Thanks to their versatility and quick results (treatments take just 5 to 30 minutes), lasers have become almost as ubiquitous as Botox. “They’re one of the fastest-growing services in-office,” says Robert Anolik, a dermatologic surgeon in New York City. Two million laser treatments were performed in 2012, according to the American Society for Dermatologic Surgery, and that number has grown at a lightning pace since. What can lasers do (or not do) for your complexion? Here, illumination.
How Do Lasers Work?
Laser is an acronym for “light amplification by the stimulated emission of radiation.” In other words, it’s “a device that focuses light energy onto a specific area,” says Tina Alster, a dermatologist and the director of the Washington Institute of Dermatologic Laser Surgery, in Washington, D.C. “For a dermatologist, that means targeting and obliterating something specific in the skin, such as water or pigment.” This creates a “controlled injury” that jump-starts the body’s healing process, says Adam Kolker, a plastic surgeon in New York City: “Nearby cells are stimulated to repair the targeted region through the production of collagen and new cells, which ultimately results in nicer-looking and feeling skin overall.”
Dozens of lasers have been invented over the years, and they fall into two general categories: traditional and fractional. And within the fractional category are ablative (which leaves skin looking visibly abraded) and nonablative (which leaves the skin surface intact). Traditional lasers emit a concentrated ray of light onto one spot, while fractional lasers emit many beams at once, allowing for numerous miniscule forays into the skin that are combined into one zap, “like pixelation in a digital image,” says Roy Geronemus, a dermatologic surgeon in New York City. Subsequently, there’s less pain and a faster recovery from each session. The only drawback: It takes multiple sessions to achieve the same results, which is why some dermatologists still opt for traditional lasers.
What’s Used for What?
The answer varies, depending on your skin texture and tone. But here are some guidelines.
The Issue: Lines and Wrinkles
The options: For the most stubborn wrinkles and the most dramatic results, dermatologists reach for traditional lasers, such as the CO2 or the Erbium. These lasers heat the water in the skin to the point where the surface skin is vaporized, prompting the production of new collagen. The catch? You pay a high price in terms of downtime and serious wound care.
For these reasons, for the treatment of lines and wrinkles, laser surgeons are increasingly recommending fractional ablative lasers (such as the Fraxel Repair) or nonablative lasers (such as the Fraxel Restore and the Clear + Brilliant Permea). These lasers leave the skin’s surface slightly red but not raw. In numerous sessions spaced about a month apart, they gradually accomplish close to what a traditional treatment does in one session. Keep in mind that you can undergo nonablative laser treatments as often as monthly (but typically annually after three initial sessions), but “you will probably need only one or two fractional ablative treatments in your lifetime,” says Fredric Brandt, a dermatologist based in New York City and Miami.
The downtime: After treatment with a fractional ablative laser, you can expect two to three days of oozing, pinpoint bleeding, and up to one week of crusting, says Paul Friedman, a dermatologist with practices in New York City and Houston. Redness will persist for several weeks. Fractional lasers of either sort offer slightly less damage and discomfort than their traditional counterparts.
The cost: Traditional or fractional ablative resurfacing, $2,000 to $5,000; fractional nonablative resurfacing, $700 to $1,500. Prices vary depending on where you live.
Pain relief: For traditional treatments, an oral prescription painkiller and, possibly, sedation. For fractional treatments of either type, a topical numbing cream.
The Issue: Broken Blood Vessels, Facial Redness, Spider Veins, or (Red) Vascular Birthmarks
The options: Lasers for vascular marks (such as the V-Beam Pulsed Dye) target and eradicate the hemoglobin in blood cells, which destroys the blood vessels. Capillaries and some smaller blood vessels respond to one treatment; rosacea, larger veins, and port-wine stains (a type of red birthmark) require several treatments. Results aren’t permanent, and touch-ups may be required yearly.
The downtime: For capillaries, rosacea, and veins, you may have no downtime, a few hours of redness, or, rarely, a bruise. For birthmarks, you can expect up to a few days of redness and crusting.
The cost: For an isolated blood vessel, $300 to $700; for leg veins, $300 to $1,000, depending on the laser used; for a birthmark, $300 to $2,000. Treatments for birthmarks may be covered by insurance.
Pain relief: A topical numbing cream.
