The Ultimate Guide to Lasers — and How to Find the Right One For You

Laser Treatment: Fractionated CO2, like Fraxel
Best For: acne scars, deeper wrinkles, sun damage
Downtime: swelling, scabbing, crusting, and peeling for at least a week

First off, a fractionated CO2 laser is an ablative laser, so it targets the top layer of skin. According to Jennifer Herrmann, MD, FAAD, a board-certified, fellowship-trained dermatologist and dermatologic surgeon, the fractionated CO2 laser works by focusing microscopic beams of light into the skin in a grid pattern. Because the laser targets water, a major component of the skin, it immediately vaporizes tissue when fired.

"The fractionated CO2 laser is best for removing significant sun damage or treating textural acne scars," said Dr. Herrmann. "By helping your skin grow its own new collagen, it can very effectively reduce lines around the eyes and mouth. It is also great for removing brown spots in a single treatment and improving the overall health of the skin because it physically removes damage." Because there are small areas of "normal" skin between the micro wounds, healing is accelerated.

Dr. Herrmann also noted that because of the heat generated by the laser, people with darker skin tones may not be the right candidate. She also said that people with melasma (not to be confused with hyperpigmentation) should be very careful with heat-based lasers as they can actually backfire and cause the melasma to spread.

In terms of downtime, you should expect a pretty red face (like the worst sunburn you've ever had) for about 7 to 10 days with some peeling and scabbing. You will likely also need to use some ointment to help the healing process.

When you're on the hunt for a laser treatment, it's important that you research what type of laser is used — for example, Fraxel, which is the most common device used for fractionated CO2 treatments, has three different settings. Fraxel Re:pair, which is the most aggressive of the three, is a fractional CO2, ablative laser. Fraxel Re:store is actually a fractional Erbium laser (more on that later), while Fraxel Dual uses two non-ablative laser frequencies.

Since the fractionated CO2 laser is quite strong, your doctor will apply a medical-grade numbing cream to your skin, and you may even be given a low dose of Xanax or Valium beforehand. You may still feel some heat and stinging both during and after the treatment.

The takeaway? Fractionated CO2 lasers are great for anyone with acne scarring, fine lines, wrinkles, dark spots, and sun damage, but you should expect a longer amount of time to heal (think: swelling, scabbing, crusting, and peeling for at least a week). Your skin will look tighter and smoother after about a week after the procedure, but the final results usually take around 3 to 6 months to really appear since it takes time for new collagen to synthesize.

Laser Treatment: Fractionated Erbium
Best For: skin texture, sun damage, fine lines
Downtime: redness, swelling, and flaking for three to five days

Like fractionated CO2, a fractionated Erbium laser is an ablative laser, but is a little less intense. This laser breaks up the beam into a grid of tiny beams that create microscopic injuries to the top layer of skin. Because only a "fraction" of the skin is treated at one time, healing pretty fast and there is much less downtime when compared to a CO2 laser. According to Dr. Herrmann, the micro injuries stimulate new collagen and elastin production for skin remodeling, ultimately smoothing and evening out skin texture and tone.

"The fractionated erbium laser is good for removing dyspigmentation, evening skin tone, and minimizing finer lines," said Dr. Herrmann, along with improving acne scars, reversing sun damage, and increasing skin thickness. She explained that settings can be adjusted by your doctor, so it can treat light and medium skin tones safely. However, because the laser uses heat, those with melasma should avoid it, and people with more melanated skin tones should speak to their doctors before trying out an Erbium laser.

When it comes to the procedure itself, your doctor will use numbing cream before getting started, but you'll likely still feel some heat. Dr. Herrmann explained that there is some recovery where the skin appears sunburned and may be swollen, then within a few days it will flake before more even and younger skin appears. Usually people are fully recovered and back to normal activities within 3 to 5 days depending on the area treated and the energy used.

Laser Treatment: ResurFX
Best For: scars, sun damage, fine lines
Downtime: redness and and peeling for a week

ResurFX is the brand name for another type of non-ablative laser. It uses a fiber laser and a scanner that hones in on a specific area of the skin and then picks little fractionated spots within it to be treated. This ensures that, unlike something like Fraxel, the entire area of skin doesn't get heated.

"During Fraxel, the doctor does the work to make sure cells in the same area are not heated or destroyed twice, but the ResurFX laser does it automatically," Dr. Michael Eidelman, assistant clinical professor at Mount Sinai and the medical director at Chelsea Skin and Laser explained.

ResurFX is used to treat scars, fine lines, and sun damage. Like most laser treatments, you'll get a numbing cream slathered on your skin, and you'll feel some stinging and heat during the procedure. After treatment, skin can be sore with some redness and peeling for about a week.

