It is an easy way to polish the skin without significant recovery,” she says. “Essentially, patients experience a few hours of redness followed by a few days of dryness. Most patients are able to resume their regular activities very quickly after treatment.”
Which skin-care products should I use after a laser?
“If the treatment is more superficial, healing will be faster and a high-moisture moisturizer that penetrates the skin will be sufficient,” Dr. Bomer says. “When the treatment is deeper, a squalane oil and/or an occlusive ointment is needed. With any laser, aggressive sun protection will be required for at least one month after a treatment to prevent pigmentation issues on the fresh, new skin.”
Which laser is best for skin tightening?
“Along the face, CO2 and Er:YAG ablative lasers continue to be the standard,” says Delray Beach, FL plastic surgeon Miguel Mascaró, MD. “However, they do involve downtime, but their results are unmatched. On the body, skin tends to respond a little differently, so radio-frequency and plasma treatments work better.”
What is the recovery like after laser resurfacing?
After nonablative treatments, recovery is much easier, with redness and dryness typically lasting one to three days. Following an ablative procedure, Dr. Alster says side effects often include redness, swelling, oozing, and mild discomfort for a week that requires diligent wound care with ice packs and ointments, followed by two to four additional weeks of skin redness.
Is there anyone who isn’t a candidate for laser resurfacing?
“Patients—regardless of skin color—who have had recent sun exposure should wait until their tans fade to reduce the risk of post-inflammatory hyperpigmentation,” says Dr. Alster. “Also, patients who have autoimmune disorders like vitiligo or lupus with involvement in the areas undergoing treatment should avoid laser skin resurfacing in order to prevent the spread of their underlying condition.” Other skin disorders that should be cleared by a doctor prior to a laser treatment include infections like warts, and inflammatory conditions like acne, psoriasis and eczema, to avoid their worsening and/or spread. “Lastly, anyone who has unrealistic expectations about the procedure— believing that all the wrinkles or scars will be erased—should not undergo treatment,” Dr. Alster adds.
Are there any lasers that get rid of fat?
According to Dr. Mascaró, a new laser called Eon targets and heats fat cells just below the skin. “It’s the only one of its kind because it’s a ‘no touch’ laser, meaning that the machine never actually touches your skin. Its robotic arm waves over the designated area, treating the unwanted fat without any contact via gels, pads, suction, etc.” The body then eliminates the fat cells naturally over the course of 12 weeks.
Post-Procedure Must-Have
Jan Marini Skin Research Post TX2 Recovery Enhancement System ($185) features three essentials for post-laser skin: a gentle cleanser, an occlusive moisturizer infused with active ingredients like growth factors, peptides and antioxidants, and a physical sunscreen. It’s the ultimate trifecta to protect and soothe skin while reducing redness and enhancing in-office results.
