Skin rejuvenation: Ablative or Nonablative Treatment?

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Skin Rejuvenation

Laser skin resurfacing procedures are popular in the United States, with good reason. As we age, time and sunlight can accelerate formation of wrinkles, fine lines, and pigment changes in the skin. Laser resurfacing treatments are an effective way to reverse this damage and restore your complexion to a more youthful and healthy state.

Laser treatments are classified into ablative or nonablative procedures, and there are significant differences you should consider before you decide upon a treatment to enhance your complexion. Ablative lasers destroy the epidermal layer of skin and penetrate to the dermal layer. This results in new skin formation with healing. The collagen in the dermis, a critical component of the skin structure, is also damaged by the heat from the laser. This triggers a wound healing process, with production of new collagen. The results can be dramatic and they are long-lasting.

Types of Ablative Resurfacing Lasers

Laser treatments have been in use to resurface the skin since the 1980’s. At that time, the continuous wave carbon dioxide (CO2) laser was used to remove skin by layers. Over time, pulsed laser systems were developed to reduce damage from heat in surrounding tissue.

In addition to the CO2 laser system, the Erbium:YAG laser is commonly used for ablative skin resurfacing procedures. These ablative lasers can produce dramatic results, particularly in areas with mild-to-moderate wrinkling and superficial pigment changes. The Er:YAG laser is also used effectively to improve scarring from acne or trauma, with patients reporting 70% to 90% improvement in acne scarring in one study. Lasers produce some tightening effect, but if you have significant laxity in your skin, a facelift may be the most effective solution.

Is It Painful?

Ablative procedures are uncomfortable and sometimes painful, as a result of thermal injury and vaporization of damaged skin. The need for sedation or anesthesia will vary by patient, but if the area to be treated is extensive, you may require oral medications. Recovery can also be painful, but pain can be effectively managed with ice and with oral pain medication.


Since ablative procedures destroy the top layer of skin, the open wound that results must have adequate time to heal. Usually, it takes about two weeks for new skin cells to replace the old skin in treated areas, During that time, the skin will be raw, red, and oozing. There’s also a risk of infection associated with ablative procedures, which makes good wound care critical to recovery. In most cases, patients will wear a mask bandage for a day or two, followed by regular application of ointment to the healing wound.


Latent herpes infections can be awakened, so most cosmetic surgeons prescribe an antiviral medication after surgery. Your doctor will monitor you during office visits for the period of your recovery. When the new skin is intact, it will be red for as long as a year. Many patients use a mineral-based foundation to cover the redness, which eventually fades.

Nonablative procedures for skin rejuvenation use lasers to target the dermal layer of skin, without damaging the epidermis. Lasers typically used for this procedure include the Intense Pulsed Light system (IPL) and Pulsed Dye Laser (PDL) Damage to the dermal layer of skin induces a wound response and collagen formation, without production of new skin cells. Since the stimulation of collagen formation is the primary mechanism that underlies skin rejuvenation, the treatment can be effective. In practice, results are not as dramatic as those achieved with ablative techniques.

Nonablative Resurfacing

Nonablative treatments are often preferred by patients who don’t want an extended recovery period. Normal activities can usually be resumed the same day. The procedures are performed during a short office visit, although multiple treatments are recommended at intervals of a month to achieve the best result. Some patients complain of stinging or slight discomfort, but the procedure is not painful and sedation or oral medications are not required during treatment or in recovery. Since the skin barrier is preserved, there is no increased risk of infection with nonablative treatments.

If you’re considering a skin rejuvenation procedure, call us today for a consultation in one of our convenient offices in Beverly Hills, Glendale, or Encino. Dr. Mehrabi is a leading cosmetic dermatologist with the experience and knowledge to help you make the right choice.

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