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CO2 skin resurfacing treatment in surrey on face

How do CO2, Erbium and skin resurfacing lasers work?

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Perhaps you’ve read about CO2, Erbium or fractional lasers in a beauty magazine. Or, maybe you’ve seen a celebrity undergoing skin resurfacing treatments. They can seem enticing, or dramatic, depending on your point of view! No doubt, this technology helps many patients with skin conditions that are either health related, or aesthetic in nature. And, they do this without surgical cutting!

But how do these CO2, Erbium and skin resurfacing lasers work? What is the technology and science that drives them? And, if you’re seeking this type of treatment, why should you care?

Below we’ll attempt to answer these questions. But, before we do, we strongly recommend you check out our related article on this subject. It explains what you really want to look for in a skin resurfacing laser:

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Lasers can break down your skin, so it builds itself up again; that’s the ultimate path to dermal restoration

Whether you want to look a few years younger by ‘turning back the clock’ (so to speak), or you want to fix a skin lesion, CO2 and Erbium lasers work by first breaking down your ‘old’ skin. That way, your body can have ‘room’ and a ‘signal’ to start creating new, fresh skin.

The same is true of other lasers in this category of aesthetic technologies. The end-goal can be referred to as the rejuvenation, reconstitution or restoration of skin.

Aesthetically, skin resurfacing through reconstitution can help to reduce:

Skin resurfacing lasers come in three forms, which we define in detail, here. In short, they are:

Laser skin resurfacing with an ablative laser - diagram
Fractional laser skin resurfacing diagram showing hole punctures made by laser to induce collagen and healing

The basic thing to know about the above types of lasers is that they work at different depths to break down ‘old’ skin. Ablative is strongest, followed by fractional ablative, and then fractional non-ablative. The latter would be considered the most mild (though there are other ways to get an even gentler treatment – all the way down to a simple, exfoliating facial).

These lasers create intentional injuries to your skin. Their beams of light emit so much energy that their heat is absorbed by water molecules in your skin. In a sense, they ‘burn’ your skin to the point that the epidermis (the top layer of skin) is damaged (on purpose, yes). In science, this is called the denaturation of collagen.

We’re talking teeny tiny wounds, though. Sometimes, it’s thousands of miniscule holes within a few centimetres. These procedures are not meant to remove thick swaths of skin – don’t worry! When put in the right hands, they execute a highly precise, targeted and controlled process.

Nonetheless, your skin’s natural response to this trauma is to go into ‘healing mode.’ It starts to regenerate skin cells by producing fresh collagen. And that’s the goal (which we also mentioned above): to create new, fresh skin.

This regenerative process can go on for more than six months, and completes at around 12 months. So, the effects of a skin resurfacing treatment won’t be seen right away.

In a way, it’s similar to healing from a cut or scrape. Except, in this case, the injury is specific and small, so as to avoid scarring.

Does skin resurfacing hurt? Can it produce side effects? Yes, and that’s why technology and science continues to advance! This brings us to our next point.

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Modern laser skin rejuvenation can be designed to produce less damage, with excellent treatment outcomes

The difference between ablative lasers and fractional ablative lasers, is that the former creates a ‘blanket’ of injury across your entire epidermis. The latter creates tiny holes called “microthermal zones.” These are the “thousands of miniscule holes” we mentioned above. The term “fractional” stems from the concept of creating “fractions,” or divisions, of injury.

With fractional ablative lasers, their ‘microthermal zones’ (i.e. hot columns, or beams) penetrate through the epidermis and into the dermis. When less skin is damaged, it can heal much faster. And, when the skin injury goes deeper, it can regenerate at a deeper level, too.

Now, it takes a lot of heat and energy to do this, especially in a precise and targeted way.

So, these types of lasers are made to deliver a specific wavelength of light. This brings us to yet another point.

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Wavelength measurements of light can deliver specific skin rejuvenation outcomes

When we discuss skin resurfacing lasers, we are speaking of engineered machines that deliver particularly long beams of light. In other words, they deliver beams that can be highly absorbed by the water in your skin, at a certain depth, to heat it up.

Light spectrum diagram with laser skin clinic logo and address

How long of a wavelength are we looking for, exactly? It’s different for each scenario and patient request. You don’t always want the beam to be the longest kind. If it is too long, it can miss important treatment areas. Or worse, it can cause side effects.

For that reason, some brands of laser machines deliver multiple types of light. This allows them to do different jobs on your skin. Other machines are designed to deliver only one or two wavelengths (with several other settings that a doctor can configure for each patient).

For example, the fractional non-ablative Fraxel® DUAL contains two wavelength options: a 1927 nm and a 1550 nm. The 1927 nm can reach further than the 1550 nm. However, at around 1300 nm, you lose depth penetration due to the intense water absorption of the beam. This means that the 1550 nm pulse can sometimes do a better job on some skin conditions than the 1927 nm, and visa versa. So, the intensity of heat matters, too.

