Procedure dossier
Laser Skin Resurfacing
Ablative and non-ablative laser treatments for skin rejuvenation and repair
Laser skin resurfacing uses concentrated beams of light energy to remove damaged skin layers and stimulate the growth of new, healthier skin [1]. The treatment is highly effective for reducing wrinkles, scars, hyperpigmentation, and other skin irregularities by precisely targeting specific layers of the skin while minimizing damage to surrounding tissue.
There are two primary categories of laser resurfacing: ablative and non-ablative [2]. Ablative lasers, including carbon dioxide (CO2) and erbium (Er:YAG), vaporize the outer layers of damaged skin, prompting the body to replace them with fresh, tighter skin and new collagen. Non-ablative lasers work by heating the underlying skin tissue without destroying the surface, stimulating collagen production from within.
Fractional laser technology, available in both ablative and non-ablative forms, treats only a fraction of the skin surface in a pattern of microscopic columns, leaving surrounding tissue intact to accelerate healing [1]. This innovation has made laser resurfacing more accessible by significantly reducing recovery time while maintaining impressive clinical results.
Average range
$1,000 - $5,000
Recovery
3 weeks
Duration
1 hour
Anesthesia
Local
Complexity
Moderate
Category
Nonsurgical
01 / The brief
What to know first
Laser skin resurfacing represents one of the most significant advances in cosmetic dermatology, offering precise, customizable treatment for a wide spectrum of skin concerns. The technology has evolved dramatically since the first CO2 laser resurfacing procedures in the 1990s, with modern devices providing superior outcomes, reduced risk, and faster recovery compared to earlier generations.
Ablative CO2 lasers remain the gold standard for treating deep wrinkles, significant sun damage, and acne scars [1]. The CO2 laser emits light at a wavelength of 10,600 nanometers, which is strongly absorbed by water in skin tissue, causing precise vaporization of the targeted layers. Traditional full-field CO2 resurfacing provides dramatic results but requires extended recovery. Fractional CO2 lasers (such as Fraxel Re:pair and ActiveFX) treat only 20-40% of the skin surface per session, reducing downtime to approximately one to two weeks while still delivering significant improvement.
Erbium YAG lasers (wavelength 2,940 nm) offer a more superficial ablation with less thermal damage to surrounding tissue compared to CO2 lasers [2]. This translates to faster healing and less risk of prolonged redness, making erbium lasers well-suited for patients with mild to moderate wrinkles, superficial scars, and uneven pigmentation. Erbium lasers are often preferred for patients with darker skin tones due to a lower risk of post-inflammatory hyperpigmentation [1].
Non-ablative lasers, including Nd:YAG (1,064 nm and 1,320 nm), diode (1,450 nm), and pulsed dye lasers (595 nm), heat the dermis to stimulate collagen remodeling without removing any skin. These treatments require multiple sessions but offer minimal downtime, making them attractive for patients who cannot accommodate a recovery period. Results are more gradual and subtle compared to ablative lasers.
Fractional non-ablative lasers, such as the Fraxel Re:store (1,550 nm erbium-doped glass fiber laser) and Clear + Brilliant, create microscopic columns of thermal injury in the dermis while leaving the epidermis intact. This triggers collagen remodeling with little to no visible downtime. A series of three to six treatments spaced three to four weeks apart is typically recommended, with progressive improvement over several months.
02 / Approaches
Techniques and options
Before ablative laser resurfacing, the treatment area is cleansed and a topical or injectable local anesthetic is applied. For extensive treatments, sedation or general anesthesia may be used. The laser handpiece is passed over the skin in a systematic pattern, with the practitioner adjusting energy settings, density, and the number of passes based on the specific area and condition being treated. Periorbital and perioral areas, where the skin is thinner, require lower energy settings to prevent overtreatment.
Fractional ablative techniques involve the laser creating thousands of microscopic treatment zones (microthermal zones) per square centimeter. The density of these zones can be adjusted from 5% to 40% coverage, allowing the practitioner to balance the intensity of treatment with recovery time. Higher density settings produce more dramatic results but require longer healing. Multiple passes at lower density may be used to build cumulative effect while maintaining safety.
Non-ablative treatments are typically performed with topical anesthesia or cooling devices integrated into the laser handpiece. The practitioner delivers a prescribed number of pulses across the treatment area, often using a stamping or scanning technique. Treatment parameters including fluence (energy per unit area), pulse duration, spot size, and repetition rate are customized to the patient's skin type and treatment goals.
