1993 · Fitzpatrick, Goldman and colleagues; Coherent UltraPulse
Ablative CO2 laser
Wavelength and depth. 10,600 nm. Removes the epidermis and heats the upper dermis.
The Coherent UltraPulse CO2 laser was FDA cleared on August 13, 1991, and CO2 resurfacing of photoaged facial skin began in late 1993. In a 1996 study of 111 perioral and periorbital areas treated at 450 mJ per pulse, wrinkle scores fell by 2.25 to 2.34 points on a 9-point scale, and loose skin tightened.[1][2][3]
Suits. Wrinkles and sun damage around the mouth and eyes. In 104 patients followed an average of 24 months, the wrinkle improvement held.
Trade-offs. In 500 patients, redness affected everyone for an average of 4.5 months, darkening 37% and herpes simplex 7.4%. Lightening of the skin was the most common long-term side effect. ASPS lists recovery of up to two weeks.
1989 · Kaufmann and Hibst
Ablative erbium:YAG laser
Wavelength and depth. 2,940 nm. Ablates the epidermis and the superficial dermis.
Erbium light makes clean, precise lesions with minimal injury to nearby tissue, as Kaufmann and Hibst reported in 1989. A high-power erbium laser removes about 2.5 microns per pulse for each J/cm2 above its threshold, at 70 to 100 microns per second.[1][2][3]
Suits. Superficial to moderately deep lines of the face, neck, chest or hands, according to ASPS. Recovery is about one full week.
Trade-offs. It causes little coagulation, so deeper passes bleed, and ablation stays in the superficial dermis.
2007 · Hantash, Bedi, Zachary and colleagues
Fractional ablative CO2 and erbium
Wavelength and depth. 10,600 nm or 2,940 nm in microscopic columns, up to 1 mm deep.
The laser drills an array of microscopic columns, each lined by a rim of heated tissue, with untreated skin between them. The first CO2 prototype made columns about 350 microns wide and 1 mm deep at 23.3 mJ.[1][2][3]
Suits. Acne scars. In 13 patients, 2 or 3 treatments reduced scar depth by a mean 66.8%, with no delayed lightening or permanent scarring.
Trade-offs. In skin type IV acne-scar patients, darkening followed 51% of sessions and cleared in about 5 weeks. A single periorbital session reduced wrinkle depth about 20%, so several sessions may be needed.
2004 · Manstein, Anderson and colleagues; Reliant Technologies
Fractional non-ablative 1,550 nm (Fraxel)
Wavelength and depth. 1,550 nm. Columns about 100 microns wide and 300 microns deep; the surface stays intact.
Fractional photothermolysis was introduced in 2004. Reliant's first laser was FDA cleared on November 10, 2003, to deliver a pattern of heat to the epidermis and upper dermis. In 30 periorbital patients, wrinkle scores improved 18% 3 months after four treatments. A dual 1,550 and 1,927 nm Fraxel was cleared on June 14, 2013.[1][2][3]
Suits. Fine wrinkles and sun damage around the eyes. In the 2004 study, redness and swelling were minimal.
Trade-offs. In 961 treatments, 7.6% had a complication: acne-like breakouts 1.87% and herpes simplex 1.77%. Darkening was more frequent in darker skin types.
2024 · Hennessey (9-patient report)
Moxi (non-ablative 1,927 nm)
Wavelength and depth. 1,927 nm. Non-ablative fractional.
Moxi is a non-ablative fractionated 1,927 nm laser. Paired with BBL HERO in one session, it improved brown-spot scores on VISIA scans in 9 patients aged 29 to 64. In one patient, the reduction was still seen almost 20 months later.[1]
Suits. Sun spots (solar lentigines).
Trade-offs. The data are a 9-patient report with variable follow-up and no control group.
2018 · Waibel, Pozner, Robb and Tanzi (multi-center trial)
Hybrid fractional laser (1,470 + 2,940 nm)
Wavelength and depth. 1,470 nm coagulates the dermis to 700 microns; 2,940 nm ablates the epidermis to 110 microns.
