Fractional Erbium Laser vs Fractional CO2 Laser: Updated 2024 Guide
By SL Aesthetic Clinic
TL;DR
- Both Fractional Erbium and Fractional CO2 laser are highly effective skin resurfacing procedures that work by renewing skin layers
- While CO2 lasers can address more profound skin concerns, Erbium:YAG lasers are better tolerated with lesser downtime especially in acne scar patients
- The best laser for you depends on your skin condition
Table Of Contents
In the vast landscape of modern aesthetic medicine, lasers have emerged as powerful tools for addressing many skin concerns, ranging from acne scars to fine lines and wrinkles.
Among the array of laser options available, Fractional Erbium and Fractional CO2 lasers are popular choices for skin rejuvenation.
As we navigate the nuances of these treatments, let’s delve into a comprehensive comparison of their fundamental differences, efficacy, suitability, and more.
Ablative and non-ablative lasers: What's the difference?
Ablative and non-ablative lasers represent two distinct categories, each with unique benefits and applications.
Non-Ablative Lasers
Non-ablative lasers work by precisely targeting specific structures within the skin without causing visible damage to the surface. These lasers are best suited for mild to moderate skin issues such as superficial wrinkles, uneven texture and pigmentation, and mild acne scars.
Because non-ablative lasers stimulate collagen production and promote skin rejuvenation with minimal downtime, they are popular amongst individuals seeking less complex skin texture and tone improvements.
Presently, several lasers can be used for non-ablative skin rejuvenation. They can be broadly divided into two groups:
| Lasers used to remove skin pigment or blood vessels: | Lasers made for stimulating collagen production: |
|---|---|
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Ablative Lasers
On the other hand, ablative lasers work by removing layers of skin, leading to significant skin resurfacing and collagen remodelling benefits.
Ablative lasers primarily come in two types:
Both are highly effective for skin resurfacing procedures and have different strengths and weaknesses. They are minimally invasive procedures that use precise laser technology to cause microscopic injury to the skin for the ultimate goal of skin resurfacing and rejuvenation.
Ablative lasers offer more intensive treatment for pronounced concerns like deep wrinkles and severe acne scars compared to non-ablative lasers.
Key differences: Fractional Erbium VS Fractional CO2 Laser
CO2 lasers were once a major advancement in facial skin resurfacing and have been used with great success to treat wrinkles, photoaging, scarring, and pigmentation.
However, problems with prolonged healing, prolonged redness, and risks of hyperpigmentation and hypopigmentation have led to the development of the Erbium:YAG Laser.
Risk of post-inflammatory hyperpigmentation & other side effects
There is a higher incidence of post-inflammatory hyperpigmentation following CO2 laser treatment in darker skin types.
The heat in CO2 lasers causes thermal damage in adjacent and deeper tissues. This thermal damage is believed to account for the delayed healing, prolonged redness and pigmentation problems commonly associated with CO2 lasers.
That said, while the Fractional Erbium Laser offers a lower-risk treatment experience, it is not completely without risks:
| Fractional Erbium Laser Risks | Fractional CO2 Laser Risks |
|---|---|
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Of course, these risks are more likely to occur in the hands of an inexperienced doctor. Therefore, it is crucial to consult a doctor who not only knows how to properly use lasers but also has the expertise to determine if laser treatment is suitable for you in the first place.
Downtime
The Erbium:YAG laser has a wavelength of 2,940 nm. It is 10 to 20 times better absorbed by water and human skin than the CO2 laser, perhaps its greatest boast over its predecessor.
Better absorption means less heat and thermal damage sustained by the surrounding tissue, leading to faster recovery times, less redness, and a significantly decreased risk of hyperpigmentation and hypopigmentation.
Precision
The main disadvantage of the Erbium:YAG laser is that it does not penetrate as deeply as the CO2 laser. Therefore, it may require a few passes to fully ablate the epidermis, whereas the CO2 laser only requires one.
Fractional Erbium Lasers do have the benefit of being gentler and more precise. Still, the removal of pigmentation in deeper tissues could be more time-consuming.
Collagen rebuilding & lower risk of bleeding
Collagen does not absorb the Fractional CO2 Laser as well as the Fractional Erbium Laser.
As it is such a significant component of the dermis, this can lead to more heat build-up and adjacent thermal damage during Fractional CO2 Laser treatment, creating a barrier for further penetration with subsequent passes. This is called the “stacking effect”.
However, the CO2 laser does cause contraction in the skin’s collagen, which might account for more skin remodelling, higher collagen regeneration, and further skin tightening.
Treatment Efficacy: Fractional Erbium VS Fractional CO2 Lasers
The Fractional Erbium and Fractional CO2 Lasers have different strengths when it comes to specific treatments and skincare concerns:
| Treatment | Fractional Erbium Laser | Fractional CO2 Laser |
|---|---|---|
| Wrinkles & fine lines | The Erbium Laser can achieve similar results, but it needs to pass multiple times over a treatment area. More precise skin ablation and less damage to the surrounding tissue. | CO2 lasers cause immediate contraction of ablated areas, denaturing old collagen and stimulating new collagen. Collagen content continues to increase long after a procedure. As a result, CO2 lasers work dynamically to alleviate fine wrinkles. |
| Acne Scars | Despite CO2 lasers having better results, the Erbium:YAG laser is better tolerated with less downtime in acne scar patients. | Deeper penetration produces more significant results, but it requires more recovery time. Side effects can occur if the skin is not adequately prepped for treatment. |
| Laser resurfacing for skin rejuvenation | Can be used with great precision to control thermal damage. More flexibility when tailoring treatment protocols allow for more superficial treatments with less downtime and less risk of PIH. | Stimulates collagen remodeling with controlled skin injury, but with more downtime and PIH risk. |
Why Erbium Lasers are becoming more popular today
Our skin typically requires 2 to 4 weeks to completely heal from CO2 laser treatment. This is when new skin begins to grow. As such, your skin will initially be quite raw and might have a sunburnt appearance.
In comparison, Erbium Lasers require a shorter recovery time due to the shallower depths of wounds they create. Furthermore, they deliver reduced thermal damage to the surrounding skin tissue, allowing faster healing.
Additionally, although Erbium lasers do not penetrate as deeply as CO2 lasers, they can mimic the effects of CO2 lasers by multiple passes, stacking, and increasing the pulse duration, all while limiting the risk of unwanted side effects.
An Erbium Laser’s overall gentleness and flexibility make it a desirable alternative to the more aggressive CO2 Laser, especially in Asian skin.
Which is the stronger laser for resurfacing?
Ablative lasers vaporise tissue and are more aggressive than gentler, non-ablative lasers that leave the skin intact. Although ablative lasers result in far more downtime and a lengthier recovery process, they remain the lasers that produce the most dramatic skin resurfacing outcomes.
On the other hand, non-ablative lasers remain free from the adverse risks of ablative lasers and leave the epidermis intact while producing rejuvenating skin effects.
Conclusion
Both fractional erbium and CO2 lasers offer results in skin rejuvenation, each with unique advantages. While CO2 lasers can address more profound skin concerns, fractional erbium lasers provide a gentler approach with fewer risks and minimal downtime.
By understanding the nuances of Fractional Erbium and CO2 lasers, you can make better decisions about your skin rejuvenation journey and confidently achieve youthful-looking skin.
Ready to take the first step? Talk to one of our doctors today.
