What’s the Best Laser for Skin Resurfacing: Ablative, Non-Ablative, or Both?

Today aesthetic providers can choose from a number of laser platforms to revitalize and resurface their patients’ skin. These platforms include ablative, non-ablative, fractional, and non-fractional technology. With varying results, all of these technologies can improve the appearance of wrinkles, age spots, scarring, enlarged pores, lax skin, and dyspigmentation. At the same time, all of these technologies offer different levels of efficacy, tolerability, and downtime.

In this article, we will discuss the strengths and weaknesses of the various laser technologies for skin resurfacing. We will also explore the advantages of combined technologies for providing optimal treatment control and outcomes.

Ablative versus non-ablative

Ablative lasers quickly superheat water molecules in the skin to vaporize and destroy the targeted tissue.1 This process removes the epidermal layer, promotes collagen formation, and causes skin retraction and tightening. Although ablative lasers produce the most dramatic outcomes, they also result in more adverse effects and a difficult recovery process. For more severe facial wrinkles, dyspigmentation, and textural skin challenges, the ablative laser is often the treatment of choice.

In comparison, non-ablative lasers deliver a milder heat deeper into the skin to coagulate the tissue. This promotes collagen production and tightens the tissue without injuring the skin’s surface.1,2 This process can create overall improvements in the skin including a reduction in the appearance of fine lines and wrinkles, reduced visible pore size, enhanced reflectivity and glow, and significant removal of discoloration. Though the results are less dramatic, non-ablative lasers are gentler and require little to no downtime.

Fractional versus non-fractional

Non-fractional lasers affect the entire area of targeted skin with a solid beam of laser energy.1 In contrast, fractional lasers affect only a portion of the projected area but in an equally distributed pattern.1 As expected, non-fractional lasers produce more dramatic results in a single treatment than fractional lasers. Non-fractional lasers are very effective at promoting collagen formation and tightening and clearing the skin; however, they can have serious side effects, including scarring, discoloration, infections, and difficult wound healing.1

On the other hand, fractional lasers require more treatments to produce the same results, but fractional lasers have fewer complications and require less downtime between treatments. Both ablative and non-ablative lasers can employ fractional or non-fractional technology.1

Fractional, ablative, and non-ablative hybrid

In 2014, an entirely new category of fractional laser was developed, called the hybrid fractional laser (HFL). By combining both ablative and non-ablative fractional lasers into one device, a hybrid laser can produce ablative-like results with non-ablative downtimes. HFLs work by delivering fractional ablation to the epidermis (from 20 to 100 microns) followed by fractional coagulation to the dermis (from 250 to 700 microns).3,4

Because both the ablative and non-ablative treatments are fractionated, the dermis remains intact. This allows the epidermis to heal quickly because basal keratinocytes can migrate across the fractionated holes quickly. When less than 100 microns of ablation are used, the epidermis regenerates within 24 hours.3

HALO® delivers the best of both worlds

The HALO laser from Sciton is the world’s first hybrid fractional laser. By delivering both fractional ablative and non-ablative laser wavelengths in the same pass, HALO treats the damage you can and cannot see at the same time. Patients receive both ablative and non-ablative results with non-ablative recovery times. What’s more, the dual wavelengths can be delivered in many different permutations of depths and coverage to customize the optimal treatment for each patient. In testimonials, reviews, and social media posts, patients express the highest levels of satisfaction with their HALO treatment and results.

References:

  1. Preissig J, Hamilton K, Markus R. Current laser resurfacing technologies: a review that delves beneath the surface. Semin Plast Surg. 2012;26(3):109-116.
  2. American Society for Dermatologic Surgery. Non-ablative laser rejuvenation. https://www.asds.net/skin-experts/skin-treatments/non-ablative-laser-rejuvenation. Accessed January 2020.
  3. Pozner J, Robb CW. Hybrid fractional laser: the future of laser resurfacing. https://sciton.com/wp-content/uploads/2600-003-13-Rev-A-Pozner-and-Robb-WP-HALO.pdf. Accessed January 2020.
  4. Cohen JL, Ross EV. Combined fractional ablative and nonablative laser resurfacing treatment: a split-face comparative study. J Drugs Dermatol. 2013;12(2):175-178.