A hybrid laser delivers a non-ablative and an ablative fractional wavelength in the same treatment. In a multi-center trial of 34 women (skin types I to IV), two treatments 4 to 6 weeks apart improved 80% of the 29 who finished, on blinded photographs. Mean pain was 4 of 10.[1]
Suits. Pigment, tone and texture of sun-damaged skin in skin types I to IV. All subjects who finished reported satisfaction.
Trade-offs. 2 of 29 had darkening that cleared within 90 days. No other adverse events were reported.
2011 · Solta Medical
Low-power fractional diode (Clear + Brilliant)
Wavelength and depth. Non-ablative fractional diode at 1,440 nm and 1,927 nm.
FDA cleared Clear + Brilliant on May 3, 2011, with the Fraxel IV SR as predicate, running at preset energies at the low end of that laser's range. Clear + Brilliant Touch was cleared on December 29, 2022. A 1,927 nm Clear + Brilliant Permea handpiece treated under-eye darkening in 4 patients of skin types III and IV with no darkening after treatment.[1][2][3]
Suits. Mild to moderate sun damage. With a dual 1,440 and 1,927 nm diode system, 4 monthly treatments improved all photodamage measures in 28 adults, and 96.4% rated their appearance improved.
Trade-offs. Studies are small: 28 adults in the dual-wavelength study and 4 patients in the Permea series. No serious adverse events occurred, and redness and swelling were minimal.
2000 · Bitter
IPL photofacial (intense pulsed light)
Wavelength and depth. Broad-spectrum flashlamp, 500 to 1,200 nm. Not a laser.
IPL targets pigment and blood vessels. Bitter treated 49 people with 4 or more full-face sessions 3 weeks apart at 30 to 50 J/cm2. Wrinkling, coarseness, pigment, pore size and small vessels improved in more than 90%, and 88% were satisfied.[1][2][3]
Suits. Brown spots, small red vessels, pore size and coarse texture.
Trade-offs. It takes 4 or more sessions. Bitter reported minimal downtime and no scarring.
2003 · Sciton
BroadBand Light (BBL)
Wavelength and depth. Wide-spectrum light, 500 to 1,400 nm, with a cooled treatment head.
Sciton's Profile BBL was FDA cleared on November 13, 2003, for benign pigmented lesions, vascular lesions including rosacea and small facial vessels, hair removal and other uses. In a 2013 pilot study, 2,265 genes changed with skin aging, and 1,293 of them moved back toward youthful levels after BBL treatment.[1][2][3]
Suits. Sun spots, freckles, redness and small vessels.
Trade-offs. The gene data come from a pilot study and do not measure visible results. BBL HERO with Moxi was reported in 9 patients without a control group.
2014 · Cynosure; Brauer, Geronemus and colleagues
Picosecond laser with lens array (PicoSure)
Wavelength and depth. 755 nm alexandrite, 750 to 850 picosecond pulses through a diffractive lens array.
PicoSure was FDA cleared on November 27, 2012, for tattoos and benign pigmented lesions. With the Focus array it was cleared on September 22, 2014, for acne scars and wrinkles in skin types I to IV. In 20 acne-scar patients, 6 treatments reduced scar volume by 24.3%; mean pain was 2.83 of 10.[1][2][3]
Suits. Acne scars and texture. In 56 patients of skin types IV to VI, side effects were redness and darkening that all resolved.
Trade-offs. The scar protocol used 6 treatments. The FDA wrinkle and scar indication covers skin types I to IV.
1997 · Reed, Joseph and Bridenstine; Langsdon and colleagues
Chemical peel (comparison)
Wavelength and depth. Acid applied to the skin. Light, medium (TCA) or deep (phenol).
A peel removes skin with an acid instead of light. In 24 people, the CO2 laser lowered periorbital wrinkle scores from 4.00 to 1.75, and a Jessner's plus 35% TCA peel from 4.13 to 3.29. In a 4-patient split-face study, phenol was as effective as the laser on thin-skinned areas and injured deeper, into the reticular dermis.[1][2][3]
Suits. AAD lists acne, age spots, uneven tone, fine lines, freckles and melasma. Light peels heal in 1 to 7 days.
Trade-offs. Laser redness lasted 4.5 months, peel redness 2.5 months. A deep peel heals in 14 to 21 days, needs general anesthesia and is done only once. AAD: people with skin of color can get permanent pigment problems without an experienced provider.