Wrinkle Reducing Lasers: Ablative vs. Nonablative Lasers
What are Lasers?
Light Amplification Stimulated by Emitted Radiations, commonly known as LASERs, are a newly emerging field for surgical and nonsurgical procedures. Their quick and easy approaches grant them increasing popularity. Lasers can be used for a variety of purposes on the skin including reduction of dark spots, tattoos, unwanted blood vessels, resurfacing the skin, and for tightening the skin to reduce the effects of aging. Lasers used to tighten the skin can be categorized into two subgroups: non-ablative and ablative, each with its own specialties for different skin types.
Lasers are concentrated beams of light caused by one specific wavelength. The wavelength defines the properties of the laser and the interaction with biological tissue.1 Generally, targets within the body consist of light absorbing molecules or cells, which then absorbs the wavelength, heats up, and bursts. Some of the targets of lasers include hemoglobin (in blood), melanin (skin pigment in hairs and the skin), and water (found throughout the skin). For skin tightening lasers, the target is typically water and the microinjury from heated water stimulates collagen formation and skin rejuvenation.
Ablative lasers cut through the layers of the skin to create microinjuries that stimulate local collagen production. One example of an ablative laser is the CO2 laser, which emits a wavelength of 10600 nm and has a high affinity for water. Our skin, having made up of a large percentage of water, allows for the CO2 laser to be fully absorbed, removing thin layers of the skin.2 Common ablative lasers are Er:YAG (2,940 nm), Er:YSGG (2,970 nm), and CO2 laser (10,600 nm).3
Non ablative lasers do not cut through the skin. Instead, they create microinjuries by selectively aiming at a target depending on the wavelength of the laser. The target heats up and undergoes damage at a microscopic level. Non-ablative lasers typically have wavelengths that range from 1,300–1,550 nm.3
Non-fractional lasers are commonly known as full field resurfacing lasers, meaning that 100% of the treated area is eliminated according to the depth needed for the treatment. However, these lasers became an issue due to their excessive depths of ablation which led to thermal damage.4 Thus, the popularity of fractional lasers followed.
Fractional Ablative and Fractional Non-Ablative
Fractional laser treatments are used for both ablative and non-ablative procedures. Fractional treatments create selective columns of microthermal damage in which treated areas are intermixed with untreated ones.2 This allows for a more rapid recovery and lower inflammation, resulting in lower risks of scarring or dyspigmentation.5 However, with fractional procedures, several treatments must be done in order to obtain satisfactory results.
Which Method Is Best?
Because ablative lasers tend to wound and cut through the skin, they has the ability to damage other parts of the skin not meant to be targeted, for example, melanin. Thus, ablative lasers work best for lighter colored individuals whereas non-ablative lasers are best for those with darker skin. However, skilled practitioners may be able to use ablative lasers on darker skin successfully.
Treatments for ablative and non-ablative laser procedures include, but are not limited to fine lines, wrinkles, hyperpigmentation, melasma, photoaging, surgical resection, scars, and drug delivery.1
Why It Works
Fractional lasers6 incise on the skin, leaving islands of healthy skin that accelerate recovery, while generating columns of injury. The necrosis columns are what trigger the dermis to produce more collagen.6
Laser assisted drug delivery (LAD) is one of the new emerging fields. The skin is made of several layers, allowing it to be an important barrier between your body and the environment. This impairs the ability of drugs to enter the body. Laser treatments for drug delivery allow the drugs to travel transcutaneously, bypassing several layers of the skin so the drug can treat the patient faster than waiting for the topical drug to sink in.
There need to be additional studies to determine the optimal treatment parameters, coagulation zones, and how long the channels of LAD remain open in the dermis.7 Various medical conditions have been studied with LAD including dysplasia, non-melanoma skin cancer, psoriasis, inflammatory conditions, local anesthesia, and scars.8
- Schena E, Saccomandi P, Fong Y. Laser Ablation for Cancer: Past, Present and Future. J Funct Biomater. 2017;8(2).
- Trivedi MK, Yang FC, Cho BK. A review of laser and light therapy in melasma. Int J Womens Dermatol. 2017;3(1):11-20.
- Paasch U, Haedersdal M. Laser systems for ablative fractional resurfacing. Expert Rev Med Devices. 2011;8(1):67-83.
- Pozner JN, DiBernardo BE. Laser Resurfacing: Full Field and Fractional. Clin Plast Surg. 2016;43(3):515-525.
- Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-438.
- Borges J, Manela-Azulay M, Cuzzi T. Photoaging and the clinical utility of fractional laser. Clin Cosmet Investig Dermatol. 2016;9:107-114.
- Waibel JS, Rudnick A, Shagalov DR, Nicolazzo DM. Update of Ablative Fractionated Lasers to Enhance Cutaneous Topical Drug Delivery. Adv Ther. 2017.
- Sklar LR, Burnett CT, Waibel JS, Moy RL, Ozog DM. Laser assisted drug delivery: a review of an evolving technology. Lasers Surg Med. 2014;46(4):249-262.