Facial Laser Treatment: Matching the Technique to the Problem

A laser produces a beam of light at a specific wavelength, chosen to reach a particular tissue. Intense pulsed light, or IPL, instead emits a range of wavelengths: it is not a laser, even though both are offered for similar cosmetic concerns. The eyes must also be protected from the different wavelengths emitted by pulsed light.

Light absorbed by tissue is converted into heat. It is therefore necessary to specify which tissue the treatment aims to reach. In hair removal, the energy absorbed by the pigmented tissue of the hair follicle can damage the follicle through heat. A treatment that targets blood vessels directs the light toward those vessels. Resurfacing, by contrast, targets the surface of the skin. Treating a blood vessel and superficial resurfacing do not aim for the same change, and a spot, a scar or uneven skin texture are not three names for the same problem. A device name is not a diagnosis: the first step is to understand the cause of what you see.

Looking for the "most powerful" laser therefore does not help you choose. Among CARE MD's treatments, the fractional CO2 laser is a laser, as is ablative CO2 laser resurfacing; intense pulsed light is not.

These three words describe two different things. "Ablative" and "non-ablative" describe what the energy does to the surface of the skin. In ablative resurfacing, the energy removes the outer layer and heats the skin underneath; the skin then repairs itself, and this repair makes aftercare necessary. The CO2 laser is an ablative laser. A non-ablative fractional laser works beneath the surface without damaging it. This technique exists, but it is not one of CARE MD's treatments. These are not two strengths of the same treatment: removing the surface of the skin requires different healing and care.

"Fractional" refers to something else: the way the energy is distributed. Instead of treating the entire surface as one continuous area, the laser treats small microscopic columns of tissue. A fractional laser can be ablative or non-ablative. When you are offered a treatment, two questions therefore give you two different pieces of information: is the treatment ablative, and is it fractional? The fractional CO2 laser is both ablative and fractional.

Ablative CO2 laser resurfacing removes the outer layer of the skin and heats the layer beneath it. The skin then repairs itself. Ablation and fractionation describe different things: the former describes what happens to the surface, the latter how the energy is distributed. CARE MD offers this resurfacing at three levels: light, moderate and intensive. To discuss the level being considered with the doctor, ask what it involves for your skin, what aftercare you will have to follow and how much time to allow for recovery.

During this repair, skin care is part of the treatment. Beyond redness, ablative resurfacing can leave a scar or cause a bacterial, viral or fungal infection, including reactivation of the herpes virus. The skin can also become darker or lighter. Before deciding, ask the doctor which risks are relevant to your skin and what precautions to take.

Looking in the mirror, you may see less smooth skin, fine lines, a scar, spots or redness. These are five concerns, not a single problem, and how they look is not enough to tell what causes them. Dark spots on the face are related to pigmentation, which has its own causes. If your redness comes back in flare-ups, ask the doctor whether it is rosacea. Rosacea treatment is not chosen based on the name of a device alone. For a scar, the doctor takes into account the skin, the scar and general health during the assessment.

Before choosing a treatment, clarify how long the change has been visible, what bothers you most and what you have already tried. Put your expectations into concrete words: making an irregularity less noticeable is not the same as expecting it to disappear completely. To compare options, ask what each treatment aims to achieve, what it will not correct and what aftercare will be needed. Also discuss the option of having no treatment. A more demanding treatment is not necessarily the right one for you.

Here is what CARE MD offers for the face:

During the assessment, ask the doctor to identify your skin phototype and the precautions it involves for the treatment being considered. In skin phototypes IV to VI, inflammation or an injury caused by a treatment can lead to more changes in pigmentation: darker or lighter areas, sometimes long-lasting. The risk of a lasting colour change is higher in brown or Black skin.

Dark skin does not automatically rule out laser treatment. The doctor examines your skin before choosing the device and its settings, paying particular attention to pigmentation changes. Tell the doctor how your skin reacts to the sun, whether it is left with a mark after a pimple or an injury, and what treatments you have already had: discuss together how this history affects the choice of treatment.