Combination approaches are increasingly common, where an ablative laser is used on areas with deeper concerns (perioral wrinkles, acne scars) while non-ablative or less aggressive settings are used on surrounding areas. This "blended" technique allows for targeted treatment intensity while minimizing overall recovery time.
03 / Candidacy
Who may be a candidate
Often considered
Ideal candidates for laser skin resurfacing are individuals with fair to medium skin tones (Fitzpatrick types I-III) who have moderate to severe wrinkles, acne scars, sun damage, or uneven skin texture. Good candidates are non-smokers in overall good health who can commit to the required recovery period and diligent post-treatment sun protection.
Patients seeking significant improvement in skin quality without surgery and who have realistic expectations about outcomes and recovery are well-suited for this treatment. Those who have not achieved satisfactory results with less aggressive treatments such as chemical peels or microneedling may benefit from the enhanced results of laser resurfacing.
Reasons to pause
Laser skin resurfacing is not suitable for patients with active skin infections, inflammatory skin conditions, or open wounds in the treatment area. Patients with a history of keloid or hypertrophic scarring are at increased risk of adverse outcomes. Those who have taken isotretinoin within the past six to twelve months should avoid ablative treatments due to impaired wound healing.
Patients with darker skin tones (Fitzpatrick types IV-VI) face a higher risk of pigmentary complications with ablative lasers and should consider non-ablative options or alternative treatments with a provider experienced in treating skin of color [1]. Active or recent significant sun exposure contraindicates treatment due to increased risk of complications. Pregnant and breastfeeding women should postpone laser treatments. Patients unable to comply with extended aftercare protocols and sun avoidance are not ideal candidates.
04 / Tradeoffs
Potential benefits and risks
Potential benefits
Laser skin resurfacing offers precise, customizable treatment with results that surpass most other non-surgical skin rejuvenation methods. The ability to adjust laser parameters allows practitioners to treat each facial area with the appropriate intensity, optimizing results while minimizing risks.
Modern fractional technology has dramatically improved the safety profile and reduced recovery time compared to traditional full-field ablative lasers, making significant skin resurfacing accessible to a broader patient population. A single fractional ablative treatment can produce improvement that would require multiple sessions with non-ablative devices or chemical peels.
Laser resurfacing effectively addresses multiple skin concerns simultaneously, including wrinkles, scars, pigmentation, texture irregularities, and skin laxity. The collagen remodeling stimulated by laser treatment continues for months after the procedure, providing progressive improvement over time. Results from ablative treatments are long-lasting, with many patients enjoying benefits for five to ten years with proper sun protection.
Risks to discuss
Common side effects of ablative laser resurfacing include redness, swelling, itching, and a sensation similar to sunburn lasting one to three weeks. Prolonged erythema (redness) can persist for several months, particularly with CO2 laser treatments. Hyperpigmentation may occur, especially in patients with darker skin tones, and usually resolves with topical treatment over several weeks to months.
Hypopigmentation (skin lightening) is a more concerning risk with aggressive ablative treatments and may be permanent [2]. Infection, including bacterial, viral (herpes simplex reactivation), and fungal infections, can occur during the healing period when the skin barrier is compromised [2]. Prophylactic antiviral and sometimes antibiotic medication is prescribed to mitigate this risk.
Scarring is a rare but serious complication, most likely to occur with overly aggressive treatment settings, improper aftercare, or treatment of non-facial areas where the skin has fewer adnexal structures for regeneration [1]. Ectropion (outward turning of the lower eyelid) can occur with aggressive periorbital treatment. Non-ablative laser treatments carry significantly lower risks, with the most common side effects being temporary redness and mild swelling.
05 / Planning
Preparation and recovery
Before the procedure
Preparation for laser skin resurfacing begins four to six weeks before the procedure. Patients are typically prescribed a topical regimen including tretinoin to accelerate cellular turnover and, for those at risk of hyperpigmentation, hydroquinone to suppress melanin production. Broad-spectrum sunscreen (SPF 30 or higher) must be applied daily to prevent additional sun damage to the treatment area.
