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Laser technologies have significantly changed dermatology, particularly in skin rejuvenation.1 In recent decades, lasers have evolved from basic tools to sophisticated devices that offer precise, targeted treatments with minimal invasiveness and faster recovery times. This progress has expanded the range of conditions treated with lasers and improved their suitability and safety.2 There are several types of lasers, including ablative lasers that remove the outer layers of skin and non-ablative fractional lasers that stimulate collagen production without damaging the skin’s surface. Fractional lasers, in particular, boost results with minimal downtime by targeting tiny areas of skin. Understanding how different wavelengths interact with the skin, the process of selective photothermolysis, and the body’s healing response is critical to optimizing laser treatments. These advances have made skin rejuvenation more effective and affordable.3
A recent review examined the mechanisms, advantages, and personalized applications of laser technologies for various skin conditions, with the goal of providing insight into the scientific advances that have improved the safety and efficacy of these treatments.
Methods
This review analyzed articles from the past 20 years on laser skin resurfacing, using keywords such as “skin resurfacing” and “laser technology” to search databases such as PubMed, Cochrane, Scopus and Google Scholar. It includes a wide range of research, from peer-reviewed studies and clinical trials to meta-analyses, covering various laser technologies: ablative, non-ablative, fractional, hybrid and picosecond. The review systematically examines the development, mechanisms, benefits and potential adverse events of these technologies.
Results
Of the 329 articles reviewed, the researchers included 92 that met criteria based on relevance, study design, and recent advances in laser skin resurfacing technology. The data collected was categorized into the following sections:
Fractional Laser
The review reported that fractional lasers have significantly advanced skin rejuvenation by delivering targeted energy in a pixel pattern, which speeds healing and reduces complications compared to traditional ablative lasers. These lasers create microthermal lesions that stimulate collagen production, effectively treating various skin problems such as wrinkles, acne scars and sun damage. Recent innovations have improved fit and accuracy, improving treatment outcomes and patient experience. Fractional lasers are praised for their minimal downtime and effectiveness in skin resurfacing.4
Laser ablatives
CO2 and Er:YAG lasers are well established in skin resurfacing, according to the review, known for their effectiveness in treating photoaging, scarring and wrinkles. CO2 lasers target water molecules in the skin for deep tissue removal and collagen remodeling, while Er:YAG lasers offer a more superficial approach with reduced recovery time. Both technologies show superior efficacy compared to other treatments and are often used in combination with other methods to improve results.5
Nonablative lasers
Non-ablative lasers (NAFLs), such as Nd:YAG lasers and pulsed dye lasers, provide skin rejuvenation with minimal downtime by targeting deeper layers of the skin to stimulate collagen without damaging the surface. The review reported that these lasers are effective for improving skin texture, reducing wrinkles and treating vascular lesions, offering a gentler alternative to ablative lasers.6
Hybrid fractional lasers
Hybrid fractional lasers combine ablative and non-ablative technologies in a single treatment, enabling comprehensive skin rejuvenation with reduced downtime. Researchers have found that this approach treats a number of skin problems and is known for its effectiveness and patient satisfaction, providing noticeable improvements with minimal discomfort.7
Picosecond laser
Picosecond lasers, known for their extremely short pulse duration, are effective for treating pigmented lesions, photodamage and scars with minimal thermal damage. Their ability to cause precise tissue disruption through lLaser-induced optical disruption makes them versatile and effective for various skin conditions.8
Laser Technologies in Ethnic Skin Rejuvenation
Advances in laser technologies have improved safety and efficacy for darker skin tones while minimizing risks such as hyperpigmentation. Technologies such as Nd:YAG and picosecond lasers are particularly suitable for ethnic skins, offering effective treatment with reduced side effects. The researchers noted that pre- and post-treatment care is crucial for optimal results.9
Other Considerations
Safety and side effects
The review found that ablative lasers have improved in safety and effectiveness, with advances reducing side effects and recovery times. They stated that proper patient selection, calibration, and post-treatment care are essential to minimize complications. Fractional and hybrid lasers further enhance safety and efficacy, although continued research is needed, particularly for darker skin tones.