CO2 lasers can reach around 10,600 nm. That’s long! They can penetrate around 2.4 mm into the skin’s surface. But, when they travel that far, they create ‘triangle’ holes in your skin; the hole width gets narrower the deeper it goes.

An Er:YAG laser can go as far as 2,940 nm.

And the list goes on…

But the length is not what you’re looking for; you’re looking for the specific result that the length can produce. For example, reducing mild wrinkles, verus deep wrinkles, or sun spots, versus moles, and so on.

Our advice is to leave the metrics to the experts! Ask what a doctor can achieve with the tools in their arsenal (which should be good tools, of course). The more options they have on hand, the more precisely they can handle your case (remember, each individual will require a unique treatment).

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Why are they called CO2 and Erbium lasers?

CO2 and Erbium (or, Er:Yag) lasers, are the two main types of lasers that can be ablative, or fractional ablative.

But why are they called “CO2” and “Erbium” lasers? This is because they get their laser light, or energy, by way of these chemicals, or elements.

CO2 stands for carbon dioxide, which is a gas. Erbium is a metal found in the earth. The aesthetic technologies we talk about above use some form of reaction to get these elements to produce light at specific wavelengths. This happens through mirror reflection, by capturing ion emissions, and other processes.

“Er:Yag” stands for “erbium-doped yttrium aluminium garnet.” So this laser uses other elements, too. CO2 lasers are also usually combined with other gases.

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What is the difference between “skin resurfacing” and “skin rejuvenation”?

Often, we hear the terms “skin resurfacing” or “skin rejuvenation” used interchangeably. For the patient, it’s important to know that these are not the same thing. The effects, and the healing time, can differ significantly with different types of procedures that are called by these names. So, we’ll define them as follows:

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The definition of skin resurfacing:

Skin resurfacing is the removal of your epidermis (or parts of it, by making ‘holes’ in the skin). It really is about getting your body to make a whole new set of skin cells. It can produce a very dramatic change in the skin. But of course, it comes with significant downtime and healing requirements.

Skin resurfacing is great for ‘big’ skin changes or even for health conditions. For example, it can be used on skin cancer, moles, scars, warts and of course, advanced wrinkles and folds.

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The definition of skin rejuvenation:

Skin rejuvenation is a general term which includes skin resurfacing. But, it can refer to other forms of milder cell regeneration techniques. When a treatment is labelled only as “rejuvenative” and not as “resurfacing,” it is likely designed to work at shallower depths in the skin.

For example, fractional non-ablative lasers can produce skin rejuvenation effects. But, they require multiple treatments to start showing results. This is because of their milder strength in comparison to fractional ablative lasers.

Or, an ablative laser can be used on a very low setting, to achieve a “laser peel,” and not total skin resurfacing. This technique removes much less skin; it is more like an exfoliation facial. Exfoliation is still considered rejuvenating the skin.

Non-laser skin rejuvenation can be done with chemical peels, microdermabrasion and other tools.

Not only that, some skin rejuvenation is meant to target specific skin concerns.

For example, spider veins causing redness, or hyperpigmentation and brown spots (sun spots). These skin conditions would require different wavelengths of light to be treated. In those cases, it is not the water that needs to absorb the light’s energy; it is pigment.

And yes, we did say that CO2 lasers can be used for brown spots… but you can start to see that each case of any skin condition can be so unique, it can require multiple tools to get the job done right.

Sometimes, people use the term “skin rejuvenation” when speaking about skin tightening. This treatment would also require yet another set of tools. Commonly radio-frequency wavelengths are used, or even embeddable threads to lift the skin.

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Cosmetic resurfacing lasers are not the only solution to better skin!

As we’ve seen above, cosmetic resurfacing lasers are scientifically made to target specific skin needs and concerns. They require intensive treatment protocols. The patient should be a good candidate for them.

If you are looking for skin rejuvenation, or your skin condition is not that advanced, there are other milder lasers that may work for you.

The best way to approach your treatment is not by copying what a celebrity did. Instead, visit an expert and tell them about your skin concerns. A good clinic can offer many solutions that fit your unique case. Solutions may, or may not, involve a skin resurfacing laser, or any laser for that matter.

If you live in the Vancouver area, we encourage you to visit our Surrey skin care clinic for your skin needs. We carry an array of treatment options to target aesthetic concerns. These span from lasers, to chemical peels, injectable fillers and more.

Book your consultation today, and we’ll get you started on the path that’s right for you!

Read more about our fractional CO2 skin resurfacing treatments, here.

See our list of cosmetic technologies, here.

See our list of treatable conditions, here.

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