Discontinue retinoids and exfoliating products one week before ablative procedures. Patients with a history of herpes simplex virus should begin antiviral prophylaxis (valacyclovir or acyclovir) one to two days before treatment and continue for seven to fourteen days post-procedure.
Avoid aspirin, ibuprofen, vitamin E, and other blood-thinning supplements for one to two weeks prior. Discontinue smoking at least two weeks before treatment, as smoking impairs wound healing significantly. Arrange for someone to drive you home after the procedure if sedation will be used, and plan for one to two weeks of reduced activity during the initial recovery.
Aftercare
Immediately after ablative laser resurfacing, the treated skin will appear red, raw, and swollen. Apply prescribed ointment or healing balm to keep the skin continuously moist and protected. Cold compresses can help manage swelling. Clean the treated area gently with a mild cleanser as directed by your provider.
Keep the skin moisturized and avoid allowing it to dry out or form scabs, as this can increase the risk of scarring. Avoid sun exposure completely during the initial healing phase and wear broad-spectrum SPF 50 sunscreen daily once the skin has re-epithelialized. Continue sun protection diligently for at least six months to reduce pigmentation risks.
Do not pick, scratch, or peel any flaking or crusting skin. Avoid makeup, fragranced products, and active skincare ingredients (retinoids, acids, vitamin C) until your provider confirms the skin has healed sufficiently, typically two to four weeks post-treatment. Sleep with your head elevated for the first few days to minimize swelling.
Significant redness, swelling, and oozing; rest recommended
Skin begins to peel; new pink skin visible beneath
Most peeling complete; residual redness persists
Redness fading; makeup can be worn to conceal remaining pinkness
Collagen remodeling continues; final results apparent
Mild redness and swelling; resume normal activities
Redness resolves; skin may feel slightly rough
Skin texture improvement noticeable
Progressive improvement with continued collagen remodeling
Expected results
Ablative laser resurfacing produces significant improvement in skin texture, tone, and wrinkle depth [1]. Patients can expect a 50-70% improvement in moderate wrinkles and up to 80% improvement in superficial wrinkles following a single full-field CO2 treatment. Fractional ablative treatments typically produce 30-50% improvement per session, with additional improvement from subsequent treatments. New collagen continues to form for three to six months after treatment, with progressive tightening and smoothing [2].
Non-ablative laser treatments produce more subtle, gradual results. Patients typically notice improvement in skin texture, pore size, and mild wrinkles after a series of three to six sessions. Results continue to improve for several months after the final treatment as collagen remodeling progresses. Non-ablative treatments are best suited for patients with mild to moderate concerns who prefer incremental improvement without visible recovery.
All laser resurfacing results are influenced by the patient's age, skin quality, sun damage severity, and adherence to post-treatment care including sun protection. Maintenance treatments may be needed over time as the skin continues to age naturally. Sun protection is essential to preserving results and preventing new photodamage.
06 / Common questions
Frequently asked
What is the difference between ablative and non-ablative laser resurfacing?
Ablative lasers (CO2 and erbium) remove the outer layers of damaged skin, causing the body to generate new, smoother skin during healing. These produce more dramatic results but require one to three weeks of recovery. Non-ablative lasers heat the underlying dermis without removing surface skin, stimulating collagen production with minimal downtime. Non-ablative treatments require multiple sessions for optimal results and produce more gradual, subtle improvement. Many patients choose fractional ablative lasers as a middle ground, offering significant results with shorter recovery than traditional ablative treatment.
How many laser resurfacing treatments will I need?
The number of treatments depends on the laser type and your treatment goals. A single ablative or fractional ablative CO2 treatment often produces substantial improvement on its own, though some patients opt for a second session after six to twelve months. Non-ablative fractional lasers typically require a series of three to six treatments spaced three to four weeks apart. Your provider will develop a personalized treatment plan based on your skin concerns, skin type, and available recovery time.
Is laser resurfacing safe for darker skin tones?
Patients with darker skin tones face a higher risk of post-inflammatory hyperpigmentation and hypopigmentation with ablative laser treatments. Non-ablative lasers and certain fractional devices with conservative settings can be used more safely in darker skin types, but require an experienced provider who understands the specific considerations. Erbium lasers carry less pigmentation risk than CO2 lasers. Pre-treatment with topical agents and test spot treatments help assess individual response. Always seek a provider experienced in treating skin of color for laser procedures.
07 / Community desk
Ask about laser skin resurfacing
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