Histology
The researchers observed that different lasers interact with skin tissues in different ways: ablative lasers remove the outer layers for immediate results, non-ablative lasers create microthermal zones for deeper collagen stimulation, and fractional picosecond lasers cause minimal thermal damage while promoting skin renewal. They stated that understanding these interactions is critical to optimizing treatment outcomes.
Long Term Effects
The review found that repeated laser treatments can enhance skin rejuvenation by cumulatively improving collagen density and skin elasticity. Long-term studies show that customized multi-session plans offer lasting aesthetic benefits and improved skin texture.10
Patient satisfaction
The researchers said patient satisfaction with laser treatments is generally high, attributed to visible improvements in skin texture and minimal downtime. Successful outcomes are often associated with realistic expectations, comprehensive pre-treatment consultations and effective post-treatment care.
Conclusion
The review found that advances in laser technologies have greatly improved skin regeneration, providing precise and effective treatments for various skin conditions. Ablative lasers such as CO2 and Er:YAG target deeper layers of the skin, but require more recovery and may have more side effects. NAFLs, such as Nd:YAG and fractional erbium, stimulate collagen production with minimal surface damage, offering faster recovery and fewer side effects. Fractional lasers further improve this balance by treating the skin in a pixelated manner, reducing downtime and risks. Hybrid lasers merge the benefits of both ablative and non-ablative approaches, allowing for customized treatments with reduced side effects and faster recovery.
The researchers found that incorporating laser-assisted drug delivery enhances therapeutic effects by creating microchannels in the skin, improving the absorption of topical treatments. They found that cooling systems have also advanced, helping to manage pain and minimize side effects, thereby increasing patient comfort and safety. However, limitations such as a focus on short-term outcomes, variability in study designs, and underrepresentation of darker skin tones in research highlight the need for continued innovation and research. Overall, they found that laser skin resurfacing continues to evolve, offering customized solutions that improve treatment efficacy and safety on various skin types, setting a new standard in cosmetic dermatology.
References
- Kirkland EB, Gladstone HB, Hantash BM. What’s new in skin regeneration and rejuvenation?G Ital Dermatol Venereol. 2010, 145(5):583-596.
- Carniol PJ, Hamilton MM, Carniol ET. Current status of fractional laser resurfacing. JAMA Facial Plast Surg. 2015? 17 (5): 360-366. doi:10.1001/jamafacial.2015.0693
- Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for skin remodeling using microscopic patterns of thermal damage. Lasers Surg Med. 2004;34(5):426-438. doi:10.1002/lsm.20048
- Jih MH, Kimyai-Asadi A. Fractional photothermolysis: a review and update. Semin Cutan Med Surg. 2008? 27 (1): 63-71. doi:10.1016/j.sder.2008.01.002
- Clementoni MT, Pedrelli V, Zaccaria G, et al. New developments in fractional Co2 resurfacing for skin rejuvenation and scar reduction. Facial Plast Surg Clin North Am. 2020? 28 (1): 17-28. doi:10.1016/j.fsc.2019.09.002
- Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional and ablative laser resurfacing. J Am Acad Dermatol. 2008;58(5):719-740. doi:10.1016/j.jaad.2008.01.003
- Waibel S, Pozner J, Robb C, et al. Hybrid fractional laser: A multicenter trial on the safety and efficacy of photorejuvenation. J Drugs Dermatol. 2018? 17(11):1164-1168.
- Haykal D, Cartier H, Maire C, et al. Picosecond lasers in cosmetic dermatology: where are we now? Overview of types and indications. Lasers Med Sci. 2023? 39(1): 8. Published 18 Dec 2023. doi:10.1007/s10103-023-03945-5
- Kaushik SB, Alexis AF. Non-exciting fractional resurfacing laser in pigmented skin: an evidence-based review. J Clin Aesthet Dermatol. 2017? 10 (6): 51-67.
- Manuskiatti W, Punyaratabandhu P, Tantrapornpong P, et al. Objective and long-term evaluation of the efficacy and safety of a fractionated microlens array 1064 nm picosecond laser for the treatment of atrophic scar acne in Asians. Lasers Surg Med. 2021;53(7):899-905. doi:10.1002/lsm.23368