According to Dr. Eidelman, you'll probably need three to five treatments at least one month apart between to get the best results. ResurFX works for all skin tones, but it is recommended that the energy levels are turned down for those with darker complexions as to not aggravate hyperpigmentation.

Laser Treatment: Clear & Brilliant
Best For: skin tone and texture, sun damage, enlarged pores
Downtime: flushed skin and sandpaper texture for up to a week

A non-ablative laser, the Clear & Brilliant treatment is a popular option because it has barely any downtime. "Most people are pink for a few hours, followed by feeling a sandpapery quality of the skin for 3 to 4 days," Dr. Herrmann said. That said, though you will see results after just one treatment, for more dramatic results (and for general upkeep) you may want to do multiple rounds.

So how does it work? "Clear & Brilliant stimulates collagen and exfoliates the outer layer of skin by placing thousands of tiny little columns of heat into the skin to gently stimulate it for a healthy glow," said Dr. Elizabeth Tanzi, the founder and director of Capital Laser and Skin.

Some of the benefits of Clear & Brilliant include improvement in skin tone and texture, reduction of fine lines and wrinkles, and decreased hyperpigmentation. It also helps to reduce the appearance of pores and makes skin generally more radiant. With each treatment, collagen production is stimulated, so results only get better over time.

Dr. Diane Berson, MD, associate professor, Department of Dermatology at Weill Medical College of Cornell University, offered this tip: "It's great for maintenance . . . but it's also a good option for younger patients with early signs of sun damage who want to begin an anti-aging protocol." For the best results, have it performed once every four to six weeks for the first four treatments. After that it can be used as maintenance two to three times a year to maintain a healthy glow.

As far as the experience goes, Clear & Brilliant is not as uncomfortable as a CO2 laser, but a numbing cream still is applied about 15 minutes beforehand. Minor post-treatment side effects include a bit of redness and sandpapery feeling skin for up to a week. It is safe to use on all skin types, but as with any laser treatment that generates heat, those with darker tones or prone to melasma should be careful. "If a patient has darker skin and melasma, I might try peels first because this type of treatment could make stubborn melasma worse," Dr. Berson noted.

Laser Treatment: Nd:YAG
Best For: enlarged blood vessels and veins
Downtime: redness, swelling, and mild itching for a few days

Many people with large blood vessels and veins on their face and bodies don't realize they can easily zap them away. Enter: Nd:YAG lasers, another non-ablative laser. "YAG lasers work by sending heat energy through the skin, which targets hemoglobin molecules," said Dr. Eidelman. "These are the molecules that cause the red pigment in our blood." Once these molecules are heated, the vessels become damaged at just the right level in the skin, without damaging the surface layer.

According to Dr. Eidelman, if there's more contrast between the color of the skin and the patient's blood vessel, there tends to be better results. "When treating for the red color in vessels, the best candidates are individuals of fair skin who have not recently gotten sun exposure," he explained.

Nd:YAG treatments can be performed on many different areas of the body spanning different treatment sizes, so pain levels before and after vary based on both factors. During the treatment, your skin might feel hot or as if it is being snapped with tiny rubber bands. Downtime is fairly minimal, with redness, swelling, and itching that may last a few days; and only a small percentage of patients bruise or form scabs at the treatment site.

"Sometimes only one treatment is needed to do the trick, but it can differ depending on what the specific target is. People with darker and larger blood vessels may find they fall into this camp," Dr. Eidelman noted. If more than one treatment is needed, he recommended waiting four to six weeks between sessions.

Anyone considering Nd:YAG treatments is in luck, because it can be used on pretty much all skin tones, but again when it comes to people with darker skin types, lower energy levels need to be used so patients don't run the risk of getting any skin discoloration.

Laser Treatment: PDL
Best For: broken capillaries, rosacea, and spider veins
Downtime: little to none, with potential light bruising

The Pulsed Dye Laser(PDL) is very similar to the Nd:YAG laser — it is used to zap away broken capillaries and spider veins, and is most beneficial for people with rosacea. "The non-ablative PDL laser specifically targets blood vessels, so it is excellent for removing broken capillaries, vessels around the nose, very small veins on the legs, and small red dots called cherry angiomas," said Dr. Herrmann. "The laser light targets hemoglobin, a protein which is in red blood cells. It heats it up, and this heat collaterally damages the blood vessel walls surrounding it, which causes them to collapse and disappear. Because we have so many extra vessels in the skin, removing a few doesn't have any negative health consequence."