The Issue: Brown Spots or Birthmarks
The options: Fractional nonablative lasers (like the Fraxel Restore Dual and the Clear + Brilliant) and the fractional or traditional Q-Switched Ruby target excessive melanin, which causes spots. “A single treatment can make a dramatic difference on the face,” says Karyn Grossman, a dermatologist in Santa Monica, California. “On the body, a second or third treatment may be necessary, since these areas scar easily and can’t be treated as aggressively.” Results can be permanent, but because areas may darken with sun exposure, touch-ups are often needed.
The downtime: Scabs form within days and fall off within a week.
The cost: For brown spots, $300 to $2,000; for birthmarks, $300 to $2,000, depending on the size.
Pain relief: A topical numbing cream.
The Issue: Acne
The options: The Isolaz, an intense-pulsed-light device that emits broadband light, is technically not a laser, but it is used for similar purposes. It destroys acne-causing bacteria, especially when used with topical or oral medication. It also has a vacuum to suck debris from pores. The Smoothbeam nonablative option targets oil glands and slows oil production. Several sessions may be needed for results that last up to several months.
The downtime: A few hours of redness.
The cost: $400 to $800 for a full face.
Pain relief: A topical numbing cream.
The Issue: Acne Scarring
The options: Fractional ablative or nonablative resurfacing lasers (like the Fraxel Repair and the Fraxel Restore, respectively) offer a 50 to 75 percent improvement, depending on the depth of the scar, in up to five sessions, says Friedman. For better results, you’ll need a traditional laser (like the CO2 or the Erbium).
The downtime: A few days of “sunburn pink” skin with possible swelling or two weeks of pinpoint bleeding.
The cost: $700 to $5,000, depending on the size of the scar and the type of laser used.
Pain relief: For traditional or nonablative treatments, a topical numbing cream; for fractional ablative treatments, a painkiller and/or an injectable anesthetic.
The Issue: Tattoos
The options: The PicoSure laser emits bursts of light that target blue and green ink. “It’s a major advance in tattoo removal,” says Friedman. The bursts make quick (therefore not painful) work of erasing that ex’s name from your …wherever. Sessions last 15 minutes for a three-inch tattoo.
The downtime: The treated area will turn white, possibly blister, then crust over.
The cost: $250 to $800, depending on the size of the tattoo and the type of laser used.
Pain relief: A topical numbing cream or an injectable anesthetic.
The Issue: Hair
The options: Defuzzing lasers (like GentleLase and GentleMax) target the pigment in strands (and so won’t work on blond or white hairs) and give longer-lasting results than waxing. The results may not be permanent; for some, hair grows back in months. Most women need several sessions with these nonablative lasers at one- to two-month intervals.
The downtime: Several hours of sunburned-like skin in that area.
The cost: $100 to $1,200, depending on the size of the area.
Pain relief: A topical numbing cream, as needed.
At-Home Lasers
Those approved by the Food and Drug Administration promise big benefits. Although they can’t do what doctors do in the office as quickly, they work much faster than topical treatments. These are worth a try.
Tria Age-Defying Laser, $495, triabeauty.com. Smooths facial lines.
Silk’n Face FX, $149, silkn.com. Treats spots and facial sagging.
Remington I-Light Pro, $250, remingtonproducts.com. Removes hair.
Surefire Strategies
Take these simple steps to ensure you have a safe and successful laser treatment experience.
- Select a laser practitioner who is board-certified in dermatology or plastic surgery. Find one at asds.net or plasticsurgery.org.
- Don’t schedule a procedure when you have a tan. It could cause blistering and scarring.
- Don’t get any laser treatment on your face or chest on the day before an important event, says dermatologist Tina Alster: “You may be OK, but there’s no guarantee. Everyone heals differently.”
- If you have a history of cold sores, tell your doctor; the heat of a laser can provoke an outbreak. You’ll be given an antiviral prescription a day or two before your treatment.
- Avoid taking aspirin, ibuprofen, and vitamin E for two weeks before a procedure or you’ll risk bruising.
- To prevent swelling post-treatment, sleep with an extra pillow on the first night.
- After a procedure, keep out of the sun and use skin care with antioxidants and SPF for further protection from sun damage, says Alster. Even ambient sun exposure can lead to hyperpigmentation.