She also noted that because these lasers target blood vessels specifically, they do not affect other skin structures and do not cause crusting, scabbing or peeling, so there is little to no downtime. You'll usually be able to return to your normal activities right away, but it is essential to use sunscreen on the treated areas.

The PDL laser feels like a small snap of a rubber band with each zap, but it's over pretty quickly — you likely won't need any numbing cream. In terms of downtime, it really depends on the amount of energy used by the laser (a setting your doctor will determine). You may just have a couple red marks that fade in a day or two, or you may see some small bruises. "Vessels may also turn darker purple and fade over a couple of weeks," Dr. Herrmann said. "If redness is stubborn, sometimes we purposefully use higher energy to create small bruises, which usually is more effective at reducing redness."

Sometimes these capillaries can be stubborn and may take a few rounds to diffuse the redness. This is especially true for people with rosacea. Dr. Herrmann also noted that redness may also return slowly over time, so future treatments may be recommended.

Laser Treatment: PiQo4
Best For: removing dark pigmentation
Downtime: redness for a few hours

The PiQo4 laser uses energy specifically aimed at a spot of discoloration of concern, and delivers it so fast that the pigment is immediately shattered with minimal heat generated. "That makes them safer for those with melasma and darker skin tones," noted Dr. Herrmann. This non-ablative picosecond laser is specifically designed for removing pigment, which can include everything from sun damage to melasma to post inflammatory discolorations from acne to birthmarks to discolored scars. It's also the go-to for removing tattoos.

The PiQo4 laser is actually pretty revolutionary — instead of using heat like most lasers, this one uses acoustic or sound energy to obliterate discolorations of the skin. According to Dr. Herrmann, the PiQ04 laser is the only laser in the US that has four different wavelengths and the ability to deliver pulses in picoseconds (one trillionth of a second!), meaning it targets just the unwanted pigment and leaves the normal surrounding skin alone. Once dissipated, the pigment naturally gets disposed by your body's lymphatic system.

You'll notice that during the procedure, there is a popping sound that comes with each laser pulse — but not to worry, this is just the photo-acoustic effect. Most people find the pain levels pretty tolerable, and you'll probably feel like you have a sunburn on the affected area after the treatment.

Laser Treatment: IPL
Best For: rosacea, sun damage, brown spots
Downtime: redness and sandpaper texture for a few days to two weeks

OK, technically IPL (Intense Pulsed Light) is not a laser. So why are we including it in this list? It works just like a laser by heating specific areas on the skin, but instead of being equipped with a glass filter, it has a crystal filter. The tool can make a dramatic difference for people with rosacea, and it can also treat sun damage, redness, and brown spots.

As with lasers, there is some pain involved, including flashes of heat and the minor sting of a rubber band snapping against the skin. Following the treatment, patients can expect a bit of redness that looks and feels like a sunburn for a few days, Dr. Eidelman said. He also mentioned that treated brown spots can take on the texture very fine coffee grinds and take up to two weeks to fall off.

He also warned that IPL should not be used on dark skin. It is better suited for those with lighter complexions because it can cause hyperpigmentation and discoloration.

Laser Treatment: Laser hair removal
Best For: hair removal
Downtime: skin sensitivity for a few hours

The non-ablative lasers used for laser hair removal are in fact pretty similar to a few of those used for skin rejuvenation. According to Mercedes Doan, Manager of Aesthetic Services and Education and Medical Aesthetician for Ever/Body, the two laser devices used for laser hair removal are Nd:YAG (which is better for people with more melanated skin) and Alexandrite (which is better for lighter skin tones). "Lasers emit a highly concentrated laser pulse into the hair follicles," explained Doan. "That energy converts to heat which is absorbed by the follicular bulb, meaning the root, destroying the follicle and inhibiting future hair growth."

The laser picks up on the pigment of the hair so if you have red, gray, or blond hair, your results may not be as drastic. The ideal candidate for laser hair removal is someone with contrasting hair pigment and skin color — for example, someone with pale skin and dark hair. When it comes to pain, you'll feel like your skin is getting snapped by tiny rubber bands (this is sort of a theme with many laser treatments) and you may experience sensitivity afterwards. "Laser hair removal typically takes 30 to 45 minutes per visit depending on the size of the area being treated," said Doan, "and 8 treatment sessions, with the area improving each time you come in."

Contrary to popular belief, laser hair removal is for permanent hair reduction, not permanent hair removal. "Everyone is different and has hormones that will naturally cause hair to grow back, so it's important to stay on top of your individual treatment timeline to help reduce the amount of growth," said Doan. "If you're in need of more sessions, or if you experience changes in hormone levels, which is often associated with a new pregnancy or hormone therapy, it's common to see hair growth as well. For hormonal areas, most will need to continue with maintenance."